MRI Clues: When to push for surgical consult?
Labor Day 2008 I injured my neck mountain biking. No big fall, but 4 days of long hard rides left my periodically stiff neck chronically painful. I've tried most conservative treatments: rest, Posture, massage, PT, Acupuncture, Chiropractor, TP injections, facet joint injection, 2 epidural injections, Mobic.
Sx: Pain seems mostly centered on the C4/C5 area (mostly on the right but can switch sometimes). It radiates down my R shoulder and between my shoulder blades. It radiates up to my head and creates frequent tensions-type headaches and less frequent (1-4 a month) migraines. Thankfully, never any pain or tingling in arms or hands. The only thing that seems to have helped has been the Mobic. Every time I have tried to ride again or be active it triggers this Chronic pain (4/10)and migraines the following day and I have to stop for at least several months before trying again. I've mostly given up on riding again, but would like to be able to at least do light fitness activities like jog, go to the gym a few days a week, yoga, ski a few times a season, etc.. Very frustrating going from weekend warrior to sedentary, as I'm sure many here can relate. I wonder what my next steps are. It took a long time to get an MRI from Kaiser...failure at many conservative txs.
My question is, am I missing something in the MRI/sx? What are my next steps? Should I push for consults about surgical options? Is "just pain" and loss of being active worth the risks of surgery or is it clear to wait to have much more severe sx before even considering that. I have a PCP and a pain management MD anesthesiologist, but it takes months to see the pain MD.
Here's the MRI from 3/24/10
FINDINGS: There is no evidence of cord signal abnormality. The
visible intracranial elements are within normal limits. No
paraspinous abnormalities are identified.
C2-C3: There is slight hypertrophy of the left facet which results in
very minimal narrowing of the left C2-C3 foramen.
C3-C4: The disc space is relatively well maintained. There is mild
right-sided foraminal narrowing due to spurring from the facet and
the uncovertebral joint. The left foramen is patent. There is no
evidence of canal narrowing.
C4-C5: There is a broad-based disc osteophyte complex which results
in moderate narrowing of the AP diameter of the canal. The foramina
are moderately to severely narrowed bilaterally more so on the right
than the left due to the lateral aspects of the bulge as well as
uncovertebral joint hypertrophy. There is straightening of the
cervical lordosis centered at the mid cervical level.
C5-C6: There is no evidence of significant canal narrowing. The
uncovertebral joint spurring on the right as well as broad-based disc
osteophyte complex results in moderately severe appearing right
foraminal narrowing. The left foramen is questionably minimally
C6-C7: There is a broad-based disc osteophyte complex which mildly
narrows the AP diameter of the canal. The left foramen appears
narrowed due to uncovertebral joint spurring.
The remainder of the imaged levels are unremarkable.
IMPRESSION: Multilevel relatively mild degenerative changes of the
mid and lower cervical spine. However, there is a disc osteophyte
complex at C4-C5 which serves to moderately narrow the AP diameter of
the canal. Varying degrees of multilevel foraminal narrowing are
described above in detail.