I have had neck pain for over 20 years. I was in a car accident at age 18, suffered a skull fracture and concussion, received 18 stitches on my left side, 4" above my ear. I have had 2 MRI's on my neck, one in July, 2008 and one in August, 2012. My neck always hurts, always on the right side. I have had radiculopathy off and on, but have kept things more or less under control with PT, NSAIDS, home traction and such.
I had a lot of trouble with my right shoulder starting a year ago, was diagnosed with a partial rotator cuff tear, couldn't get in to see an ortho for 3 months. The PT said my right shoulder was noticeably smaller than my left and my biomechanics were completely out of whack. I started getting a specific headache, a shooting pain in the right eye socket a couple months ago. Two weeks ago I was holding a large, glass mug of hot tea in my right hand. The mug dropped in my lap, giving me a pretty good scalding, but fortunately not a serious burn. I have had the 'clumsy hand' going on for a while. I have a very good primary care doctor now, who ordered the MRI and is sending me off for electrical studies and to a neuro-surgeon. Previous electrical studies have been normal. My primary said I might need 'decompression'.
When I started having the shoulder trouble last year I described it as 'my right arm doesn't feel attached to my body'. Is this more likely from the further cervical degeneration, as opposed to an 8mm rotator cuff tear?
July, 2008
Straightening of the normal cervical lordosis. No evidence of compression deformity or listhesis. Brainstem and cervical cord demonstrate normal morphology and signal. However, there is mild indentation of the cord in the mid cervical spine from degenerative disc disease.
Brainstem-C3: Mild bilateral facet arthrosis. No protrusion or stenosis.
C3-C4: Mild bilateral arthrosis. No protrusion or stenosis.
C4-C5: Moderate posterior diffuse disc bulge-osteophyte complex with more focal protrusions in the right and left paracentral regions. Moderate bilateral uncovertabral hypertrophy. Moderate right foraminal stenosis. Canal diameter lower limits normal at 1 cm, but no definite central canal stenosis.
C5-C6 Moderate posterior disc bulge-osteophyte complex. Moderate bilateral uncovertebral hypertrophy, right greater than left. Moderate right and mild left foraminal stenosis.
C6-C7: Moderate disc space narrowing. Mild disc bulge-osteophyte complex. Mild bilateral uncovertebral hypertrophy. Mild to moderate bilateral foraminal stenoses. No central canal stenosis.
C7-T4: These levels appear normal
August, 2012
Findings: Further progression of reversal of normal cervical lordosis centered at C5. Vertebral body heights are normal. Type II bone marrow changes are present at C5 and C6. Normal relationships are seen of the structures at the craniocervical junction. There is no evidence for Chiari malformation.
C2-C3: no evidence for disc herniation, foraminal encroachment or canal stenosis.
C3-C4: no evidence for disc herniation, foraminal encroachment or canal stenosis.
C4-C5: there is a broad based posterior osteophytic ridge unchanged from prior examination. Moderate left facet arthropathy has progressed. There is moderate left formaminal encroachment, previously mild. There is a right-sided posterior lateral disc herniation that appears to impinge on the right C5 nerve root, this is slightly larger than observed on the prior study.
C5-C6: there is a broad based posterior osteophytic ridge impresses upon the thecal sac but does not compress the spinal cord. The AP dimension of the spinal canal is 8mm, previously 10mm. Bilateral uncovertabral joint which is also increased in size resulting in moderate to bilateral foraminal encroachment. A soft disc herniation is not identified.
C6-C7: there is a broad based posterior osteophyte which has increased in size from the prior study. The AP dimension of the spinal canal is 9mm, previously 11mm. Lateral uncovertabral changes result in severe bilateral foraminal encroachment, or 4 previously there was mild right and moderate left foraminal encroachment. A soft disc herniation is not identified.
C7-T1: there is no evidence for disc herniation, foraminal encroachment or canal stenosis.
OK, well that doesn't make sense. Sort of like describing something as "small to yellow". I think I will just assume that the word "severe" was dropped, because that's the ONLY word that could make that sentence make sense.
I'm a little confused by the statement in the first MRI that "there is mild indentation of the cord in the mid cervical spine", because he in no way backs that up when describing the individual levels.
Anyway... to my slightly (self-) educated eye, it certainly seems plausible that you're suffering from radiculopathy at three levels on the right side and one or possibly two on the left. I think I can sympathize with the feeling that your right arm isn't "connected", and my GUESS would be that it has more to do with the cervical spine than with the rotator cuff. As for your right arm being smaller, I have that with my right leg, the result of cord damage many years ago. If the nerve pathways to certain muscle fibers are interrupted, those muscle fibers will atrophy from lack of use.
