Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Degenerative Spine Disease And Constant Dizziness
Question: My mother(60yrs) was diagnosed with the following on December 25th 2014 after she fainted that day:
Cervical Spondylosis with variable disc dessications, narrowed C4/C5/C6 disc spaces & few pivds as.
* C3-4: Postero central disc protrusion
* C4-5: RT postero lateral disc protrusion identing rt. Neural foramen, impinging right C5 existing nerve root.
* C5-6:diffuse circumferential disc bulge,indenting thecal sac and bilateral neural formina, just impinging bilateral C6 nerve roots
* C6-7: left postero lateral disc protrusion indenting left neural foramen, impinging left C7 exiting nerve roots.
Multilevel mild indentation of thecal sac are seen. The spinal cord shows normal signal intensity. No intradural or extradural liason is seen.
She has constant dizziness and fainted again on 03/30/2015 and 04/03/2015. She was undergoing physical therapy since XXXXXXX 2015.
Cervical Spondylosis with variable disc dessications, narrowed C4/C5/C6 disc spaces & few pivds as.
* C3-4: Postero central disc protrusion
* C4-5: RT postero lateral disc protrusion identing rt. Neural foramen, impinging right C5 existing nerve root.
* C5-6:diffuse circumferential disc bulge,indenting thecal sac and bilateral neural formina, just impinging bilateral C6 nerve roots
* C6-7: left postero lateral disc protrusion indenting left neural foramen, impinging left C7 exiting nerve roots.
Multilevel mild indentation of thecal sac are seen. The spinal cord shows normal signal intensity. No intradural or extradural liason is seen.
She has constant dizziness and fainted again on 03/30/2015 and 04/03/2015. She was undergoing physical therapy since XXXXXXX 2015.
Brief Answer:
Vertebral artery insufficiency
Detailed Answer:
I read your question carefully and I understand your concern.
That MRI report indicates degenerative spine disease which can be manifested with neck pain radiating in the neck and shoulders, if there is nerve root impingement pain can radiate in the limbs.
However the fainting episodes indicate something more than mere nerve root impingement, they could indicate a temporary lack of blood flow in the posterior part of the brain. That area is supplied by two main blood vessels called the vertebral arteries.
These arteries are in close relation to the vertebrae and so degenerative spine disease with bony spurs can cause at times compression and narrowing of these arteries which lead to dizziness and fainting episodes when there is insufficient blood flow to the brain. Often the flow is reduced more by hyperextending and rotating movements of the neck which can precipitate the symptoms.
However often the narrowing is not due to spinal disease alone but can be a combination of that with also atherosclerosis of these vessels narrowing their lumen. Atherosclerosis is well probable in her case with diabetes, high cholesterol and blood pressure.
So I believe an evaluation of the arteries is necessary. It could have been done through MRI of the neck vessels with contrast, but I don't see any mentioning of that to have been done on the report. Apart from MRI they can be evaluated also by Doppler ultrasound which is a more easy and cheap test, or Angio CT - CT of the neck vessels.
If that is confirmed to be the cause treatment with a blood thinner like aspirin or clopidogrel as well as atorvastatin is advised. If atherosclerotic plaques are seen treatment of risk factors is necessary such as high blood pressure (shouldn't be lowered abruptly and too much though - would exacerbate the insufficient flow), diabetes, high cholesterol, smoking is necessary.
These additional measures and tests do not mean that physical therapy shouldn't be continued when possible, it should. If the symptoms are pronounced the use of a cervical collar for 1-2 weeks can also help alleviate the symptoms.
I remain at your disposal for further symptoms.
Vertebral artery insufficiency
Detailed Answer:
I read your question carefully and I understand your concern.
That MRI report indicates degenerative spine disease which can be manifested with neck pain radiating in the neck and shoulders, if there is nerve root impingement pain can radiate in the limbs.
However the fainting episodes indicate something more than mere nerve root impingement, they could indicate a temporary lack of blood flow in the posterior part of the brain. That area is supplied by two main blood vessels called the vertebral arteries.
These arteries are in close relation to the vertebrae and so degenerative spine disease with bony spurs can cause at times compression and narrowing of these arteries which lead to dizziness and fainting episodes when there is insufficient blood flow to the brain. Often the flow is reduced more by hyperextending and rotating movements of the neck which can precipitate the symptoms.
However often the narrowing is not due to spinal disease alone but can be a combination of that with also atherosclerosis of these vessels narrowing their lumen. Atherosclerosis is well probable in her case with diabetes, high cholesterol and blood pressure.
So I believe an evaluation of the arteries is necessary. It could have been done through MRI of the neck vessels with contrast, but I don't see any mentioning of that to have been done on the report. Apart from MRI they can be evaluated also by Doppler ultrasound which is a more easy and cheap test, or Angio CT - CT of the neck vessels.
If that is confirmed to be the cause treatment with a blood thinner like aspirin or clopidogrel as well as atorvastatin is advised. If atherosclerotic plaques are seen treatment of risk factors is necessary such as high blood pressure (shouldn't be lowered abruptly and too much though - would exacerbate the insufficient flow), diabetes, high cholesterol, smoking is necessary.
These additional measures and tests do not mean that physical therapy shouldn't be continued when possible, it should. If the symptoms are pronounced the use of a cervical collar for 1-2 weeks can also help alleviate the symptoms.
I remain at your disposal for further symptoms.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
