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Got severe had injury. Have nerve root compression, loss of vertebral height and osteophyt. Prognosis?

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General & Family Physician
Practicing since : 2005
Answered : 364 Questions
To any M.D. out there, please help.

I have a more general question rather than specific, but it is nonetheless extremely important. My name is XXXXXXX I'm 30 years old, and have had scoliosis (I have been told) since birth. I was in a car accident (roll-over, no seat belt which caused my head to repeatedly hit the roof of the car with great force) in 2001, which certainly did not help my curved spine. In 2007, another condition requried an MRI. The radiologist noted how bad my scoliosis had gotten (increased percentage of curvature, etc.) and also that the cervical part of my spine had developed a lot of osteophytes and degeneration. I had simply dealt with the pain in my neck over the years, and it was actually somewhat comforting to know something of what was causing the pain. Anyway, to the present. In January, the pain reached a crescendo. In the last year or so, the pain had been getting worse at a faster rate, and I had also started to notice something that was pretty scary, a numbness and "tingling" almost all the way down the bottom part of my left arm.. and only my left arm. So that Friday night in January, after an almost unbearable week at work (I'm a banker- a loan review officer- so I simply sit at my desk all day, but by 1-2pm, the pain in my neck, radiating down to my shoulders, and upwards, to the base of the back part of my skull resulting in a severe headache back in that area- is literally excruciating) I was taken by my mother to the ER. I was in severe pain, it must have been obvious to her as she immidiately ordered a CT scan after I gave her a description of what was doing on and a short history. After the scan, the nurse quickly came in with morphine to put into the IV they had already started when I arrived. The morphine worked, and I felt relief that I haven't felt in a long time. I didn't feel "high", I felt "normal" or simply pain-free. After she (ER M.D.) had a discussion/reviewed CT scan findings with the radiologist, she came in to explain what they had found. Apparently, a lot of bad things have happened in my cervical spine. She diagonosed me with "cervical rediculopathy" which she described as nerves being pressed upon by large bone spurs, etc. Briefly from the radiologists notes: "multilevel degenerative changes are demonstrated with uncovertebral spurring, anterior osteophytosis, endplate scleriosis. Loss of vertebral body height and intervertebral disc height, most pronounced at C7-T1. Neural fornaminal narrowing and spinal canal stenosis.. XXXXXXX The morphine the ER physician had given me combined with exhaustion from little sleep due to pain leaves me without memory of what she said verbatim. However, I remember her mentioning possible surgery, types, etc. to my mother. Here is my main question: I would rather have almost any pain management plan before surgery on my neck. The prospect alone is pretty scary. My family doctor, who knows me and my entire family well, is still to conservative I think with the current pain medication, Ultram ER 300mg. once daily with 5/500 mg. for breakthrough pain. Although in pain at a level that my doctor (who has probably never experienced any chronic pain, certainly not of this degree) probably could not stand, I take my one Ultram ER and only 2 of the hydrocodone 5/500 tablets a day; once after work around 5:30 pm, and a 2nd an hour or two before bedtime. We have neurologists (specialists) in my hometown, but my insurance isn't the best and I simply cannot afford the many visits, MRI(s) PT, etc. The costs would run into the thousands, if not the tens of thousands. I don't just want relief, I need relief. The pain is wearing me down both phsyically and mentally. A human can only stand so much pain. In the end, it seems that most doctors (even specialists) unless they know you personally, and even with actual evidence (MRI, CT scans, etc) previous medical history, doctor's notes, etc, seem to be reluctant to the point of making a person feel humiliated if they ask for something stronger to control the pain. (I realize, sadly, that many have probably been lied to by drug-seekers, etc. in the past, and that the addicts seem to now control how medication is given, not the people actually suffering) Are there compassionate doctors out there? How does one go about trying to find a doctor who will give the patient the medication that is strong enough to help them, whatever it may be? Thank you for reading this, I apologize for the length, but I'm desperate for help, advice, etc. from an impartial, non-judgemental M.D.
Thank you very much.
Posted Fri, 22 Mar 2013 in Bones, Muscles and Joints
Answered by Dr. Mamun Kabir 2 hours later

Thanks for your query.

I am sorry to know that you are suffering a lot.

From clinical features it is obvious that there is nerve root compression.
Loss of vertebral height, osteophyt & radiculopathy indicate some disease.
It may be inflammatory, tubercular or due to degenerative change.

But first of all, the main thing is significant root compression.
Decompression must be done for complete recovery.
A good neurosurgeon will be better for you.

Chronic use of both NSAID & opiod will be harmful for you. Though you can go for intrathecal steroid injection which may help regeneration of damaged nerves, the effect lasts for short duration and may increase the threshold for any other treatments.

So take a wise decision.

I hope I have answered your query.
Please write if you have any doubts.
Take care.
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