There are so many things that need to be addressed that I'd have a hard time saying what the best surgery(ies) would be. Hard to even guess what the surgeon will want to do, but I'd bet he'll want to take out the C5-6 disk, at a minimum. Some surgeons would probably want to go C4-C7.
I don't know if removing the disks (ACDF's) would address the bone overgrowths in the facets and the uncovertebral joints, or even if they'd fix the osteophyte complexes. My guesses would be "no" to the facets, "maybe" to the uncovertebrals and "probably" to the osteophyte ridges. The surgeon, of course, will be able to tell you in a second.
I think you need surgery. Maybe even REALLY need surgery. Of course, my opinion counts for almost nothing, but be prepared for the surgeon to tell you something similar.
I was confused on the same items you mention in your first 2 paragraphs. The Type II Bone Marrow change was something I have never heard of, but near as I can tell means I have micro-fractures in the vertebra and when I say 'my neck always hurts', it really does.
Thanks for the input. I see the neurosurgeon on Wednesday. I was/am hoping to put off surgery for as long as possible.
WebDozer-you seem to prefer neurosurgeons. Up here in Seattle the UW medical school has some impressive work going on within the ortho-spine department. I am wondering if an ortho with a cervical spine specialty might be better than a neurosurgeon, especially with regards to the heavy growth of osteophytes.
I have maintained very good range of motion and score well on the standard in-office neurological tests. The nerve conduction test is Monday, my third since 2004. The other 2 were completely normal. I also have a herniated disc at L3-L4, it protrudes to the left, but all the pain is in my right hip, so I seem to be wired a bit differently. I also had meningitis at age 26, it took a long time for me to recover. I suspect the meningitis made my central nervous system hypersensitive. I would not be surprised if the electrical study comes back as unremarkable. I received a lot of blank looks from various doc's and PT's when I told them it felt like my arm wasn't attached, given that my reflexes and overall strength appear within the normal range.
I am wondering if it wouldn't be better to do the least amount required now, remove the one disc, reduce the osteophytes, open the foraminal areas rather than multiple level fusion. My overall health is excellent and I have worked hard to maintain my strength and range of motion. Do you have any links to the research on adjacent disc deterioration in fusion surgeries? I am extremely uneasy about having a fusion.
I prefer spine specialists. Cervical specialists even better. I have no interest in whether they came from orthopedics or neurosurgery.
<< I received a lot of blank looks from various doc's and PT's when I told them it felt like my arm wasn't attached >>
Maybe because that's not a result of cervical spinal problems, but maybe also because the doc's and PT's DON'T HAVE nerve damage, so they can't fit they way you feel into any template they understand.
<< I am wondering if it wouldn't be better to do the least amount required now, remove the one disc, reduce the osteophytes, open the foraminal areas rather than multiple level fusion. >>
You're talking about multiple surgeries, at least two and maybe three. You could do an ACDF at C5-6, but then you'd have to come in from behind to get at the osteophytes at the other two levels. Since those osteophytes are at two non-adjacent levels, that might be two surgeries just for them... I don't know. I also don't know if uncovertebral osteophytes, or disk-osteophyte complexes, can even be accessed from behind.
Easy questions for the surgeons to answer.
<< Do you have any links to the research on adjacent disc deterioration in fusion surgeries? >>
This site doesn't like us to put links in our posts. Easy enough to find a number of things if you do a search on "adjacent disk disease". Opinions are all over the board. I guess you could boil it down by saying that fusions put adjacent levels under more pressure, but the actual necessity for follow-up operations is still fairly low.
Thanks for the clarification on neuro v ortho. My apologies for
'getting the wrong end of the stick' as my British friends would say.
I appreciate your feedback and will let you know what the neurosurgeon
says. I am going to get an appointment at the UW spine center as well.
If I am looking at surgery/surgeries I think I should have it done there. Thanks
again, it is kind of you to be a sounding board for whoever shows up.
It makes things seem far less daunting.
The Neurosurgeon wants to do a 3 level foraminotomy, C3-C4, C4-C5 and C5-C6. Electrical study shows mild carpal tunnel. He said a fusion wasn't necessary and wasn't concerned about the osteophytes. I am going to see a spine specialists at the UW in 3 weeks for a second opinion.
