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Neurology (Expert Forum)
Neck pain and radiculopathy, no herniations, what should I do next? I'm in pain
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Neck pain and radiculopathy, no herniations, what should I do next? I'm in pain
by seashelly, Jan 17, 2007 12:00AM
I have moderate to severe neck, arm and shoulder pain, numbness, weakness and visable atrophy in my left arm. x-rays showed bone spurs at C5 & C6.
MRI conclusions:
Mild to moderate C5-6 uncovertebral degenerative changes are present which produce mild to moderate right greater than left C6 ventral rootlet posterior displacement, mild central canal compromise and moderate to advanced bilateral neural foraminal narrowing.
Mild C4-5 uncovertebral degenerative changes are present and accompanied by mild posterior displacement of the left C5 rootlets and moderate left foraminal narrowing.
Asymetric mild to moderate C3-4 uncovertebral degenerative changes are noted which failed to contact the C4 ventral rootlets.
Moderate C6-7 disc degenerative changes are present which failed to compromise the central canal or result in cord or C7 nerve root impingement.
My GP ordered the MRI, she wants to refer me to a "pain specialist". Shouldn't I be concerned about the CAUSE of the numbness and atrophy? Am I risking permanent nerve damage?
What causes foraminal narrowing? Is this the same as spinal stenosis? Should I see a neurologist? Orthopedist? NSAID, muscle relaxers, tylenol do not help. Neither does massage. Any suggestions appreciated.
MRI conclusions:
Mild to moderate C5-6 uncovertebral degenerative changes are present which produce mild to moderate right greater than left C6 ventral rootlet posterior displacement, mild central canal compromise and moderate to advanced bilateral neural foraminal narrowing.
Mild C4-5 uncovertebral degenerative changes are present and accompanied by mild posterior displacement of the left C5 rootlets and moderate left foraminal narrowing.
Asymetric mild to moderate C3-4 uncovertebral degenerative changes are noted which failed to contact the C4 ventral rootlets.
Moderate C6-7 disc degenerative changes are present which failed to compromise the central canal or result in cord or C7 nerve root impingement.
My GP ordered the MRI, she wants to refer me to a "pain specialist". Shouldn't I be concerned about the CAUSE of the numbness and atrophy? Am I risking permanent nerve damage?
What causes foraminal narrowing? Is this the same as spinal stenosis? Should I see a neurologist? Orthopedist? NSAID, muscle relaxers, tylenol do not help. Neither does massage. Any suggestions appreciated.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Feb 06, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story that you provide are consistent with a radiculopathy (pinched nerve) at multiple levels in your cervical spine. This occurs when the vertebral bodies of your spinal column (the bones that make up the spine) degenerate and begin to collapse on each other. In addition body outgrowths (from arthritis) can also contribute to 'nerve pinching'. The reason the nerves are pinched is because they exit the spine in openings in the vertebral column called foramina, and when the structures begin to degenerate these openings collapse on the nerve. This is different from 'spinal stenosis', which is compression of the spinal cord or nerves inside of the spinal column (not exiting it). When these nerves are 'pinched' by the degenerating spine this causes pain, numbness/tingling, weakness and atrophy in the distribution of the nerve. Early on this process is reversible (nerve demyelination), but as the process continues, permanent damage is done (also called axon loss). From what you have described, I suspect that at least some permanent damage has been done. When permanent damage is done then surgical intervention will not help this portion and a pain specialist will be of the most help. To evaluate you for the amount of permanent and reversible damage that has been done you should see a neurologist and get an EMG (nerve muscle test). The EMG will be able to differentiate axon loss and demylination and assess the amount that a possible surgery to repair your cervical spine might help. After the neurologist I would recommend that you see a spine surgeon (ortho or neuro) to evaluate your surgical options. I do think that you GPs suggestion of seeing a pain doctor is a good one, because reguardless of your surgical options you will likely have chronic pain issues that they can address most efficiently.
I hope this has been helpful.
The symptoms and story that you provide are consistent with a radiculopathy (pinched nerve) at multiple levels in your cervical spine. This occurs when the vertebral bodies of your spinal column (the bones that make up the spine) degenerate and begin to collapse on each other. In addition body outgrowths (from arthritis) can also contribute to 'nerve pinching'. The reason the nerves are pinched is because they exit the spine in openings in the vertebral column called foramina, and when the structures begin to degenerate these openings collapse on the nerve. This is different from 'spinal stenosis', which is compression of the spinal cord or nerves inside of the spinal column (not exiting it). When these nerves are 'pinched' by the degenerating spine this causes pain, numbness/tingling, weakness and atrophy in the distribution of the nerve. Early on this process is reversible (nerve demyelination), but as the process continues, permanent damage is done (also called axon loss). From what you have described, I suspect that at least some permanent damage has been done. When permanent damage is done then surgical intervention will not help this portion and a pain specialist will be of the most help. To evaluate you for the amount of permanent and reversible damage that has been done you should see a neurologist and get an EMG (nerve muscle test). The EMG will be able to differentiate axon loss and demylination and assess the amount that a possible surgery to repair your cervical spine might help. After the neurologist I would recommend that you see a spine surgeon (ortho or neuro) to evaluate your surgical options. I do think that you GPs suggestion of seeing a pain doctor is a good one, because reguardless of your surgical options you will likely have chronic pain issues that they can address most efficiently.
I hope this has been helpful.
Indeed, it is better to spend time looking for such qualified medical care than to waste said time with a different doctor unable to provide quality care and/or unwilling to admit that he/she cannot be of further help.
Pain is like a pie; one slice is "stress", another is "medical conditions", another is "diet", another is "family and friends", etc. Try to work on all aspects of your life, it seriously helps you to cope better. I used to be in pain every single minute of the day; now I have days completely pain free.