Neurology Expert Forum
Bum 5/6 Cervical --- pain, pain, pain.
About This Forum:

This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Bum 5/6 Cervical --- pain, pain, pain.

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.
Related Discussions
Avatar_n_tn
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.
14 Comments
Blank
Avatar_n_tn
Did you have an accident?
Blank
Avatar_n_tn
I have had chronic neck and head pain before and increasing after two surgeries in Feb and May 1999. The first to remove a benign tumor under the occipital and down to the C3 vertebrae which included partial removal of the occipital bone and a C1-C3 Laminectomy  (11.5 hours).    The second to treat Hydrocephalus by placing a peritoneal ventricular shunt to relieve pressure.  The resulting pain was severe enough to interfere with any work and especially sleep. Even strong doses of  hydrocodone (10mg @  4-6 hrs) and Oxycontin (10mg @ 12 hrs) did not bring sustained relief. After finally seeing a Pain Management Doctor who combined physical therapy and steroid ejections I had a 20 to 30 % decrease in pain. The greatest benefit came from a  relatively new procedure called (I think) Radio frequency rhizotomy. After this procedure with medication I was able to return to work full time. I sleep 5-6 hours at a time but for the last two and a half years I have still had to use Hydrocodone. Sometimes up to 10 to 20 mg every four to six hours but it beats the heck out of laying in bed in constant agony.  Hope this helps and God bless you.
Blank
Avatar_n_tn
Hi,

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!!!!!
Blank
Avatar_n_tn
Please see a Pain Management Doc.  They are there to treat CHRONIC pain. You can be dying from pain and your GP is going to treat you with Advil, vioxx or celebrex. Pain cannot be felt if the nerve pathways that relay pain impulses to the brain are interrupted. To block these pathways, a neurosurgeon (nine was a qualified Pain Management Doctor) may cut a nerve, or inject chemicals close to the spinal cord. This is called a rhizotomy. Rhizotomy is a relatively new selective nerve ablation procedure used in chronic pain management. If your pain is mostly from nerve damage or irritation you should look into this. My procedure was a Radio Ritzotomy which is like a probe that emits microwave (yes it is a bit painful especially if you try it with no sedation)and burns the nerve at the point of pain. Some can return to a normal life without long term narcotics use. Also helpful to me has been other helth boosters, I also have Hep-C that I received from blood that that was before 1990 when they started screening for it.
Good Luck and may God Bless you with healing.
This was a helpful site.  http://www.healthquarters.org/
Blank
Avatar_n_tn
Hi,

I don't think my situation is as bad, but similar.  

I went to the ER, because I couldn't stand the pain in my "wing" , shoulder/arm one minute longer, but my EKG decided to be abnormal.  They had my norm EKG on file and being it was left shoulder/arm pain I ended up with a 3 day stay ck'g out my heart.  And still getting nothing for the pain all that time, because heart wasn't cleared until 3rd day.

I saw an ortho, got an MRI which did show cervical spondyloarthropathy (stenosis, disc probs, encroachement, arthr,etc), but he said it wasn't bad enough to cause this pain.  (My cardio and I think it could very well be, so I will be seeing my reg ortho who isn't affiliated with that hosp).  I insisted that I wouldn't leave the hospital until pain mgt. came to see me. I left with scripts for oxycontin and vicoprophen.  At first it didn't do much at all, but when I combined them...  

But what made me want to add my story was that I was sent to vascular surgeon to be checked for TOS - thoracic outlet syndrome.  He really took his time with me and told me what they look for, how they diag, etc.  I didn't have the typical onset - no trauma, or typical presentation, however I did lose my pulse in arm when lifted and a muscle in my neck went into spasm.  So, I was prescribed muscle relaxer (which I thought I needed all along), Flexeril (sp) and at home PT exercises.  If it improves with this then I will have the diag of TOS.

