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Neurology (Expert Forum)
Bum 5/6 Cervical --- pain, pain, pain.
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Bum 5/6 Cervical --- pain, pain, pain.
by Redrosee, May 01, 2003 12:00AM
Neck/upper back/shoulder/arm pain. MRI says: Multilevel osteoarthritic changes of cervical spine with osteophytes from the vertebral bodies at several levels & endplate degenerative changes at C7-T1 & disc desiccation at multiple levels, as well as disc space narrowing at C5-6, C6-7 & C7-T1. C4-5, small broad based ventral extradural defect appears to be related to osteophyte & small broad based posterior disc bulge. Slightly indents the ventral thecal sac, cerebrospinal fluid space is patent anterior to the cord with no significant spinal canal stenosis & forminal encroachment. At C5-6, small broad based ventral extradural defect which appears to be related to osteophyte & broad based posterior disc bulge or protrusion. This does indent the ventral thecal sac & may slightly flatten the ventral surface of the cord at C5-6 with complete or near complete obliteration of the cerebrospinal fluid space anterior to the cord at C5-6 with mild to moderate spinal canal stenosis. At C7-T1, the foramina cannot be ideally assessed, but no disc herniation. Mild soft tissue prominence along far lateral forminal region on left likely due to normal neurovascular structures, less likely small soft tissue or neurogenic abnormality. Sagittal images, slight asymmetric enlargement of the right T1 root sleeve. Axially images not obtained at this level. Could be normal & due to tech. factors, but may instead represent small perineural cyst or other cause of mild root sleeve enlargement.
Neuro Doc says Ibuprofen-I'm NOT IMPROVING after 4 mos. Please recommend next step. Thank you for your time.
Neuro Doc says Ibuprofen-I'm NOT IMPROVING after 4 mos. Please recommend next step. Thank you for your time.
Doctor's Answer
by CCF-Neuro-M.D.-JT, May 01, 2003 12:00AM
Without personally reviewing your MRI, I cannot give an accurate medical opinion. WHat I can say is based on the report that you've provided, it sounds like you have significant degenerative disease in your cervical spine (especially at C5-6)which may be causing your symptoms. If you've tried conservative therapy which includes physical therapy, gentle stretching, and the ibuprofen without any relief, then it may be time for surgical evaluation. Bring your films to a spine specialist (neurosurgeon or ortho) and let them take a look at your case. If you're in the area, Drs. Ed Benzel, Kalfas, and Whitfield are excellent spine surgeons at the clinic. ANother consideration is an EMG to characterize whether or not there is any nerve damage from the degenerative spine disease. This may lend a stronger argument towards surgical options if there is active nerve damage going on in your neck/arm. It can also help to serve as a baseline for how you are now compared to down the road with or without surgery. As for now, continue with the ibuprofen or try vioxx, celebrex and stay away from lifting heavy objects (nothing more than a gallon of milk) and contact sports. Good luck.
Doc CT...thank you very much for your insightful reply. Are you saying I'm becoming an old hag??? Hahaha!
cdm787...I am sending healing thoughts your way, you have been through a trying ordeal & I feel guilty for complaining about my problem. Your condition is much, much worse than mine I'm sure. Keep the faith!!!
Croz...thank you for your inquiry. Nope, no accident, unless present condition stems from falling on ice back in the 1980's---a high heel/rushing to get to my car to get to work on time scenario. I fell & slipped & absolutely ended up smack dab UNDER my car. I found myself in a position looking up at the rusty underside of my old Dodge Diplomat & could have easily changed the oil or repaired the muffler.....hahaha! Luckily, I live rurally with low traffic volume so no one saw how stupid I looked all sprawled out. About a week later I lost feeling in left hand & had excruciating pain up & down my left arm & shoulder. I could not lie flat, I slept for 4 nights in a straight back chair with my arm hovering over my head. Went to Doc Browneyes (my regular doctor) & he doped me up with some strong pain meds which only masked the symptons & turned me into a zombie sleeping 'round the clock. I next chose to try Chiropractic care & within 6 treatments I was out of trouble & back to work. Supposedly I had a pinched nerve, relating to #6 cervical vertebra.
Whether my probs now are related to that incident, I do not know. I suspect they may be. However, this round of Hell is right side & not left. It came on suddenly at Christmastime 2002. I awoke one morning with a horrible headache that Tylenol wouldn't touch. Later that day I felt awful pain in my left shoulder/upper back. I secured an appointment with my Chiropractor & from that day on the problem shifted from the left to the right. WEIRD!!! 8 Chiro treatments & NO RESULTS. She insisted it was a muscle problem. No X-rays which kinda puzzled me. Doc Browneyes decided to semi-retire (boo-hoo) so I had to find a new GP & told her the problem. She advised Ibuprofen for daytime & Valium (yikes!) for sleepy time.
Continued CONSTANT pain in neck, shoulder blade (I call it my "wing") & running up & down the outside of my arm. Some numbness in thumb & forefinger although that is not my main complaint. The wing pain is the worst.
Another visit to new Doc & she says "Let's take some X-rays"...........wahooooooooo, maybe finally someone believes me when I say I am hurting. X-rays showed the bum 5/6 so Doc orders MRI. MRI results prompted her to advise me to see a Neurosurgeon in the big city. That was a mistake---he barely had time nor room to examine me. He was gruff & his first words were, "What did you do?". I said I wish I knew & explained wing/shoulder/arm pain. He says "It's your neck, I see thousands of necks". Well, whoopy do!!! He never did look at the full MRI report, only read the summary paragraph at the end & said the Radiologist was "long-winded" which I didn't think was very nice to say of a colleague. Neuro Doc then grabbed a rather intimidating looking hammer (LOL) & tapped my knees & elbows. Next he hands me a yellow slip of paper & says to go downstairs & get 2 more X-rays. I already had 6 at my home clinic. When I returned with the X-rays, Neuro Doc was standing in the hallway talking to someone (probably his stock broker...LOL). He motioned me to return to the examining room but quickly changed his mind & said, nope, someone is already in there. Then he told me to go to another room, nope that one was full too. He grabs the X-ray & slaps it up on a screen thingy with background light located in the hallway & trys to tell me what the X-ray was telling him but was talking to the phantom stock broker at the same time. He says "I wouldn't do surgery cuz something wasn't overlapped". Truly I should have questioned him further on the overlap comment but I felt rushed & guilty for taking up his time. I was relieved to think I wasn't in bad enough condition for the knife. As Neuro Doc was waving bye bye, I asked what to do about the pain & he said "take Ibuprofen, the cheap stuff"....his exact words! He gave no indication about a follow-up visit or how LONG to take the Ibuprofen. At that point he was already ushering a new patient into an examining room. Needless to say, I got the feeling that since I wasn't bad enough for surgery, he could see no $$$'s for himself with me. I was disappointed in his demeanor & even more disappointed that he wasn't going to "cure" me of this God-awful pain. Doc Neuro's invoice arrived promptly.......$392.00 for the hallway rendezvous & another $108.00 X 2 for additional X-rays.
Tuesday I return to my New Lady Doc at home clinic. I will ask her how to go about getting the EMG thingy. I'm at the point of trying most anything. Luckily I work in a home-based biz so the boss (Hubbsy) let's me slack off at work. I feel much better in mornings but most days I am shot by noontime & have to lie down for the remaining hours of the day. If I ever, ever feel normal again, I have promised myself an evening or perhaps an entire weekend of excessive imbibement of the highest calibur swamp water, a/k/a BRANDY!!!!!