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You have substantial degenerative changes at multiple levels in your cervical spine. Neck pain generally develops from degenerative disc and facet disease. Shoulder and arm pain is typically generated by nerve root compression. You have both finding on your MRI.

Surgery most likely can help you but will not return you back to when you were 16 years old. If your expectations are within range (reduction but not elimination of neck pain) and you have no desires to compete in the Olympics (you could be satisfied with only a modest increase in activity), the surgery could be quite helpful.

A three level fusion at C4-7 might not affect your range of motion much at all. Many people think that a three level fusion will significantly stiffen the neck. If your MRI reading is accurate, look at your flexion/extension X-rays. Have an expert measure the motion of these segments. Motion of these segments should normally be greater than 50 degrees but I bet your motion would be less than 10 degrees now with these degenerative segments.

This means that you would only lose ten total degrees of motion with a three level fusion. One bonus is that with pain reduction, you might even gain motion from a fusion as without pain, you might be more likely to move your neck further as the painful segments will not trigger a muscle spasm pain response.

The caveat here is the C3-4 level where it is noted “moderate disc degeneration and bulging. Large left foraminal disc osteophyte complex, resulting in severe left foraminal stenosis”. This could be a pain generator now or in the future and you would need a work-up to determine how symptomatic this level is. That might consist of discograms, selective nerve root blocks (SNRB) or facet blocks.

Dr. Corenman

Your base of skull pain most likely is from the degenerative spondylolisthesis at C2-3. This 5mm slip can only occur from severely degenerative facets. The facets here can cause substantial irritation of the C2 and C3 nerve (greater and lesser occipital nerves). These nerves radiate into the back of the head over to the eye and around the ear.

If the C2-3 level is stable (no motion with flexion/extension views) and you do not put your neck at risk (skiing, mountain biking, horseback riding, etc..), then you might not need surgery. However, if you do participate in some potential risky behavior or there is motion of this level, you would probably need surgery to prevent a potential catastrophic injury.

Assuming you do not engage in risky behaviors, facet blocks could diagnose your disorder (see the website for understanding of this procedure). You might then be a candidate for rhizotomies (again-website).

Dr. Corenman

The presence of the synovial cyst makes me think there might be an associated degenerative spondylolisthesis (see website) associated with this problem. Synovial cysts develop in degenerating facet joints and these joints can break down leading to the slip of one vertebra on the other.

In addition, recurrence of these cysts can occur in about 10% of operated patients. Recurrent disc herniations also have about a 10% recurrence rate.

A new MRI is warranted along with standing X-rays including flexion/extension views. This will determine what new or recurrent pathology has occurred.

Dr. Corenman

Sorry i posted in here. I kept trying to make new post and it sent to the front homepage.

But from the response you gave me on my post about being 30 yrs old

description: transitional vertebra at L5-S1 .Normal vertebral body heights,disc spaces,and alighnment.Straightening of lordotic curvature.No change in alighnment with flexion orextension with limted range of motion.No visible fracture.Straightening of lordotic curvature represents a change compared to previous exam 4/14/07

impression
1) possible muscle spasms
2) transitional vertebra at L5-S1 with partially lumbarized S1 segment.

I hope this helps from my earlier post.

Sorry i posted in here, Im new and i just couldn’t get a new topic started. I apologize