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Dr. Andrew Rynne

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Hi, My wife went through MRI scan for her Chronic

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Dr. Olsi Taka

Neurologist

Practicing since :2004

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Posted on Fri, 18 Jan 2019 in General Health
Question: Hi,

My wife went through MRI scan for her Chronic pain in Neck,right shoulder and right arm and here are the conclusions written by the Radiologist. Can you please help us understanding this?

1. 2-3 mm broad-based central posterior disc protrusion at C6-7 with ventral cord abutment.
2. Mid and upper cervical spondylosis with reversal of cervical lordosis and a mild cervical curve to the left.
3. Congenital block C2-3 vertebra.
default
Follow up: Dr. Olsi Taka 0 minute later
Hi,

My wife went through MRI scan for her Chronic pain in Neck,right shoulder and right arm and here are the conclusions written by the Radiologist. Can you please help us understanding this?

1. 2-3 mm broad-based central posterior disc protrusion at C6-7 with ventral cord abutment.
2. Mid and upper cervical spondylosis with reversal of cervical lordosis and a mild cervical curve to the left.
3. Congenital block C2-3 vertebra.
doctor
Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Explanation as follows....

Detailed Answer:
Hello and welcome to HealthcareMagic!

The first part describes a displacement of one of the intervertebral discs, the cartilages situated between the vertebral bodies, this one the disc between the 6th and 7th vertebrae. It is displaced posteriorly, centrally (not to the right or left), protruding 2-3 mm out into the spinal canal. Since it protrudes in the spinal canal, where the spinal cord is situated it comes into contact with the anterior part of the spinal cord. However the positive thing is that no changes to the spinal cord itself are mentioned, meaning there is no compression of the cord. No compression of the nerve roots is mentioned either.

The second part refers to diffuse changes of the spine, spondylosis, which refers to diffuse changes to the vertebrae and the discs with formation of bony spurs, changes in the small joints between the vertebral arcs and discs drying out, losing normal height and shape (the above mentioned protrusion is also part of the picture). There are changes to the normal curvature of the cervical spine, there isn't the normal lordosis, inward curve it normally has and is also slightly curved to the left. Such chronic degenerative changes are found in many people, the more we age the more the spine is prone to such chronic changes due to the wear and tear it has to endure. In some people they may appear earlier than others as seems to be your wife's case at the age of 36. They may be accelerated by genetic factors, heavy physical work, trauma or born abnormalities.

The born abnormalities bring us to the third findings, congenital block C2-3 vertebra. It is a congenital, born anomaly, where the bodies of two vertebrae are not separated as they normally should be but fused together, as a single block. It is a common anomaly, often not symptomatic, but it may play a role in an earlier manifestation of the chronic degenerative changes we mentioned above as reduced mobility between the C2 and C3 vertebrae may increase the load on the joints between the other vertebrae and predispose to earlier degenerative changes due to the wear and tear over the years.

I hope to have been understandable in my explanation. What I would take from that report from a practical point of view would be that there is no indication for any invasive procedure such as surgery as there is no compression of the spinal cord or nerve roots described. Management would remain limited to pain killers and physical therapy. Use of a cervical collar for some time may help. So may sports like yoga. Other alternatives which could be tried when the above fails might be cervical traction therapy or acupuncture.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Olsi Taka 0 minute later
Brief Answer:
Explanation as follows....

Detailed Answer:
Hello and welcome to HealthcareMagic!

The first part describes a displacement of one of the intervertebral discs, the cartilages situated between the vertebral bodies, this one the disc between the 6th and 7th vertebrae. It is displaced posteriorly, centrally (not to the right or left), protruding 2-3 mm out into the spinal canal. Since it protrudes in the spinal canal, where the spinal cord is situated it comes into contact with the anterior part of the spinal cord. However the positive thing is that no changes to the spinal cord itself are mentioned, meaning there is no compression of the cord. No compression of the nerve roots is mentioned either.

