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MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Surgery needed?

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Spine Surgeon
Practicing since : 2002
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Dear Doctor, On the bases of MRI cervical spine done two years of now ,report attached, doctor advised me for - 1.CERVICAL /THORACIC FACET JOINT INJECTION C4-5, C6-7 LEFT AND RIGHT , FINDINGS NOTED ON THE REQUISITION --CERVICAL SPONDYLOSIS & FACET DESEASE C4-5 AND C6-7 . Please clarify for this injection- a)Does this is safe to have ? does this carry any side effects? For how much time this is good? b)In case no betterment in pain seen than what will be further treatments? Present symptoms- Pinning,tingling,vibrations and pain around shoulders both,arms. Weakness in arms and legs. Heavyness in legs,while walking getting weakness, swelling on elbows, ankles, pain is travelling towards head specially to centre of head and front sides both. Neck is stiff from both sides, feeling difficulty in movements. Always feeling tired and dizzy. Pain is experiencing on lower back also. Stairs climbing and standing from chair is like hard.Bowl movements are also changed like always feeling bowl movements- but happened every time. Neurologist about one year advised Physiotherapy –which was started about 10 days= 3 seatings were done- physiotherapist given Neck attaraction with hot get treatment and 3-4 exercises for 25-20 times, during first day he used three needles on back side with BIOFREEZE and have given light manipulation only. He has mentioned that this is a C6-7 Radiculopathy --does this is correct? He also mentioned distal parasthesia , he has started isometric exercises and range of motion,he asked for to start GEBAPENTIN , this was tried last year,gets some side effects,now doctor is not advising this. He refused to favour SOFT COLLAR. What do you suggest for Soft Collar. On the same time he asked for home neck traction- does this is safe to use every time on daily bases. I don’t think that home based traction of neck is advisable, does this is correct? In Canada ,these injections are being given by Radiographer , does this is a appropriate method? Advise that does these injections are safe to have? You can please guide with details. What do you suggest that after injections does there is only surgery option for this.
Posted Sat, 11 May 2013 in Osteoporosis
Answered by Dr. Rahul D Chaudhari 2 hours later
Welcome to XXXXXXX
You have cervical sponylosis with resultant facet disease and foraminal stenosis at C5-6 and C-7. Facet disease usually results into axial neck pain and forminal stenosis results into nerve compression causing neurological symptoms such as tingling, numbness in upper extremities, neck pain radiating to arms.
You have tried various treatments. One need to know how bad is your pain? does physical therapy relieves the pain? Do you get arm pain daily? in night as well?
Facet injection is one of the treatment option when you have more neck pain and minimal neurological symptoms as it will not relieve the nerve pressure and it is not useful for foraminal stenosis. Response to these injections vary from patient to patient however if it relieves your neck pain at least 50% then we can always repeat those injections. Typically side effects are minimal with risk of bleeding or infection.
Conservative treatment such as cervical traction is also helpful and you can consider it doing at your home as well if it gives you relief.
Now I would suggest to get a fresh MRI before considering any invasive intervention. Get examined by a spine specialist to know more about the neurological component in your symptoms and signs. If you have significant nerve pressure and related symptoms then facet injection wont help and in that case you can consider doing cervical epidural block if you dont want a surgery. Thanks.
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Follow-up: MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Surgery needed? 9 hours later
Yes I have pain in neck both sides,arms daily and in night.
Like minor relief is feeling with physio.
Does pain in legs,weakness while walking and heavyness like swelling in legs is due to this problem,
Sometimes neck gets so stiff and experienced that there is swelling too.
Pain is traveling to frontal head both sides and center of head does this is due to cervical,
Does I have both radiculopathy and Facet arthropathy?
Here in Canada MRI takes many many months, does the latest changes can be evaluated by CT of Cervical and Lumber? You can please guide for CT with what type of specific details I can ask doctor even this will take around 20-25 days to book appointment.
Does Xrays can evaluate latest changes? Do I need any specific blood work?
