View Full Version : Cervical MRI - Can "Severe DD" be treated conservatively?

10-24-2017, 10:01 AM
Hey friends,

Cervical MRI shows that I have 2 discs compressing some nerve roots which is giving pain in arm and numbness in thumb. The pain less intense now. EMG test showed mild C6. I have "slight' weakness which also seems so be slowly (like molasses slow but still progress) getting better. I am only on Naproxen at the moment. There is no spine compression only nerve root. Here is the MRI workup -

FINDINGS: Mild retrolisthesis of C4 on C5 by 3 mm. Alignment otherwise preserved. Degenerative changes most severe at Cl-C2. Marrow signal intensity within normal limits without evidence of fracture or bone marrow edema. Cord signal intensity is within normal limits. Most severe canal stenosis is at the C4-05, C5-C6 levels.

C2-3: No significant disc bulge, canal stenosis or neural foraminal compromise. No significant uncovertebral hypertrophy.
C3-4: Mild diffuse disc bulge with mild canal effacement. Mild uncovertebral joint hypertrophy. No significant neural foraminal compromise.
C4-5: There is a severe disc protrusion more pronounced on the left. This results in severe canal narrowing. Extruded disc noted to the left with severe encroachment on the left foramen magnum by disc material. Mild encroachment on the right neural foramen. Mild uncovertebral joint hypertrophy.
C5-6: Extruded disc to the left with severe canal stenosis asymmetrically worse on the left than the right. Extruded disc measures at least 11 mm transverse and at least 8 mm AP dimension filling the left lateral recess. Severe encroachment on the left neural foramen. Mild encroachment on the right neural foramen. Moderate uncovertebral joint hypertrophy.
C6-7: No significant disc bulge, canal stenosis of neural foraminal compromise. Mild uncovertebral joint hypertrophy.
The rest of the visualized levels of the upper thoracic spine are unremarkable.

Severe disc disease at C4-05 and C5-C6 levels. Extruded disc most severe at the C5-C6 level encroaching on the left neural foramen to a severe degree. There is an asymmetric disc protrusion at the C4-05 level also more severely affecting the left than the right, but the findings appear more severe at the C5-C6 level.

I guess my question is can something like this still be treated conservatively i.e. injection & PT if already showing signs of improvement (albeit slowly)? I have an injection this Friday and start PT the following week.

Thanks much!

10-25-2017, 09:22 AM
Welcome to the board. Your nerve compression is being caused by the disc issues as described in the report. It is possible for discs to heal but it does require a good deal of patience.

Many years ago my husband had ruptured discs at L4-5 and L5-S1. It took about six weeks to get beyond the excruciating pain stage. He had physical therapy and six months later, was back to running. Most Americans are not patient and can't deal with pain, so surgeons routinely operate sooner. In Europe, the number of discectomies is way, way below the number
preformed in the US.

As long as the cord is not being compressed, you can afford to wait and see if PT helps. However, there is a possibility that there may be some permanent nerve damage. Unfortunately, there is no way to know if or when this may happen.

I waited almost three years to have surgery with a lumbar issue and it proved to be too long. I am left with some numbness in my feet, running up into my ankles and almost no ankle reflexes.

These are things to discuss with the spine surgeon. You don't mention if you are seeing either an orthopedic spine surgeon or a neurosurgeon for an evaluation and plan of treatment. If not, I highly recommend that you do. Your issues are too complex to be left in the hands of any specialty other than a board certified spine surgeon. What I specifically would want more information on is the "degenerative changes most severe at C1-2." These two vertebra are different from all other vertebrae in the spine. There is lots of information online if you are interested in learning more.

Do you have trouble moving your neck?

10-25-2017, 09:31 AM
Thank you for the reply! Actually my range of motion in my neck has been ok. The pain is def less the last few days and the numbness seems to only be confined to my thumb now. I get the "shot" this Friday and start PT next week. I am hoping this all helps.

I will def research the C1-C2.

I have been seeing an ortho who referred me to a neuro. That is who I am with now. I am supposed to see a spine surgeon "just in case" soon (same building complex). I seem to be "SLOWLY" improving so that gives me some hope for not needing surgery.

Again, thanks for all the info!

10-25-2017, 06:29 PM
Keep us posted with your progress!

Good luck.