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MRI,lordosis,spondylosis,degenerative disc disease,arthropathy,osteophyte

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Orthopaedic Surgeon
Practicing since : 2000
Answered : 170 Questions
I am a 62 yr old female in good health. I weight 145 lbs and am 5'7". I recently had a cervical Mri which showed the following: Mri shows normal lordosis. No fracture or compression abnormalty. Mild diffuse spondylosis. Mild degenerative disc disease at C5-6 and C6-7.No significant dis space narrowing. C2-3 canal and foramina are patent. The facet joints are fused. C3-4, 2.0 mm anterior spondylosisthesis with minimal disc bulge and bilateral facet arthropathy.Slight impingement upon the cord and small possibility of right C4 root impingement. C4-5 mild disc bulge, mild bilateral facet arthropathy with slight narrowing of canal with minimal cord impingement. No nerve root impingement. C5-6 mild disc bulge with endplate osteophyte..mild stenois of the canal and both foramina. Mild cord impingement and possible C-6 nerve root impingement. C6-7 mild disc bulge produces mild stenosis of the canal and foramina with slight cord impingement and small possibility of C7 nerve root impingement. the facets are normal. C7-T1 Disc is normal. Cervical cord is normal in size and signal. Prevertebral and paraspinal soft tissues and musculature are unremarkable. I'm sorry to include all this information but didn't want to leave anything important out. All the lingo in the report scares me because I don't understand it.
My Dr. received the report and didn't seem overly concerned. He advised Naproxen 500 for inflammation and pain if need and he has sent me to physical therapy with traction, massage, stretching and strengthening ultrasound, electric stim, ice, 3x per week. I am in my second week? Do you feel that was the right approach? I had nerve conduction studies done which showed an impingement possibly in the elbow (?) He suggested a consultation with an orthopedic surgeon for the elbow impingement but said it was not urgent. I have not done that prefering to try alternative therapy since I am currently having no pain there. I have no neck pain, just a little soreness sometimes along with soreness in the shoulder area. I do get some tingling in my fingers in my right hand from time to time and my right arm feels achy, tired and weaker than my left from time to time .If physical therapy is the right approach how long should it take to see any improvement? I would appreciate your opinion. Thank you very much.
Posted Mon, 7 May 2012 in Brain and Spine
Answered by Dr. Atul Wankhede 5 hours later

Thanks for the query.

I believe you landed up doing MRI because you had pain in neck, now you dont, Is it?

Thanks for taking time writing the entire report as it is and sending a copy. It may sound worrisome as as you said, but we'll see you through.

There's no trouble upto C2-3 level. At C3-4 and below you have canal stenosis which means the bony canal in which the spinal cord floats is narrowed, due to degenerative changes. These changes are expected at this age.

Also you have at this level an anterior listhesis meaning forward shifting of C3 vertebra over C4. In addition the MRI report says facetal arthropathy as well. All these along with disc bulges are causing pressure over your spinal cord and the nerve roots originating from it. The symptoms are in accordance with the report.

I agree with your physician and the line of management chosen is surely in the right direction. You may delay your consultation with Orthopedic Surgeon as there are currently no symptoms of whatsoever about delayed nerve conduction. Carry on with the said physiotherapy. Discontinue anti inflammatory if dose is complete. In addition you may use a soft cervical collar for right posture and limited mobility of neck. DO NOT use pillow. Rely on strengthening exercises as they are the final and long term remedy. There are no said time to stop these exercise as I ask you to continue them in the best interest of your health.

You may take a call on the alternative procedures if the pain is not improved on after 8 weeks of physiotherapy.

For any further queries feel free to get back to us.

Get well soon and have a Good day.
Above answer was peer-reviewed by
Follow-up: MRI,lordosis,spondylosis,degenerative disc disease,arthropathy,osteophyte 18 hours later
Dear Dr.,
Thank you for your informative reply. I am sorry I did not explain to you why the MRI was done initially. I was suffering from a virus which was making the rounds..mostly low grade fever and tension/sinus headache. Toward the end of the illness I was starting to develop weakness in my right arm and feeling extremely weak. I had been bedridden for over a week. My Dr. said he wanted it evaluated immediately so he sent me to the ER where they did a CT scan of the brain, (normal), blood work, (all normal) and xrays of the Cervical spine which showed some arthritis. They then said to do the MRI next day. They also checked for MS which didn't show on the CT scan plus I had had an MRI done of the ears/brain about 5 months ago to check for acoustic neuroma and they said MS would have shown on that. I never really had any neck pain. The nerve conduction studies did show some conduction problems in my right arm and that is why my physician suggested an orthopedic consultation. However, as I previously mentioned I wish to continue the course of therapy as the therapists have said they have been able to help people through this. I undertand the exercises designed for this will have to be done continually and I am more than willing.
You mentioned not to use a pillow? I use a cervical pillow now to sleep and it gives wonderful support. I do not wake up with any neck issues or aches. Is that acceptable?
I have discontinued the medication but was told to take it on a as needed basis. The trouble is I don't have alot of pain if at all so I don't know when it is actually "needed." I thought it was meant to keep inflammation down.
What I would like to ask is if any particular type of exercise would have a negative impact on my condition or be dangerous? I have always used weights and would like to be able to continue that with light weights if at all once I feel strong enough.
Thank you so much for your time. I love my Dr. and trust his advice but Dr.'s are so busy they usually don't have the time to explain things in detail and I am the type of patient who wants to know pretty much everything before making decisions and take an active part in my treatment.
Anyway, I have only begun therapy less than two weeks ago and am already having some good days. I expect some ups and downs while going through the process so am not discouraged.
Again, many thanks.
Answered by Dr. Atul Wankhede 2 hours later

Nice to hear from you. I see you are a strong person who is willing to fight back.

Thanks for updating me about the viral condition.

We may say that the changes in your spine are incidental findings and are less symptomatic, but not to be ignored.

The weakness in right arm can be attributed to viral fever, though atypical since usually all four limbs are equally affected, but possibility cannot be ruled out.

The second possibility is the cervical spine changes noted on MRI, that is evidence to a severe degeneration.

since you never had neck pain you need not continue medicine and as rightly said by your physician take it on as needed basis.

Continue doing physiotherapy, that is the best thing you can do for yourself in this condition and to arrest any further degeneration.

Stick to neck isometric exercises for long term, if not any other. No harm has been reported by any exercises.

You may resume lifting light weights after 6-8 weeks post complete therapy.

Cervical pillow is a relatively newer concept with no proven literature to support evidence of it's usefulness, so i reserve my comments on that.

Traditionally I recommend my patients to discontinue pillows completely, I'll say the same to you too.

We at healthcare magic are more than happy to help you any time you need, so feel free to ask any more queries.

wish you a good health.

Above answer was peer-reviewed by
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