[mystical44]

#7826

I would like some help please reading this MRI. I have had neck and shoulder pain for about 3.5 years. It is much worse, to the point of intolerable lately. I am not getting good sleep because of it, and my walking is not quite right lately (I walk a bit stiff and am clumsy). I also have had the dropsies (I drop things) for about three months.

MRI FINDINGS The C2- 3 disc is un remarkable. At C3-4 there is a mild broad disc bulge. The C 4- 5 disc shows a central disc bulge approaching the spinal cord. At C 5-6 there is a wide central disc protrusion impinging on the spinal cord. The C 6-7 has a central focal disc protrusion and annular disc tear. The C 7- T1 disc are unremarkable.

There is diffuse straightening of the expected cervical lordosis. Mild disc space narrowing is at C5-6. Other disc heights are satisfactory.

Impression: There is a broad disc protrusion at C5-6 impinging on the spinal cord.
Mild broad disc bulges at C3-4 to C4-5.
There is straightening of the cervical lordosis which suggests muscle spasm or sprain.

Please note I have had multiple Epidural injections, physical therapy, and I am currently taking pain killers. The PT and Epidural injections did little to nothing to help.

If you could would you please render your opinion or what the MRI means and what you think the next course of action could or should be. Thank you so much.

[Donald Corenman, MD, DC]

#7829

We have to break down your symptoms into two separate sets; neck pain and imbalance/incoordination.

Neck pain generally has the origins of degenerative disc or degenerative facet disease for central neck pain and you can add mild to moderate nerve root compression to the list regarding neck pain that is one sided (unilateral). A good history and physical examination will help reveal if the pain is in one of those categories. After that, careful review of the images including X-rays with flexion/extension views and the MRI would be important.

Once the potential structure causing pain is identified, diagnostic testing is normally required (with some exceptions). This might require facet blocks, an epidural or SNRB (see website) or even discograms. Then it is a matter of treating that structure with an intervention that has a tract record of success (injection, radio-frequency ablation or surgery).

The imbalance/incoordination set of symptoms can be spinal cord related. Compression of the cord can cause myelopathy (see website) which includes these complaints. In this case, a careful physical examination can reveal the presence of signs of cord compression. If this is the case, an ACDF in my opinion would be required to remove the compression and prevent future irritation to the cord.

The impression of the radiologist is that the C5-6 level is impinging on the spinal cord. It is a possibility that this level is causing both neck pain and myelopathy from cord compression. It might be a simple matter that you need an ACDF at that level to solve most of your complaints. You need a consultation with a good spine surgeon, a careful history and physical examination, review of the images and diagnostic intervention.

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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