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Spinal Cord Disorders Message Board

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I've had another MRI in September (had one last year following a C6-c7 disc herniation) and I wondered what the long term outlook might be if I don't have surgery to widen the foramina holes (I wish I could just dremmel them!) as I'm receiving a course of physiotherapy which isn't really doing much to relieve the constant burning pain in my neck, nor the stabbing pains down my shoulders/upper arms when I move my head to either side - any info gratefully received

[I][B]MRI Spine Cervical:[/B]

Flattening of the physiological cervical lordosis is present.

There are spondylotic changes from C3/C4 to C6/C7
disc-osteophytic bar complex that indents the anterior epidural space and at C3/C4 and also at C6/C7 (focal posterocentral disc herniation) may contact with the spinal cord. The spinal cord returns normal signal. Close clinical correlation and referral to the specialist is advised. The spinal canal is copious and no stenosis is present. The alignment of the vertebral bodies is preserved.

There is bilateral narrowing of the neural foramina at several cervical levels, more marked the right at C3/C4, the left at C4/C5 and bilateral and more severe at C5/C6 and right at C6/C7 that may cause nerve root impingement. No significant posterior disc protrusion or stenosis of the spinal canal is present at the upper thoracic spine. [/I]

thanks in advance
Welcome to the board from "across the pond"...

You have a few things going on:

"disk-osteophyte bar complex..." - Arthritic bone spurs are pushing back into the space for the spinal cord and possibly touching it. This sounds bad, but may or may not be causing you problems. The bone spurs are unlikely to get better but you can stabilize your spine through exercise and potentially keep that from getting worse. Generally you don't get symptoms of myelopathy until the cord is quite compressed (I've read about 30%) but it is individual which is why they want you to be monitored by a specialist. Myelopathy symptoms like hand clumsiness or wasting, gate disturbance, urinary disturbance can indicate the need for surgery to decompress the spinal cord. You don't mention those, so it's probably a "watch and see" thing.

"focal posterocentral disk protrusion..." - that's a herniation pushing into the spinal canal. I'm not sure how to parse the fact that they put it in parentheses, but it seems generally that you don't have significant spinal canal stenosis from this or the spurs. These disk protrusions may or may not heal on their own unlike the bone spurs.

"bilateral narrowing of neural foramina..." - something (they don't indicate what exactly), is causing relatively severe narrowing of the holes where the nerve roots exit at multiple levels of your spine most severely on both sides at C5/C6. This is likely what is causing your sensory symptoms (the pain and burning).

From just the language in the MRI, it doesn't appear that you have significant impingement on you spinal cord. What is there seems to be caused by bone spurs and therefore is likely to worsen over time unless you can stop the bone spur formation process. It is possible to add stability and strength through PT exercises for your intrinsic neck muscles which *may* help.

How long have you been doing PT and what modalities are they using (massage, exercise, e-stim etc)? I found e-stim, TENS and oral steroids helped quite a bit although they won't let you take steroids long term. Luckily, the pain part of my issues mostly went away before I had to decide on Epidural steroid injections(ESI) which may also help with radiculopathy symptoms like you are showing.

Long term it's difficult to say what will happen. Radiculopathy (the likely cause for your pain and burning) can most often be treated by non-surgical means such as PT, traction, ESI etc. Sometimes it can't. In that case, surgery *may* be indicated. Often, it's a matter of weighing the severity of your symptoms against the complications of surgery. Sometimes, more severe symptoms such as arm weakness or atrophy develop in radiculopathy which may tip the balance toward surgery as it is an indication of more severe compression and possible long-lasting nerve damage. If spinal stenosis causes myelopathy by pressing on your spinal cord more, then that would also be in indication for surgery depending on the severity and type of symptoms.

I will tell you that I have a bit worse situation than yours : I have a "little bit" of compression at C5/C6 from a large bone spur complex and pretty severe radiculopathy into my left arm. In my case I did have some strength loss and a little atrophy but it has mostly come back over the last 6 months. The overall recommendation was to watch and wait, do PT etc, and that has been pretty successful. The consensus was that I'd likely need surgery at some point however, due to the likelihood of the spinal cord compression worsening.

It is important to get under the care of a reputable spine specialist (fellowship trained orthopedic surgeon or neurosurgeon) that does nothing but spines. They can help monitor your spinal canal issues and give guidance on which treatments are applicable at what times based on your symptoms and diagnostic studies. I have no idea how you'd go about that in the UK, but my guess is the process will take a long time so start soon!

Good Luck and let us know how you get on...

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