You note chronic neck pain with radiation into shoulders. Your report states: “Marrow signal is notable for degenerative endplate changes within the C4 level, progressed from the prior exam…There is severe right and moderate to severe left neural foraminal narrowing”.
Also; “There is worsening junctional zone spondylosis at C4-C5, where there is a new retrolisthesis and there are degenerative changes”
It does not appear that your Chiari type I is significantly symptomatic so I would believe that C4-5 is causing a majority of symptoms. The way to test this is to get bilateral SNRBs at C4-5 and keep a pain diary. If your symptoms temporarily are eliminated, this is good evidence that a surgical intervention (ACDF or ADR) would be quite helpful.
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.