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  • Avatarerin1214
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    Post count: 2

    Dr Corenman,

    I am a 42 yr old heathy active female. I’ve had neck and shoulder pain for about 4 years. Had an MRI done. See Findings below.
    EXAMINATION: MRI Spine Cervical w/o Contrast, 01/03/2020:0949 COMPARISON: XR Spine Cervical 4 or 5 Views, 7/18/2019 9:24:00 AM EXAMINATION: MR cervical spine without contrast. INDICATION/HISTORY: Myofascial muscle pain
    TECHNIQUE: Multisequence, mutliplanar MR imaging of the cervical spine was performed. Imaging performed on a 1.5T magnet.
    FINDINGS:
    Alignment: Normal, including craniocervical and cervicothoracic junctions.
    Bone marrow: Normal. Vertebral bodies: Normal. Cervical cord: Grossly normal.
    C2-C3: Left parasagittal/uncovertebral disc protrusion results in mild narrowing of the left neural foramen.
    C3-C4: Mild disc space narrowing with posterior disc osteophyte complex and mild facet arthropathy with no significant spinal canal or foraminal narrowing.
    C4-C5: Moderate disc space narrowing with slight posterior disc osteophyte complex. Severe right facet arthropathy with evidence of acute inflammation. There is mild to moderate right foraminal narrowing. There is mild to moderate left facet arthropathy with mild left foraminal narrowing.
    C5-C6: Moderate to severe disc space narrowing with posterior disc osteophyte complex and prominent left greater than right uncinate hypertrophy resulting in moderate to severe left and mild-to-moderate right foraminal narrowing.
    C6-C7: Normal.
    C7-T1: Normal.
    Visualized paraspinous structures: Normal.
    IMPRESSION:
    Advanced degenerative changes at the C4-5 and C5-6 levels with acute inflammation of chronic severe osteoarthritis on the right
    at C4-5 and large uncovertebral joint osteophyte complex on the left at C5-6 which results in moderate to severe left foraminal narrowing.

    I was doing PT for this but wasn’t getting much relieve. In the middle of all this, I started having lower back, hip and buttock pain. It has progressed to pain in my legs and a lot of foot numbness. Below is the MRI for the lower Back.
    * Technical quality: Adequate.
    * Numbering: Non-transitional anatomy.
    * Alignment: There is a 3 mm (grade 1) anterolisthesis of L4 on L5, likely secondary to degenerative facet arthropathy. Alignment is otherwise maintained.
    * Bones: No acute fracture or other acute osseous abnormality.
    Bone marrow signal within normal limits for age. * Conus/Cauda equina: Normal for age.
    * Soft Tissues: No significant abnormality.
    Incidental findings: Imaging follow-up is not recommended.
    * Visible thoracic and sacral region: Normal for age. * Lumbar disc spaces:
    L1-L2: Small right central disc protrusion. Mild bilateral facet arthropathy. No neural foraminal or spinal canal stenosis.
    L2-L3: No significant disc or facet degeneration.
    L3-L4: Symmetric posterior disc bulge. Mild bilateral facet and ligament flavum hypertrophy. No neural foraminal or spinal canal stenosis.
    L4-L5: Grade 1 anterolisthesis of L4 on L5. Symmetric posterior disc bulge and bilateral facet/ligament flavum hypertrophy contribute to severe spinal canal stenosis. There is compression of the bilateral transiting L5 nerve roots within the
    subarticular zones. Mild bilateral neural foraminal stenosis.
    L5-S1: Central disc protrusion. There is annular fissuring along the posterior disc margin. Bilateral facet arthropathy. No
    neural foraminal or spinal canal stenosis.
    IMPRESSION:
    Grade 1 degenerative anterolisthesis of L4 on L5. Superimposed disc and facet degenerative changes resulting in severe spinal canal stenosis at this level.

    My Dr told me cortisone shots aren’t an option for the lower back. She is suggesting a surgical consult. As for the neck, she is suggesting Cervical epidural steroid injection versus right third occipital nerve block.She thinks this will help with the headaches Im having. Suggestions on both issues? Should I fix one before the other?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7400

    You note “I’ve had neck and shoulder pain for about 4 years” You have good reason for the pain.
    C4-C5: Moderate disc space narrowing…. Severe right facet arthropathy with evidence of acute inflammation…C5-C6: Moderate to severe disc space narrowing with posterior disc osteophyte complex …resulting in moderate to severe left and mild-to-moderate right foraminal narrowing”.

    Severe right facet arthropathy at C4-5 will cause local significant pain on the right, especially with right lateral bending and extension of the neck. C5-6 has significant foraminal stenosis which will compress the C6 nerve root. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

    You then note “In the middle of all this, I started having lower back, hip and buttock pain. It has progressed to pain in my legs and a lot of foot numbness”. The source for this is obvious.
    “L4-L5: Grade 1 anterolisthesis of L4 on L5…contribute to severe spinal canal stenosis”.

    This is a typical degenerative spondylolisthesis at L4-5 with severe spinal stenosis. You could try an epidural steroid injection and probably gain some relief but you probably are headed for surgery. See https://neckandback.com/conditions/degenerative-spondylolisthesis-or-spondlylolysthesis/ and https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/

    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.
    Avatarerin1214
    Participant
    Post count: 2

    Thank you for your response and all the informative links. Do you feel the neck pain would be helped with epidural steroid injections or would a nerve block be the better option? Currently the only relief I’m getting is from Diclofenac Sodium and an occasional muscle relaxer. This takes the edge off, but that’s about it.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7400

    If you have right sided neck pain, I would go with facet blocks and rhizotomies at right C5-6 facet. For left sided neck pain, I would consider a selective nerve root block at C5-6 left.

    See https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/ and
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/

    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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