C-Spine MRI - Pain management or surgery?

[spinedecline]

MRI Impression:
Multilevel cervical spondylosis from C4-C5 through C6-C7 with mild to moderate central spinal stenosis and neural foraminal stenosis at these levels.
C4-5 Broad disc osteophyte complex, eccentric to the right. Effaces the ventral thecal sac and causes mild to moderate central canal stenosis. Bilateral uncovertebral hypertrophy and facet hypertrophy causing moderate right and mild left neuroforaminal narrowing.
C5-6 Broad central disc osteophyte complex which effaces the ventral thecal sac and flattens the ventral aspect of the cord without overt cord signal abnormality. There is moderate central spinal stenosis and obliteration of CSF at this level. Bilateral uncovertebral hypertrophy and facet hypertrophy cause mild bilateral neuroforaminal narrowing.
C6-7  Disc osteophyte complex which effaces the ventral thecal sac and causes mild central spinal stenosis. Bilateral uncovertebral hypertrophy and facet hypertrophy with a focal osteophyte in the left neural foramen. there is mild right and moderate to severe left neurofoaminal narrowing.

Current Symptoms:
Left arm pain radiating to hand and fingers. Tingling and cramping on top of hand and fingers. Severe intermittent headaches which last 2-3 days at a time with nausea and occasional vomiting. Constant burning neck pain radiating through shoulder and down along spine between shoulder blades. Constant muscle spasms around base of neck and between shoulder blades. Daily, intermittent tingling and burning down both legs.

Based on the above MRI report and current symptoms do you think its time for surgery or can this continue to be managed with transforaminal injections and pain medications? I do not want to risk any permanent damage to my spinal cord.

[Prem Pillay, MD]

I would recommend that you seek a second opinion form a neurospine specialist in town.
You may need an EMG/NCS as well.
You can certainly try physical therapy and pain management first before deciding on surgery. If you don't improve with them, this would be another indication that surgery may be an option.

[mustanggt]

hi, I know what you are going through and it is hell.  I had a car accident and was in immediate back and neck pain.  I searched for answers for 6 months and the saw a doctor who said that I needed surgery.  Little did I know, I was being led down the worst road that I could have ever gone down.  I had brain surgery and a C1-C7 laminectomy spread out over 2 different surgeries.  It is the worst thing I could have done.  The surgeries made my life a thousand times worse than it was before the surgeries.  I am not sure what kind of surgeries the doctors are recommending, but if you know, tell me what they are and I will give you any information that I can.  I have been dealing with my back issues for 6 years now, so I know a lot about different procedures, and surgeries.  I am only 25 years old and I am not able to work, and can barely functioin at this point.  I can tell you that from my experience, surgery was the wrong thing to do, and I wish every day that I would have just dealt with the pain that I had before the surgeries.  There are a lot of things that you can do to manage the pain without having surgery.   PLEASE THINK LONG AND HARD BEFORE HAVING SURGERY.  IT CAN RUIN WHAT LIFE THAT YOU STILL HAVE.  You may feel right now that things can't get much worse and that your life is already ruined, but I am telling you, things can get much worse and the pain can be so bad that you wont be able to leave your house or even get off of the couch.  I understand what you are going through and if you need someone to talk to, I am here.   Sincerely, Vanessa

[spinedecline]

Uploaded Pictures from MRI

[SilverLining00]

Hi - Sorry to hear your in pain.  12 years ago, I was where you are now.  Right arm/shoulder pain, chronic muscle twitches, and pain.  My pain progressed to atrophy of my deltoid and shoulder muscles.  They didn't have prosthetic discs yet.  I had herniated disks at C4-5-6-7.  C4-5 wasn't too bad yet, but I was losing the strength in my arm and when the pain disappeared, I was happy and told the neurosurgeon, who quickly squelched my joy with the comment that it wasn't necessarily a good thing.  Needless to say, I ended up with a fusion of c5-6-7.  I'm not sorry I did it, but I wish I could have waited until the prosthetics were available.  My life now consists of limited mobility, vigilance on my posture and head position, headaches from turning my head in any direction for more than a few minutes.  I can't sleep on my stomach or my back.  Now, 12 years later, my c4-5 level is definitely acting up as I am getting pain in my arms again.  For me, I'm planning on trying to rebuild my neck muscles to better support my movement and alleviate and strain.  Surgery is the last thing I want.  You may want to do what Dr. Pillay suggests and definitely give PT a good try.  Best of luck!

[spinedecline]

Thank you for your comments.
My biggest concern is the flattening of the spinal cord, can this pressure on the cord cause permanent damage over time?
Injury was over 5 years ago, seeing phys. med. & rehab. doctor for over 2 years now.

[Shore Guy]

Your MRI is not far off mine, and symptoms are almost exact. I will fight and work as hard as it takes not to have surgery. You can survive and based on some results and the possiblity of permanent paralysis etc. from the surgery I would hang in there as long as possible. when I am real active it is not fun to be me but it has gotten better with time once I figured out what aggravates it and what I can get away with to keep up activities like walking etc. to keep up health when the pain permits it.I am told due to fusion of spine in this area swivelling of neck  wears out upper and lower facet joints at an increased rate causing issue in 10 years? Pain clinic was a big help.

[OneDayataX]

I agree with mustaggt I'd think long and hard and save it for the only other alternative because the outcome may cause many more problems.  My husband and father in law had back surgery and said if they had it to do over again - they wouldn't the pain was more severe after the surgery.