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Cervical MRI

  : I am 39 years old.  Had symptoms of carpal tunnel which EMG revealed negative.  Had recently MRI of cervical spine performed.  It revealed loss of lordotic curve.  Partial loss of height at C5-6 disk space.  Bulging disk at C5-6.  Osteophytes at posterior and inferior borders of C4 and C5.  AP dia,eter at C4-5 and C5-6 measured 9 mm.  Impression was mild spinal stenosis at C405 and C5-6.  What causes spinal stenosis?  What is treatment other than anti-inflammatories which I take but don't do any real good?  Aren't I too young for spinal stenosis.  Is the carpal tunnel symptoms related to the stenosis or a separate condition?  Does this get worse, as MD wants another MRI at end of year, or is it suggestive of something else?  What treatments are available?  Responses will be greatly appreciated.
  I would like to add I was worked up via various blood tests and brain MRI for MS, all of which were negative.
Dear Diane:
Spinal stenosis is the cervical region is most often due to spondylosis or ligametous thickening.  Spondylosis  is a condition in which there is progressive degeneration of the disks leading to proliferative changes of surounding structures such as bone and linings of the cord (meninges). It occurs in 5-10% of the population between 20-30 years and increases to >50% by age 45.  Symptoms include neck pain, spastic gait (stiff legs, is the most common finding), urinary changes, increased reflexes, sensory changes and weakness. These symptoms are progressive over time.
Cervical disks can cause a radiculopathy (nerve root compression)  whcih at the C5/C6 level would affect the C6 nerve root. Symptoms would include weakness in the shoulder muscles (deltoid) and biceps muscle. Loss of bicep reflex and sense changes in the shoulder, anterior arm and lateral (thumb side) of arm.  A pins and needles sensation may be felt in the thumb and index finger.  The MRI did not comment on any particular root or cord compromise.  A majority of people without symptoms have some degree of disc disease.  However, patients with a canal diameter of less than 11mm are at risk for a radiculopathy or myelopathy (cord compression). In addition, if  there is disc involvement you may notice symptoms during a particualar movement/position. I am assuming that your neuro exam was normal.  I would agree with conservative treatment ( rest, NSAIDs) for now. An MRI scan in 1 year is appropriate. If you would develop worsening syptoms, you may need to be rescanned sooner to see if there are any changes. Surgery is an option for disc or spondylosis if definate disc/ cord compromise is found. Good Luck.

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