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Have neck pain and rheumatoid arthritis. Done MRI. Is surgery a reasonable approach?

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I've had neck issues for a few years now - treated conservatively with PT, epidural steroid injections, TENS unit, and pain meds. I am 49 years old and also have rheumatoid arthritis (altho the neck issue may not be related) treated with Orencia infusions every four weeks. Neck continues to be painful, with pain radiating to my right arm and hand.

Last week, MRI for history of cervical myelopathy shows: C2-C3: mild generalized disc bulge eccentric to the right; findings efface the anterior thecal sac but do not impinge on the spinal cord; C3-C4: generalized disc bulge with superimposed left paracentral/left lateral disc protrusion which extends into the neuroforamina on the left. Findings likely impinging on the exiting left C4 nerve root. Findings abut the anterolateral aspect of the spinal cord on the left. Moderate left-sided neuroforaminal narrowing secondary to uncovertebral joint hypertrophy. Mild right-sided neuroforaminal narrowing secondary to uncovertebral joint hypertrophy; C4-C5: generalized disc bulge which is eccentric to left. Small focal central disc protrusion. Findings efface the anterior thecal sac, impinge on and deform the anterior surface of the spinal cord. Moderate left-sided neuroforaminal narrowing secondary to uncovertebral joint hypertrophy. Mild right-sided neuroforaminal narrowing secondary to uncovertebral joint hypertrophy; C5-C6: generalized disc bulge with small central disc protrusion and osteophyte. Findings efface anterior thecal sac and cause mild cord compression. Mild bilateral right greater than left neuroforaminal narrowing secondary to uncovertevral joint hypertrophy; C6-C7: focal central to left paracentral disc protrusion. Findings efface the anterior thecal sac and cause cord compression; mild bilateral neuroforaminal narrowing secondary to uncovertebral joint hypertrophy. Impression: Multilevel degenerative changes cervical spine with multilevel disc protrusions present. Slight worsening of findings from MRI of one year prior.

I don't like the pain - nor do I want to jump out of the frying pan and into the fire. Is surgery a reasonable approach at this point, or is that just asking for trouble?
Posted Thu, 27 Sep 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Praveen Tayal 5 hours later
Hello,
Thanks for posting your query.
You have disc degeneration with compression of nerve roots causing radiculopathy. The surgical treatment is kept as a last resort if the medical treatment fails. After taking appropriate medical treatment, if you are having a debilitating pain which is interfering with your daily activities, there is numbness along with muscle weakness of the hands which is not improving with regular physiotherapy and cervical traction then surgical treatment needs to be considered.
Surgical treatment will help in improvement of your symptoms but since it is a progressive disease, you will have to maintain a careful lifestyle with regular exercise to avoid the further progression.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
 
Follow-up: Have neck pain and rheumatoid arthritis. Done MRI. Is surgery a reasonable approach? 10 hours later
Thanks, Dr. Tayal. This does help answer my questions; all of the treatments you've mentioned DO help to a degree, and I do continue with them. The epidural steroid injections also provided some relief (especially of the pain, burning/tingling, and numbness in my arm and hand), but I'm reluctant to undergo them on a regular basis, not in the least because I know repeated use of steroids can create a whole host of problems itself.

I guess there are several factors involved in what I do with my neck. I'm only 49; 10 years ago, I figured I'd be working and active well past retirement age. Now I don't know how I'll make it TO retirement age. I'm fortunate to have a wonderful support network at home with a wonderful husband who helps however he can. Until three or four years ago, I was a quite active person (walking, competetive horseback riding, etc.) - I'm mostly inactive now due to pain/fatigue. I don't ride at all anymore, and walk less than I did. A lot of this is due to the pain/fatigue from the rheumatoid arthritis (diagnosed three years ago) - and although my neck issues are degenerative, no one can really tell if they're exacerbated by the RA. And if the rheumatoid arthritis IS contributing to my neck issues, would surgery provide long-term relief?

So, I guess I have a bunch of nebulous questions for which there aren't really any clear black & white answers. But it helps to ask them, at least - so it's not all so mixed up in my head. :)

Thanks for your input. I do appreciate it!
 
 
Answered by Dr. Praveen Tayal 4 hours later
Hello.
Thanks for writing again.
Rheumatoid arthritis exacerbates the cervical spine degeneration problems. The surgery cannot assure you a long term relief as the problem is degenerative in nature. Since the therapies are helpful, it is best to delay the surgery as far as you can. Local steroid injections are a better option than surgery as local injections do not produce the widespread side effects as are seen with systemic steroids.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by
 
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