The neurosurgeon was not specific. I did see a spine-rehabilitative doctor within the UW group last week. He noticed that my right trapezius is significantly atrophied. I had a partial right rotator cuff tear a year ago-it didn't require surgery, but I am still rehabbing it. The spine doctor thinks my shoulder is causing more pain/symptoms than the cervical DDD.
My PCP also sent me for an ultrasound for Thoracic Outlet Syndrome this past friday, which showed positive.
The chart records for my shoulder stated 'frozen shoulder', which puzzled both me and the spine doctor. My shoulder is still hypermobile-similar to 'dead arm', definitely not a frozen shoulder. I am getting another shoulder MRI, with arthrogram tuesday. The right trapezius wasting and occupital headache could be from nerve damage, apparently or TOS. Things are becoming more confusing. My appointment with the spine surgeon is in 10 days-hopefully he can make some sense of all the data.
Look what happened to you. One car accident destroyed your whole life. They should have never invented those machines called cars and keep those wagons. At least, with wagons you can't have whiplash. On top of it they cannot cure chronic pain caused by car accident with all those soft tissue damage.
They say with BMW you cannot be injured in case you are in a car accident.
Not cheap, but perhaps worth the price.
Look what happened to you. One car accident destroyed your whole life. They should have never invented those machines called cars and keep those wagons. At least, with wagons you can't have whiplash. On top of it they cannot cure chronic pain caused by car accident with all those soft tissue damage.
They say with BMW you cannot be injured in case you are in a car accident.
Not cheap, but perhaps worth the price.
I appreciate the concern, but I don't see my whole life as destroyed. I am a bit of a history buff and lots of people were killed by wagons, either being thrown off or run over. Roads were cobblestone or ruts, it had to be a rough ride and not easy on the body. The Library of Congress has a program digitizing old newspapers from all over the US-it is called Chronicling America. Worth looking through the daily newspapers in mining and timber towns to see the toll of industrial accidents, outbreaks of polio and tuberculosis.
Not important, really. It's only your cervical spine....
...which is why I got myself booked into a top spine surgeon.
Fortunately my new PCP is extremely thorough. The Thoracic Outlet Syndrome stuff is really out of left field, though.
When you say your trapezius is atrophied, what do you mean by it?
Sory I am asking this, but I understand in car accident the trapezius gets damage, or am I wrong.
I have pain in my trapezius muscles since the accident. I know it's the trapezius muscle cause my doctor told me that what it's called. But it's only one the left side.
Right side is fine.
Could be....but you couldn't get a whiplash from wagons....Whiplash started with train invention and cars. As of today there is no cure for whiplash and it causes agony for those who suffers from that. Pain in the neck cannot happen from wagons, ie whiplash.
You can check, you cannot get whiplash injury from wagons. so no soft tissue damage from wagons. Doctors, as we know, don't know how to treat soft tissue damage.
There is no cure for soft tissue damage when your tendons, ligament and muscles get damage.
Neck pain is not a normal pain cause neck has intersection of nerves in it and a little injury affect it. I once had a knee pain and it's nothing compares to neck pain. My knee is fine now and I don't waddle anymore. Neck is a different issue-----once it's injured, most of the time the pain cannot go away.
I just know that with cars like BMW you cannot get seriously injured. So it worth the money than not being able to work and function.
I would also get other opinions on the Thoracis Outlet Syndrome as I haven't heard of an ultrasound being the way to diagnose this.
There are many other tests that need to be done to really determine if you have this. You can google this and search on the Mayo Clinic website on tests and diagnosis.
And just to throw out there....people can get whiplash or any other type of injury anywhere, anytime in our lives. We can't stay locked up in our rooms fearful to get in a car or leave our house and enjoy our lives. I was a Firefighter/EMT for 10 years and believe me, there isn't a car out there that will prevent you from getting injured. BMW is not some magic vehicle as I've seen many deaths with every type of car/truck out there.
Everyone knows how "dangerous" motorcycles can be but that will never stop me from riding on one (as a passenger now) but I do everything possible to stay safe which means only riding with an experienced driver and wear protective gear. And I'll certainly never give up driving my car as that is freedom
KingFelix....it is good you are seeking out Board Certified Neurosurgeons to go over everything and explain things to you in great detail and if they can fix things mechanically without a fusion right now, that is best. I have had 3, two-level, fusions and the last one was going in from the front and the back of the neck.
The good news is that it took away the majority of my nerve pain. I just have residual pain from the scar tissue and other active herniations...
MRI Analyses 
