Options for cervical spondylosis and other cervical problems

[Bonz]

My MRI results came back. I have a prominent osteophyte formation which is producing severe encroachment on the left neural foramen, with mild central stenosis and compression of the cervical spinal cord.  Also, at C5-C6 there is osteophyte formation with small disc herniation to the right of midline, and also the mild central stenosis and compression of the cervical spinal cord.  At C3-C4 and C4-C5, there is a 1-2 mm. central disc protrusion. Could this be explained to me in layman's English?
   What sent me to the doctor was severe pain in the left arm, with frequent numbing. I was almost totally incapacitated for two weeks, even with good pain meds. At the worse times, the arm felt like it was on fire. This week, it's eased off some, I can get about again, although I still need pain meds. I have some numbness still, though not to the degree of last week. There is significant improvement, but it's not gone by any means.
   My rheumatologist sent me to an orthopedic specialist for his opinion. Right away, he wanted to do surgery. Isn't that a little drastic for this? I was surprised, I had thought he'd say "physical therapy, etc." first, and if it didn't work, then surgery. It seems like a serious surgery, and I don't want it, unless absolutely necessary. But on the other hand, I don't want to put off something necessary if it is necessary. Will this ease up, or will it get worse? Thanks for any help, I'm scrambling around trying to educate myself on this.

[CCF Neuro[P] MD, RPS]

Dear Bonz:

The segment of spinal cord in your neck has some boney changes.  Encroachment of the foramen, what level?  means that where the nerves exit the cord there is compromise (either inflammation or boney encroachment), usually this can cause sensory changes.  The herniation just means that the discs are protruding from their usual location, out of the spinal canal.  Several discs protrude enough to push on the spinal nerves running down the cord, but just alittle.  

Surgery is the last resort, considered when PT, rehab fail.  The results are still mixed.  Some indications for surgery is severe cord compromise, severe pain, muscle atrophy, reduced nerve conductions down the nerve, and other EMG changes.  I would seek a second opinion from a neurologist/neurosurgeon.  Take all your films and tests and see what someone else indicates.

Sincerely,

CCF Neuro MD

[Ellen]

My MRI shows small left posterior osteophytes and possible small left  posterolateral disk protrusion C2-C3. Small left posterior disk protrusion at C3-4. Bulging annular fibrosis moderate comprimise of the spinal cord at C6-7 and mild flattening of the cervical spinal cord.  There is a loss of cervical lordosis.????My symptoms are: headache-neck pain every day, some times loose my balance and sometime the left side of my head feels like it is tingling.

Can you explain what this is in my terms

[CCF Neuro[P] MD, RPS]

Dear Ellen:

What did your doctor tell you what these were?  When there is irritation of the vertebrae there is ossification of the bone and boney protrusion can form from the vertebrae-osteophytes.  When small, they usually do not cause any pain or cord damage.  Small bulging of the discs (the smooth cartilage the allows movement of the vertebrae) usually is just a happenstance finding and does not usually cause pain.  When the spinal cord is pushed against it compromises the cord.  When major it can cause pain and loss of muscle strengh and numbness.  Mild loss of lordosis can be the result of degeneration, either of the discs or the vertebrae themselves.  Headache would be very, very unusualy coming from the lower cervical cord as these nerves go to the arms and the longer tracts to the legs.  Neck pain is a possibility.  

Ellen, you need to talk to your doctor.  He/she needs to tell you what he/she thinks because they are the ones seeing the films and have done the physical exam.  If you don't understand then you need to ask.

Sincerely,

CCF Neuro MD

[marie]

I've been under a neurologist for over 4 months now and was given several medications for my "cervical strain" secondary to lifting and handling over 500# pt. My MRI showed mild/minimal bulging and protrusion of C2-C6 with minimal/small central ventral defect. Ever since the injury, I've been having pain from my head down to my legs. Increasing migraine h/a and now on MIGRIN almost daily, sharp shooting pains on my arms and at times heavy/lazy feeling on both arms and legs,amd mostly, pain over my shoulder blades. My most comfortable position is laying flat on my back. I'm on anti-depressant, Vioxx, Baclofen and TML. I can't stay in one position for over an hour. With all these drugs, I'm not totally pain free. What is going on with me?

[Karen Morrell]

Dear Doctor, I comunicated with you several weeks ago as a comment on Cameron Rogers original question. I have since had a third opinion from University of Washington spine center. You may remember I had a first opinion from a young (1 year in private practice) neurosurgion, 3 level ACF, a second from a more mature neuro. (6 years in private practice) 3 level 3-4 4-5 5-6 laminectomy. You suggested I go to a teaching hospital for the third opinion, I did. Although I was never able to talk to the Dr. his assistant told me he said 3 level ACF. I have since gone back to the 2nd. doc and had a further consultation with him. I have decided to go with the laminectomy. The condition of swan neck was brought up by #1 (phone consultation after 2nd opinion) #2 said there was about a 10% chance of swan neck and that if that occured further surgery at one level would take care of it. He also said my chances of further surgery down the road after an ACF at my age (57) and life expectantcy, would be very likely. How do you feel about it? Would you agree  a 10% chance of the swan neck is reasonable? Thanks for your opinion.  Karen

[CCF Neuro[P] MD, RPS]

Dear Karen:

I don't think I really can give you a percentage, but what you were quoted seems about right.  The more levels that you immobilze, the greater change of having a swan neck.  I hope that things work out well.  At 57 you have just begun middle age, so you have a long way to go.

Sincerely,

CCF Neuro MD