As said that Bowl movements is changing does this is side effects of changes happened in Cervical spine?before considering any invasive intervention-does injection is invasive intervention? should I go for injection only after fresh MRI, which is like impossible to have MRI in this country.what does mean- by cervical epidural block as you said.
You know due to spine problems getting confused what should be taken? Here even simple to simple treatment takes months and even years.Anyway
Till date I did not get appointment for injection, please help me in understanding- Does CERVICAL/THORACIC FACET INJECTION C4-5 ,C6-7 are same that of CERVICAL EPIDURAL BLOCK INJECTION, there is lot of confusion mentioned at link. WWW.WWWW.WW , mentioning this injection.
Your clarifications will be of great support.
More you can please clarify that CERVICAL/THORACIC FACET INJECTION C4-5 ,C6-7 carry which stuff?
Answered by Dr. Rahul D Chaudhari 12 hours later
You have radiculopathy and facet disease. cervical epidural means steroid injection in the cervical spine. It may help you. Facet injection and epidural block is different.However fresh mri is must. CT will not help.
Medicine you suggested can be continued. Bowel changes due to medicine side effects and not due to spine. Thanks.
Above answer was peer-reviewed by
Follow-up: MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Surgery needed? 15 minutes later
I have been asked cervical facet joint injection-they are explaining these are steroids, does this is correct and these does not carry any side effects at all, does this is correct?
Answered by Dr. Rahul D Chaudhari 8 hours later
Facet injection is steroid injection in the facet joint of the spine. Risks associated with this procedure are infection and bleeding however it is relatively simpler and safe procedure. It may not relieve your arm pain but it may help to reduce the neck and shoulder pain. Thanks.
Above answer was peer-reviewed by
Follow-up: MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Surgery needed? 2 hours later
Thanks a lot Dr.Chaudhari,
You carry tons of knowledge and expertise. What do you suggest for arms pain -elbow,wrists and pain in lower extremities legs and knees,does this is due to other reasons, guide for this. due to high ESR like from 25 to 45 during last three years, Low IgM, low IGF-1, High Hyptoglobulin,Low RBC,Hemotacrit,hemoglobin,Should I send detailed blood work done so far, having severe obs,sleep apnea non compliance of CPAP. TSH was 0.03 synthroid has been stopped about 15 days back. lower parts of legs getting weak and pain.Sleep is disturbing too. Lumber pain is often coming , lower back pain.Lots of concerns.
Answered by Dr. Rahul D Chaudhari 36 minutes later
Legs problem mostly a separate issue and may be due similar changes in the lumbar spine. The arm pain needs to be differentiated. Radiculopathy means radiating pain along the arm and it is different from wrist and elbow joint pain. I would suggest to consult orthopedic doctor before going ahead. Patient examination is important.
You can still consider facet injection with high esr. Thanks.
Above answer was peer-reviewed by
Follow-up: MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Surgery needed? 2 days later
MRI waiting time is around over 2 years, family doctor is confident that I should go for facet injections, SHOULD I?
Radiologist have given four different dates for injections at C4-5, C6-7 means one each at right and left during every seating, he will give one injection at a time at right and left on second seating. Does this is correct procedure.
Can I discontinue after first injection at say right side of C4-5, in case there is any increase in pain /signs, does this will give any adverse effect? they are going to give CORTISONE .I will go only as per guidance from specialists from India.
Latest Thyroid results 18 april shows- Free T4 8.8 pmol/L (LOW), TSH 6.14 mIu/L(HIGH), Thyroid Peroxidase Antibody - 5.8 KIU/L,RANGE IS 0.0 - 34.0,
Ultra sound of thyoid and neck is enclosed.
Regards XXXXXX
Answered by Dr. Rahul D Chaudhari 29 hours later
If MRI taking so much time then I would suggest to go ahead with facet injections. It can be done at both sites in the same sitting. However if they looking for diagnostic value of the procedure then they may consider doing it in different stages. I would have considered doing at the same stage. USG thyroid and neck is normal nothing to worry and for thyroid functioning please consult physician to guide you. Thanks.
Above answer was peer-reviewed by
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