I will still keep my appt with my ortho.
Just thought I'd give you another angle to ck out.
Blank
Avatar_n_tn
In 1994 I was diagnosed with bilateral thoracic outlet syndrome. yeah, cut down on the computer and practice good computer posture.  In 1996 I sat down on a stool and the back came off and back i went landing on my back or neck ( I was in shock ).  Now the battle with real pain begins.  I have been from specialist to specialist and P.T. to P.T. and any other treatment you can think of because I was in Northern Calif.  A pharmacologist from UCSF gave the the title of having a "sympathetic Nerve Reaction".  After countless drug cocktails and more tests and treatments, I was off to Stanford University to convince them I was in 'unlivable' pain.  A NeuroSurgeon gave me the special title of " Myofacial Nerve Disorder".  I have had 3 mri's 2 emg's and countless x-rays.  Now I take my cocktails of celebrex (400/DAY) 30MG Amitriptyline/day, 1mg Clonazepam, 4-6 10mg Hydrocodin and a 50mg Fentanyl patch just so I can wake up and have some level of comfort.  I moved to Fl to see if the warmer weather would help but to no avail.  I have now quite my job due to the pain and my inability to concentrate through it.
I'm trying to make lemonade but it's a pain in the neck.
I'm hypersensative to touch in the neck to the middle of the shoulder blades and cannot place any wait on my shoulders (no purse), no heavy or even light weight jacket.  A feather has been used to try to desensatize the area and I couldn't take it.
I was told it was my fault, the chair wasn't checked to see if it could hold my weight (125 lbs).  I'm sick and tired of being sick and tired!!!!
Blank
Avatar_n_tn
Approximately 10 months ago I went through cervical C5, C6 disc fusion surgery after battleing sore neck/radiating pain down my arm for 2 years.  My doctor was excellent and listened to my pain complaints and immediately ordered xrays.  It happened at work by lifting 30 lbs from eye level to slightly above shoulder level.  Since my surgery I have had alot of problems with my voice, my larinex is red and swollen and I just got informed today that my surgeon has done all he can do and the injury to my larinex is permanent.  My husband and I met at Karioki and my passion has been singing and I no longer can do that without people having ear plugs.  Has anyone that has had surgery (disc fusion) had a similar problem, or a way to treat this?
Blank
Avatar_n_tn
Boy did your situation hit a nerve with me (ha,ha). I had the same exact situation! My voice was unbelievably hoarse and throat raw for over 5 months after a c5-6 fusion. I was about to have a laryngoscope to check out what the heck was going on when I happened to talk with an ENT Doc about what could possibly cause this. He mentioned that sometimes when people experience silent esophogeal reflux this can happen because the tissue is never able to adequately heal with the acid constantly irritating it. So, I happened to have some prilosec at the house and took one that night. Would you believe the very next day I woke up and could speak normally?! I was amazed! I don't know if this is the case with you but before investigating with more invasive methods, have your doc try that! Hope the best for you! Let us know how you do in any event! These comments help everyone to learn...
Blank
Avatar_n_tn
Thanks for you suggestion,  actually I had just had an ENT specialist appoint before my surgeons and he prescribed rinitadine for acid reflux similar to yours.  Unfortunately I don't suffer from that and the medicine made me really sick, headaches, depression, and also everything I ate gave me heartburn as opposed to getting it like once every three months.My family doctor said to stop taking it and gave me Prevacid for when I do have heartburn.  My surgeon did say that it would be permanent damage and would get better some days and relaps the next, any other suggestions?
Blank
Avatar_n_tn
hi red!  i just had a very similar experience---c5 and c6 were interpreted on the mri to have mild to  moderate herniation.  was seeing chiropractor,physical therapy with cerviacal traction,steroids,the works.  no improvement.  I went to an orthopedic surgeon who saw my biceps reflex disappear and then my arm strength leave and He called a neurosurgeon and spoke directly to him and told him i was a surgical case.  The neurosurgeon who did my surgery pioneered the microdissection.  This does not involve fusion and the incision is from behind the neck, not the front, so the voice complications don't occur.  I had the surgery mid january and my arm is back to full use now and NO PAIN fron neck.  Please-try to get in to another neurosurgeon and ask about the microdissection--good luck--i feel for you...
Blank
Avatar_n_tn
Hi again, just want to tell you that I NEVER had heartburn! That is why it was considered silent reflux. I would try the prevacid for a few nights even if you don't feel like you need it. Perhaps it will help in your case too. If the prevacid doesn't work there are those like prilosec and the new one Nexium that actually heal the tissues if there was damage. It may not work, but it couldn't hurt for a few days to try it anyway. Best of luck in any event.
Blank
Avatar_n_tn
I had neck surgery in Aug 2002 on my c6-7 disk where they replaced my disk with what they described as a shim (bone chip) to keep my vertebrae apart. After 2-3 months of recovery I seemed to be experiencing little pain except a slight occasional ache in my neck. But all the shoulder, arm, wrist, hand and finger pain seemed to subside (on left side). I was released from the surgeon in October and told I could gradually resume normal activities.
   I did not do much over the winter (alot of snow) except for some walking, but in March started doing a few activities like golf (3 rounds during March) and 1 set of tennis. It seemed like overnight that some of my original pain returned towards the end of March. The worst is the constant pain in my neck and numb, tingly even sore (arthitic like) feeling in the fingers and joints of my left hand(thumb, index and middle fingers - which gets worse as the day progresses). I also have off and on pain in my left shoulder, bicep, elbow and wrist, which is intense sometimes. My neck also cracks all the time during the last two months where I could never remember my neck cracking before or after the surgery at all. I wakeup in the morning with only slight neck or finger pain but as the day progresses the pain increases and I can only slightly relieve it by laying down for an hour or two and/or medicating. I have returned to taking pain killers in order to try to sleep at night (One of either hydrocodone, percocet and even occasionally ambien), but have limited myself to Extra strenth tylenol during the day which really doesn't help much. I am trying to avoid the narcotic addiction I experienced after the surgery which is why I rotate my nightly sleeping aids (I know - bad logic).
   I am fortunate that my work has allowed me to work from home via my work laptop for the last 3-4 weeks (its a one hour one way drive) but I feel they are growing impatient for my permanent return. My surgeon has put me through an MRI, XRAYS, and EMG which shows everything still in place from surgery and no apparent nerve damage from EMG results. I see him again 5/29 where he has already told me via phone calls that I will need to make a choice of a cervical Epidoral and/or physical therapy.  Sometimes the pain seems as bad as before the surgery and I am getting frustrated as to what to do next. I was also wondering if there are any success stories from cervical epidorals. I do however realize that this will only be a temporary relief of pain, but I feel I may need it just to make the physical therapy bearable and to be able to try to return to work before they get rid of me and I loose everything.......
Blank
Avatar_n_tn
I have had similiar symptoms, related to an incident at work.  I lifted a box of parts (75 lbs) and when I set it down I felt what I can only describe as a hot pulling/tearing pain in my back.  The next morning I couldn't turn my head at all and had so much pain when dressing myself I was in tears.  Unfortunately, this happened in October of last year, and since it is work related, I have only seen "Workers Comp" doctors who work with my employer.  I was sent to phys. therapy before any tests were done and prescribed ibuprofen.  I have been on every pain med and muscle relaxer that I know of, and none helped.  In December/January I finally had x-rays and an MRI done.  I was not shown the films, but was told then that everything was normal..  "just a strained muscle"... Finally, last month, I was sent to an Orthopedic doctor, who actually showed me the films.  He said "You have a slight bulge in your c5/6, but it wouldn't be anything to cause your symptoms..... yours is strictly muscle".  Let me note.....  I can not drive for more than 20 minutes without suffering for it the next several days.  I can not reach with my left arm without pain, and I cannot use my left arm in any repetitive manner at all (I work in a factory.... what will happen to my job??).  I go in next week for trigger point injections and phys therapy, but is it going to help??  I have been through all this before, and just want to feel normal again!  If the injections and therapy don't work, will my only other option be surgery?  I don't want anyone cutting my back, especially these doctors.  I have heard too many horror stories about botched surgeries.  Please advise!!!
Blank
Avatar_n_tn
A related discussion, post op pain was started.
Blank
Avatar_f_tn
Hello, I have had back pain sence I was 18yrs old. I got pulled through some rafters I was installing in my techinal school carpentry class. This heavy kid slipped and decided I was a good way to stop his fall. 1 leg was laying flat asmy body was slidding down the roof and they other got pulled strait down between the rafters behind me.

