Archives

Since I doubt you are a professional mountain biker or bump skier at this point, it does not appear that you put your neck at too much risk. The questions for C2-3 are two. One is stability and the other is pain. A set of X-rays with flexion/extension views would be helpful to determine stability. An MRI would look at the health of the disc, joints, nerves and spinal cord.

The C2 nerve is right next to the degenerative facets and can be compressed or irritated by these facets. This nerve (also known as the greater occipital nerve) travels over the back of the head and stops right above the eyes. Irritation to this nerve will cause pain and paresthesias (pins and needles) in this distribution. A nerve or facet block might be helpful to diagnose and possibly treat this disorder.

Dr. Corenman

You have multilevel degenerative changes in your cervical, thoracic and lumbar spines. You have had a previous ACDF fusion at C5-7. There is some concern that the C6-7 level did not fuse as the x-ray reading notes “Severe disc space narrowing C6-7” when it should read; “fusion C5-7 (not C5-6) vertebral bodies, fusion completely fused w/no visible residual disc material. A pseudoarthrosis (lack of fusion) could be causing your neck pain at this level but other degenerative levels could also be causing pain.

Nonetheless, the CT scan was read as a solid fusion of C5-7 but this scan might not have had the care taken for reading a solid fusion as it was performed for lymphadenopathy and not for fusion.

You have a degenerative spondylolisthesis of L4-5 as read by the radiologist (but not identified); “Slight anterolisthesis L4-L5” and “There is severe facet hypertrophy, there is thickened ligamentum flavum”. One of the questions is if this level is unstable. This would require X-rays including flexion/extension views. Instability could cause lower back pain, an instability pattern (see website for description) and neurogenic claudication (again-on website).

Your thoracic spine displays degenerative changes associated with disc herniations at multiple levels. What is somewhat surprising is that you have a reduced kyphosis as most patients with this condition generally have an increased kyphosis from degenerative disc disease or Scheuermann’s disorder (see website).

In general, your spine surgeon is correct in that you should try every therapeutic method before you should consider surgery. I think that epidural steroid injections can be quite helpful for these disorders. Extension strengthening exercises are important (rowing type exercises) to reduce the load on the discs and get the cord away from the herniations.

Medications like NSAIDs, muscle relaxants and membrane stabilizers (Lyrica and Neurontin) should be tried.

If extension (bending backwards) feels worse than flexion, you might also have facet syndrome. Facets blocks can diagnose a facet disorder if extension yields no relief.

I will assume that you do not have long tract signs in your legs (imbalance, hyperreflexia and clonus) as your cord is working well.

Dr. Corenman

Neck pain can develop from the disc or the facet. Annular tears (see anatomy of the cervical spine on the website) may be ignored by the reading radiologist and facet disorders may be present even with a normal MRI. Flexion/extension X-rays may reveal a subtle slip that will not be revealed on an MRI. A good physical examination with careful attention to palpation of the facets may also reveal the problem.

Dr. Corenman

Surgery for your neck is predicated on many different conditions. Since you have no significant central canal stenosis, your spinal cord is most likely not in jeopardy. You then have to compare symptoms to the problems in the neck including disc degeneration, facet degeneration (degenerative spondylolisthesis) and nerve root compression. See the section under “When to have neck surgery” to obtain a better understanding of what surgical conditions look like.

Your question on the stability of the 5 mm anterolisthesis of C2-3 (which is a degenerative spondylolisthesis by the way) is a good one. Is this level stable with flexion/extension X-rays or does it move? Also, what activities are you involved with? If you have a sedentary lifestyle, then the risks are significantly lessened. If you are an avid mountain biker or jump horses, your risk increases.

Degenerative spondylolistheses are also typically found above and below significant degenerative discs. These degenerative disc segments increase the load on the levels above and below. The facets wear out and the vertebra slips on the one below.

Dr. Corenman