The second part refers to diffuse changes of the spine, spondylosis, which refers to diffuse changes to the vertebrae and the discs with formation of bony spurs, changes in the small joints between the vertebral arcs and discs drying out, losing normal height and shape (the above mentioned protrusion is also part of the picture). There are changes to the normal curvature of the cervical spine, there isn't the normal lordosis, inward curve it normally has and is also slightly curved to the left. Such chronic degenerative changes are found in many people, the more we age the more the spine is prone to such chronic changes due to the wear and tear it has to endure. In some people they may appear earlier than others as seems to be your wife's case at the age of 36. They may be accelerated by genetic factors, heavy physical work, trauma or born abnormalities.

The born abnormalities bring us to the third findings, congenital block C2-3 vertebra. It is a congenital, born anomaly, where the bodies of two vertebrae are not separated as they normally should be but fused together, as a single block. It is a common anomaly, often not symptomatic, but it may play a role in an earlier manifestation of the chronic degenerative changes we mentioned above as reduced mobility between the C2 and C3 vertebrae may increase the load on the joints between the other vertebrae and predispose to earlier degenerative changes due to the wear and tear over the years.

I hope to have been understandable in my explanation. What I would take from that report from a practical point of view would be that there is no indication for any invasive procedure such as surgery as there is no compression of the spinal cord or nerve roots described. Management would remain limited to pain killers and physical therapy. Use of a cervical collar for some time may help. So may sports like yoga. Other alternatives which could be tried when the above fails might be cervical traction therapy or acupuncture.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Olsi Taka 2 hours later
Thank you Dr. Olsi Taka.

That detailed explanation helped us a lot. My wife going through pain from past 3 year and went through 2 MRI scans.After the first MRI scan the Spine surgeon we visited asked to go through pain management or steroid shots. We opted for conservative treatment. My wife went for physio therapy, chiropractic,massages and even tried acupuncture but nothing seems to be providing her comfort and pain seems to be aggravated from past 2 - 3 months.

I giving you both the reports and hoping if you can give us more comprehensive conclusion for treatment options.

MRI scan report from XXXXXXX 17, 2017:
----------------------------------------
INTERPRETATION:

Fat suppressed images are negative for acute and subacute fractures. Positive vertebral artery flow and no paraspinous mass lesions. No active facet inflammation.

C2-3: Congenital block vertebra. No spinal stenosis at the craniovertebral junction.

C3-4: No disc herniation or central stenosis and patent nerve root canals. Facet joints are unremarkable.

C4-5: No bulge, herniation or stenosis and patent nerve root canals. Facet joints are unremarkable.

C5-6: No bulge, herniation or stenosis and patent nerve root canals. Facet joints are unremarkable.

C6-7: 3 mm central protrusion nearly contacts the cord. Foramina appear patent and facet joints are unremarkable.

C7-T1, T1-2 and T2-3 levels are unremarkable.


CONCLUSION:

1. 3 mm central C6-7 disc protrusion nearly contacts the cord without central stenosis.

2. Congenital block C2-3 segment.

3. No significant facet arthropathy.

MRI scan report from Dec 26, 2018:
----------------------------------------

INTERPRETATION:

Normal signal intensity within the cervical and upper thoracic cord. No Chiari malformation or syrinx, no intrinsic cord lesion and no intradural mass. Normal vertebral artery flow voids.

Cervical spondylosis with reversal of the midcervical lordosis, a mild cervical curve to the left and a congenital block C2-3 vertebra. No spinous process avulsion.

T3-4 through C7-T1: Normal intervertebral discs and facet joints. No stenosis or impingement.

C6-7: 2-3 mm broad-based central posterior disc protrusion with ventral cord abutment. Normal facet joints and patent neural foramina.

C5-6, C4-5 and C3-4: Spondylosis with normal dorsal disc margins. Mild foraminal narrowing on the left at C3-4 with uncovertebral arthrosis. Facet joints normal.

C2-3: No central or foraminal stenosis.

No degenerative or erosive changes within the atlantoaxial or cervico-occipital joints.

Normal signal intensity with the vertebral marrow spaces. No destructive bone lesion and no paraspinous mass.

CONCLUSION:

1. 2-3 mm broad-based central posterior disc protrusion at C6-7 with ventral cord abutment.