I have been able to ease off the pain when is worse from rainy weather. But every 2 to 3yrs my back would go out for around 2 weeks. And never twice in the same year.

That changed this year. Im now 36yrs old. The first time this year was 3/19/10 and I returned back to work on 3/28/10' I was still in some pain and couldnt beleave it eased of in 1 week. I was in pain while at work (heavy equipment mechanic for caterpillar) for anouther week or so. I then had a relapse on 5/2/10 and have been off of work till at least 6/14/10, today is 5/26/10 and I had a mri on 5/8/10 and my doctor made an appontment with dr. Cheng a nero at Vanderbilt hospital in Nashville, tn. 6/14/10.

The mri report said:
   Mri lumbar spine w/o contrast
Techniqe: sagittal t1, t2, and stir, axial t1 and t2 images lumbar spine were obtained.

MR images reveal slight straitening of lumbar spine. Bone marrow signal shows diffuse low signal changes on all sequences. Conus medullaris appesrs normal. Loss of t2 signal within the discs at l4 and l5 with generalized disc bulging at l4 and l5. Benign appearing hemangioma involving l2. The lumbar formina appear generally patent bilaterally. Mild diffuse disc bulding at t12-l1 with slight indentation of the thecal sac.

l3: l3 disc space is essentially normal.

L4: moderate central disc protrution posterior and mid-line at l4 contributing to moderate indentation of the ventral sac. There is some mild facet hypertrophy as well. Patient has a generally narrowed spinal canal. There is some loss of fat signal between the lateral disc and l4 nerve root on the left. No definite displacement.

L5: moderate central disc protrusion at l5, a litte more pronounced at left of mid-line. This appears to abut the s1 nerve sleeve within the lateral recess and there may be mild posterior displacement. The facet joints appear fairly normal.

Impession:
   1   diffuse marrow signal changes somewhat atypical for age. Findings may indicate mylofibrosis or atypical red marrow replacement.

   2   moderate disc protusions of l4 and l5 and dicussed above. Potential  nerve impengement involving the left s1 nerve root as dicussed above.

   3   congentitally narrowed spinal canal.

   4   mild fac ea t hypertrophy l4-5.

Dictated by: Stallworth, James M. M.D
Radiologist
Board Certified ABR
  
Can you tell me if this is bad enough for surgery?

Please email me at ***@**** if there are any questions needed.


Blank
Continue discussion Blank
Blank
Request an Appointment
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
How to Silence Your Inner Critic an...
Apr 16 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eaters: How to Silence Yo...
Mar 26 by Roger Gould, M.D.Blank
1344197_tn?1392822771
Blank
Vaginal vs. Laparoscopic Hysterecto...
Feb 19 by J. Kyle Mathews, MD, DVMBlank