[Steph810]

#25810

Hi,

I have had problems with debilitating pain in my neck since a car accident in 1996. I have been off and on pharmaceutical drugs, when I had insurance to pay for them. Mostly I ate Advil like it was candy because it only seem to keep the pain from getting to the point of me crying and throwing up. Finally a doctor took it seriously and did an MRI in 1997. I do not have those records. He said I had some injury to my neck, that I don’t even remember to this day what it was called, however, I do remember him telling me the hospital should have put me in traction right after the accident but that their job was just to take X-rays and make sure nothing was broken and that was why it was overlooked. He used something called “bio-electric medicine” and massage therapy, three days a week. I could finally had complete mobility of my neck back. As soon as he introduced physical therapy my neck pain flared up and then I lost my medical insurance and could not pay for any more therapy. So years later in 2010 I had great medical coverage and I was getting married. My husband to be made me go to the doctor to get a physical, and I him, so we were even. I brought up my neck pain to my doctor and he ordered an MRI. The results said the following: Cervical lordosis, vertebral body height, bone marrow signal and alignment are preserved. Visualized spinal cord is normal size and signal. Cerebellar tonsils are normal in position. Cervicothoracic alignment is preserved. There is minimal disc desiccation and trace bulging of C5-C6. Cervical intervertebral discs are otherwise well preserved in height, signal, and morphology. No significant central canal or neuroforaminal narrowing is seen in the cervical spine. IMPRESSION: Essentially unremarkable MRI of the cervical spine with no central spinal or neuroformaminal stenosis.

In 2014 my insurance had switched to my husbands because we were now married. I was in so much pain that Advil just wasn’t cutting it and my husband had become very worried about me. I went to my normal family practitioner who referred me to Jefferson. The neck specialist at Jefferson ordered an MRI CERVICAL SPINE WITHOUT CONTRAST, again. The findings were as follows:

C2-C3: No disc herniation. Mild facet arthrosis bilaterally. No central canal or foraminal narrowing.
C3-C4: No disc herniation. No central or foraminal narrowing.
C4-C5: Small disc bulge with superimposed trace central protrusion type disc herniation and mild facet arthrosis. No central canal or foraminal narrowing.
C5-C6: Small disc bulge. No herniation. No central canal or foraminal narrowing.
C6-C7: trace central protrusion type disc herniation without central canal or foramina narrowing.
c7-T1: No disc herniation. No central or foraminal narrowing.
The disc spaces in the upper thoracic spine to the level of T4-T5 are evaluated on sagittal images only, demonstrating no disc herniation or central canal/foraminal narrowing.
The paraspinal soft tissues are normal.

Jefferson told me there was no shots or surgery that could fix these issues and they started me on 100mg of Gabapetin 3xday; 15mg of Flexeril 3xday; and a anti-inflammatory also 3xday.

Now 3 years later, I am on 300mg Gabapetin 3xday; 15mg Flexeril 3xday; and 300mg Etodolac 2xday.

On top of this, over the past three years Jefferson also told me I had Carpal Tunnel in both my hands. Both hands were weak with my right hand being weaker. My hands started going numb whenever cold about 2-1/2 years ago. This past year my hands would go completely numb when sleeping. My new doctor gave me braces to wear 24/7 and sent me to have my nerves mapped. He wanted them mapped from my neck down, but the person who did the mapping only did from my bicep down. They only found that I have Carpal Tunnel, which I already knew. The night of the mapping the pain in my neck flared up so much the 2400mg that I was currently taking did not work. My doctor was out of town on vacation and another told me to continue taking the current medications and add ice to my neck. It was already found that my neck pain flared up more in cold weather then in warm. I did what that doctor recommended and of course it made it worse. My doctor, thank god, was back the next day, told me to discontinue the cold therapy and add 1000mg of Tylenol 3xday and get an MRI of my neck and he wants to send me to a neck specialist to talk about surgery or shot options if there are any. I had the MRI done last week and I am waiting for the results.

My question is what did my MRI really say was going on in 2014 and should I have been watched more closely instead of being given one pill after another? What is the surgery to correct this, if any? Are there shots? I have gotten mixed opinions on both surgery and shots. Some specialists say yes, it can be done, but it is a 50/50 shot at making things works and some say there is nothing that can be done.

What is your expert opinion?

And I will definitely follow up here with the results from the MRI I had done last week when I have the results.

[Donald Corenman, MD, DC]

#25873

Neck pain generally does not show up on “nerve mapping” (EMGs) which will demonstrate only compression of the peripheral nerves (carpel tunnel syndrome) or radiculopathy (nerve compression in the neck). Most neck pain is generated by structural problems of the vertebra (disc or facet and rarely ligaments). Nerve compression in the neck can sometimes cause local neck pain and will not show up on EMGs unless there is motor weakness.

“My new doctor gave me braces to wear 24/7 and sent me to have my nerves mapped. He wanted them mapped from my neck down, but the person who did the mapping only did from my bicep down” is unusual as normally the posterior neck muscles should also be tested. Nonetheless, I don’t believe that even if this portion of the test was included, there would be any valuable findings.

Your MRI findings “C4-C5: Small disc bulge with superimposed trace central protrusion type disc herniation and mild facet arthrosis. No central canal or foraminal narrowing. C5-C6: Small disc bulge. No herniation. No central canal or foraminal narrowing. C6-C7: trace central protrusion type disc herniation without central canal or foramina narrowing” indicate typical findings of degenerative disc and facet disease. Depending upon your severity (which is not indicated by this MRI reading), these findings could explain your pain generators.

You would need a workup to determine if you have anything fixable. This would include facet blocks and even possibly discograms. You do have to be prepared to accept the findings that you are not a good surgical candidate and that only conservative measures will help.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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