2. Mid and upper cervical spondylosis with reversal of cervical lordosis and a mild cervical curve to the left.

3. Congenital block C2-3 vertebra.

4. Comparison with 1/17/2017 shows minimally increased cervical kyphosis.

Thanks again and looking forward to hear from you soon.
default
Follow up: Dr. Olsi Taka 0 minute later
Thank you Dr. Olsi Taka.

That detailed explanation helped us a lot. My wife going through pain from past 3 year and went through 2 MRI scans.After the first MRI scan the Spine surgeon we visited asked to go through pain management or steroid shots. We opted for conservative treatment. My wife went for physio therapy, chiropractic,massages and even tried acupuncture but nothing seems to be providing her comfort and pain seems to be aggravated from past 2 - 3 months.

I giving you both the reports and hoping if you can give us more comprehensive conclusion for treatment options.

MRI scan report from XXXXXXX 17, 2017:
----------------------------------------
INTERPRETATION:

Fat suppressed images are negative for acute and subacute fractures. Positive vertebral artery flow and no paraspinous mass lesions. No active facet inflammation.

C2-3: Congenital block vertebra. No spinal stenosis at the craniovertebral junction.

C3-4: No disc herniation or central stenosis and patent nerve root canals. Facet joints are unremarkable.

C4-5: No bulge, herniation or stenosis and patent nerve root canals. Facet joints are unremarkable.

C5-6: No bulge, herniation or stenosis and patent nerve root canals. Facet joints are unremarkable.

C6-7: 3 mm central protrusion nearly contacts the cord. Foramina appear patent and facet joints are unremarkable.

C7-T1, T1-2 and T2-3 levels are unremarkable.


CONCLUSION:

1. 3 mm central C6-7 disc protrusion nearly contacts the cord without central stenosis.

2. Congenital block C2-3 segment.

3. No significant facet arthropathy.

MRI scan report from Dec 26, 2018:
----------------------------------------

INTERPRETATION:

Normal signal intensity within the cervical and upper thoracic cord. No Chiari malformation or syrinx, no intrinsic cord lesion and no intradural mass. Normal vertebral artery flow voids.

Cervical spondylosis with reversal of the midcervical lordosis, a mild cervical curve to the left and a congenital block C2-3 vertebra. No spinous process avulsion.

T3-4 through C7-T1: Normal intervertebral discs and facet joints. No stenosis or impingement.

C6-7: 2-3 mm broad-based central posterior disc protrusion with ventral cord abutment. Normal facet joints and patent neural foramina.

C5-6, C4-5 and C3-4: Spondylosis with normal dorsal disc margins. Mild foraminal narrowing on the left at C3-4 with uncovertebral arthrosis. Facet joints normal.

C2-3: No central or foraminal stenosis.

No degenerative or erosive changes within the atlantoaxial or cervico-occipital joints.

Normal signal intensity with the vertebral marrow spaces. No destructive bone lesion and no paraspinous mass.

CONCLUSION:

1. 2-3 mm broad-based central posterior disc protrusion at C6-7 with ventral cord abutment.

2. Mid and upper cervical spondylosis with reversal of cervical lordosis and a mild cervical curve to the left.

3. Congenital block C2-3 vertebra.

4. Comparison with 1/17/2017 shows minimally increased cervical kyphosis.

Thanks again and looking forward to hear from you soon.
doctor
Answered by Dr. Olsi Taka 25 minutes later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information!

After reading those two reports the findings seem to be more or less the same, only a mild alteration in the normal curvature compared to the first MRI, no significant differences between the two, the disc protrusion has been there on the first MRI and doesn't seem to have increased.

As for treatment options, you seem to have tried most conservative options. You don't mention medication, but I assume that NSAIDs, muscle relaxants and chronic pain medication (antidepressants like amitriptyline, nortriptyline, duloxetine or anticonvulsants like gabapentin, pregabalin) have been tried at some stage or the other during this period....if not then they should.
I am afraid not many conservative options remain to suggest. Cervical traction remains a possibility which can be tried, it has been effective where other methods have failed in a few of my patients.

Otherwise I am afraid there aren't other conservative options I can offer, steroid shots should be tried as the next step.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Olsi Taka 0 minute later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information!

