Spondylostenosis

Posted by Sandy on April 26, 1999 at 09:46:47
I have been experiencing >extreme< pain in my right arm since 2/14.  After messing around with prednisone & nerve conduction tests, I had an MRI 3
weeks ago.  What follows is the summary of the radiologist's report.
1.  There is a broad-based disk protrusion at C5-6 impressing upon the thecal sac creating a mild to moderate degree of spondylostenosis.
2.  Mild degenerative changes are present at C6-7.
3.  There are jugular chain and posterior triangle lymph nodes present, none of which meet CT criteria for lymphadenopathy.
Okay.  What does this mean?  I have been referred to a neurosurgeon, but I would like to know ahead of time what sort of treatment/procedures are called for in such a case.  I'm totally in the dark here, as well as in tremendous pain.  "Mild to moderate degree" indeed!  Definitely depends on whether you're the person with the condition.  It HURTS!!!!
Please give me some little hints as to what I can expect to happen when I have my first visit to the neurosurgeon next Monday.
Thank you.

Posted by CCF MD mdf on April 26, 1999 at 19:14:11
This is basically wear and tear on the spine. It gets worse with time. Some people are fortunate and theirs is never particularly painful; others hurt quite a bit, especially if a nerve root happens to get squashed in the bargain.
The right arm pain results from irritation of the nerve roots coming out of the cervical spine (in your neck). These send signals to the brain, which doesn't know any better and assumes the problem comes from the arm. This "radiating" pain (or sometimes tingling etc) is characteristic of nerve root problems. The technical term is radiculopathy.
Between C5-6, the disc has deteriorated to the point where there is less room for the cord to pass. I don't have enough data from what you've written to be able to say whether the cord itself is in any danger of being compressed, but it usually is not.
I refer people to spine surgeons for two reasons:
(1) progressive weakness of muscles which happen to be connected to the nerve that goes through the affected nerve root (in you, it would be a particular pattern of weakness in your arm).
(2) pain that simply won't go away despite the best medical and physical therapy.
It is not a bad call to send you to a neurosurgeon for an opinion. The better ones will weigh all the pluses and minuses of a surgical procedure and go over them with you. Most good surgeons are conscientious about trying NOT to operate on someone who shouldn't be operated on, but you should know the rationale for surgical and nonsurgical treatement before you go in for the examination.
By the way, the degree of stenosis (narrowing of the space for spinal cord or nerve roots) is NOT correlated to the degree of pain. The radiologist calls what he/she sees in terms of how many millimeters are available for passage of the neural tissue. Only YOU know how much pain you're in. Time and time again I have seen people in excruciating pain with relatively minor degree of damage. So don't assume the doctor thinks your pain is any less just because the MRI doesn't look as ugly as your arm feels.
I hope this helps. CCF MD mdf.