After reading those two reports the findings seem to be more or less the same, only a mild alteration in the normal curvature compared to the first MRI, no significant differences between the two, the disc protrusion has been there on the first MRI and doesn't seem to have increased.

As for treatment options, you seem to have tried most conservative options. You don't mention medication, but I assume that NSAIDs, muscle relaxants and chronic pain medication (antidepressants like amitriptyline, nortriptyline, duloxetine or anticonvulsants like gabapentin, pregabalin) have been tried at some stage or the other during this period....if not then they should.
I am afraid not many conservative options remain to suggest. Cervical traction remains a possibility which can be tried, it has been effective where other methods have failed in a few of my patients.

Otherwise I am afraid there aren't other conservative options I can offer, steroid shots should be tried as the next step.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Olsi Taka 15 minutes later
Thanks a lot for your quick reply.

My wife said cervical transaction therapy was also tried when she went to see Chiropractor. She is is complaining about the pain all the time and it is limiting her daily activities and seems to be loosing interest in most of the things. She is taking over the counter pain medication Advil (400 mg on worst days). But I read that over usage of Ibuprofen affects kidney function so I am worried that she is popping pain killers every day.

I would like to ask you if this is a pain she has to survive rest of her life or there is a surgery option which can give better results.
default
Follow up: Dr. Olsi Taka 0 minute later
Thanks a lot for your quick reply.

My wife said cervical transaction therapy was also tried when she went to see Chiropractor. She is is complaining about the pain all the time and it is limiting her daily activities and seems to be loosing interest in most of the things. She is taking over the counter pain medication Advil (400 mg on worst days). But I read that over usage of Ibuprofen affects kidney function so I am worried that she is popping pain killers every day.

I would like to ask you if this is a pain she has to survive rest of her life or there is a surgery option which can give better results.
doctor
Answered by Dr. Olsi Taka 22 minutes later
Brief Answer:
Read below.

Detailed Answer:
Hello again!

If you mean 400 mg a day of Advil then it is a low dosage (usually 800-1200 mg a day divided in 2-3 doses), the risks are small especially at her age, though of course it is preferable to be used as little as possible. I would suggest trying a medication for chronic pain like one of the antidepressants I mentioned as apart from their effect in reducing pain perception they also help with the psychological component which is often present in such chronic issues and contributes to perpetuate the issue.

Surgery doesn't offer any benefit at this not at present, looking at that MRI report there is no cord or nerve root compression for the surgeon to operate on, there is not a localized pain focus on which to intervene.
Whether she will have this pain for the rest of her life, she will probably have chronic issues, her spine won't get younger with age, but not necessarily of this intensity, usually there are periods of remissions and periods of exacerbation with flaring up of the symptoms due to inflammation and muscle spasms during which medication may need to be intensified or injections become necessary. Physical therapy and yoga even if not helping now, remain important at a later stage to be continued as they help in preventing (at least partially) this periods of worsening as they help improve posture and strengthen core muscles in order to reduce the load on the spine.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Olsi Taka 0 minute later
Brief Answer:
Read below.

Detailed Answer:
Hello again!

If you mean 400 mg a day of Advil then it is a low dosage (usually 800-1200 mg a day divided in 2-3 doses), the risks are small especially at her age, though of course it is preferable to be used as little as possible. I would suggest trying a medication for chronic pain like one of the antidepressants I mentioned as apart from their effect in reducing pain perception they also help with the psychological component which is often present in such chronic issues and contributes to perpetuate the issue.

Surgery doesn't offer any benefit at this not at present, looking at that MRI report there is no cord or nerve root compression for the surgeon to operate on, there is not a localized pain focus on which to intervene.
Whether she will have this pain for the rest of her life, she will probably have chronic issues, her spine won't get younger with age, but not necessarily of this intensity, usually there are periods of remissions and periods of exacerbation with flaring up of the symptoms due to inflammation and muscle spasms during which medication may need to be intensified or injections become necessary. Physical therapy and yoga even if not helping now, remain important at a later stage to be continued as they help in preventing (at least partially) this periods of worsening as they help improve posture and strengthen core muscles in order to reduce the load on the spine.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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