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oldsoul59 03-08-2012 12:17 PM

cervical osteophytes
Hi, I have a question on my MRI I have mutiple medical issues, I work for a neuro-surgeon full time in his office and in his billing. I was having some numbness so he ordered an MRI of the crevical. So when it was done he looked at it and said there were issues. He is a very arrogent doctor and spends no time with his patients, he would rather be doing surgery. Anyway my MRI done in Dec of 2011 shows evidence of right C4-C5, C5-C6 disc hernistion with right osteophyte comples, with articulation with the spinal cord, with evidence of stenosis with reversal of normal cervical stenosis. First I need to know how bad this actually is, because I am in a lot of pain, and was recently diagnosised with bleeding ulcers so I was taken off my anti-inflamatory, and now the pain is worse. I can put up with a lot of pain but I have only been off it for 2 weeks and the norco is not helping at all. Does any one know what this MRI reading really says. I am not sure I would want the doctor I work for to treat me, he is a good doctor but bad bed side manner and I don't think I would be comfortable seeing that I do work for him, I would be wondering if things are being cared for as they should since our office is short handed to begin with, but I don;'t know it I would have a job if I went else where either I guess the worse of two evils. Any suggestions??? Also does anyone know what the MRi really says in people language??

WebDozer 03-08-2012 12:52 PM

Re: cervical osteophytes
Could you post the MRI more completely?

oldsoul59 03-08-2012 01:11 PM

Re: cervical osteophytes
MRI says there is straightening of the normal lordotic curvature. There is no acute compression deformity. There is a loss of signal within the disc space but no significant loss of disc height. c2-3 unremarkable, c3-4 mild endplate changes with possible disc bulge causing mild thecal sac effacement but no cord deformity or myelomalacis. c4-5 right paracentral posterior disc osteophyte causing thecal sac effacement and flattening of the cord, right side greater than left. There is narrowing of the right neural foramen. The left neutal foramen is patent. c5-6 right paracentral and right foraminal posterior disc osteophyte with uncovertabral hypertrophy. There is a moderate right-sided spinal canal stenosis with flattening of the cord. There is mild moderate right and mild left neural foraminal foraminal stenosis. There is no myelomalacia. c6-7 unremarkable. c7-t1 unremarkable. Posterior disc osteophyte complexes at c4-5, c5-6 causing flatening of the cord, right side greater than left. There is no myelomalacia. There is neural foraminal stenosis as described above. this is how the MRI report reads. Thank u

WebDozer 03-08-2012 01:33 PM

Re: cervical osteophytes
OK... keeping in mind that I'm just a somewhat-informed amateur with a fair amount of personal experience, and that nothing I say should be substituted for consultation with a qualified physician (no matter now arrogant)...

I certainly have seen MUCH worse MRI's, including a few of my own, but some things on yours should be considered...

At C4-5 and C5-6 you have disks bulging back into the spinal canal far enough to not only push away the spinal fluid, but also to "flatten" the cord somewhat. This may or may not be problematic. Sometimes, the spinal cord can take a fair amount of abuse, and sometimes it can't. At least, he didn't say the cord is "indented", which w/b worse.

At both those levels the disk is bulging in a manner than is lopsided to the right, and pushing into the foraminal opening where your peripheral nerves leave the spinal cord and head off into your shoulders/arms/hands. This may cause pain in the neck (at the site of the foraminal compression). It may also cause a variety of symptoms in the shoulders/arms/hands. Problems at these levels might show up a bicep or tricep or deltoid weakness, or pain/tingling in the thumb. I'd expect whatever symptoms you do have to be right-sided.

in edit: I notice he refers to "disk osteophytes". I assumed he meant a "disk-osteophyte complex", where a disk is bulging and has stimulated osteophyte growth. that's probably what he meant, but he MAY have just meant that there are osteophytes growing off the vertebrae adjacent to the disks. Not likely, though, as they'd have to be real whoppers to affect your cord without concurrent disk involvement.

Traditionally, the operation to fix your problem would be an ACDF at the two affected levels, removing the offending disks and clamping the adjacent vertebrae together. Pretty routine stuff. Surgeons may have ideas for treating you that are less drastic, though.

The reversal of lordosis means that your cervical spine has straightened somewhat, that is, it has lost its natural backward bend (lordosis). Not good, but not very unusual, either.

I'd recommend talking to your doc/employer and asking if he thinks he is the guy to go to, or if he'd suggest seeing a spine specialist. I don't see how you can avoid talking to him. However bad you may find him now, that's not as bad as he'll be if/when he finds out you are dealing with someone else...

oldsoul59 03-08-2012 01:45 PM

Re: cervical osteophytes
I know I need to address this with him, as he is a surgeon. The problem I have is we have a very small office where I work and we do all the incomming work for all the free standing clinics which is about 10 and I have a office manage who just took an indefinate leave of absence and now the billing manager is the office manager so all the billing duties are now on me to be done, so my work has doubled, our office is strange as there is no one to go to with a problem, so I am hesitent to bring things up in fear of losing my job, and my insurance then I would be with out anything. I have so much pain in my neck and shoulders after a work day I bearly make it home, which is a 45 minute drive each way, I also have so many other medical issues, I am just not sure what to do? Any sugestions whould be appericated.

WebDozer 03-08-2012 01:49 PM

Re: cervical osteophytes
I'm afraid I am NOT the person to talk to about all this. However, I would GUESS that the best approach w/b to tackle the problem head-on and talk to the doc about it. Once he's been made aware of your problems, I'd guess he probably CAN'T fire you, for fear of some kind of unlawful termination lawsuit...

jennybyc 03-08-2012 03:53 PM

Re: cervical osteophytes
I would actually go about this a slightly different way. He ordered the MRI so he knows what condition your neck is in. But here's the thing with neurosurgeons...they really don't care about pain. In order to have pain, you have to have live and kicking nerveS and they worry about nerves dying...or spinal cords dying. You aren't in that are in the earlier stages of a bad neck(sorry to say) and aren't surgical so you don't need his services(luckily)but you do need his understanding and I don't know if you're going to get it.

I would go talk to your primary care doc and have him/her help you get into a pain management doc. That is what you need right now...someone to help you with pain so that you can work until such time as you do need surgery. Anyone in your area will no doubt know your boss and that is good for you. Work with them.

Ask the pain doc about wearing a collar at work to rest the muscles. Raise up the monitor of your PC so that you aren't looking down all the time. Get on pain meds that really help and don't make the ulcer worse. Take a muscle relaxer at bedtime. Your primary doc may be able to get your started with meds before you see a pain doc and that would help too. Drugs like Lyrica and Cymbalta can really help with nerve pain too.

Your neck is really not that bad as necks go but the muscles of our neck try to hold the neck joints in the right orientation and often they can't so they work overtime and those muscle spasms HURT!. So start there. Pick up some Therma Care wraps for the neck and put one on at work to see if the heat they generate will help with the pain. Raise up your monitor if you aren't using it at eye level now. If you can afford it, get a deep muscle neck massage at least once a week to help break up the spasms. Magnesium helps muscles relax so if you aren't taking any...worth a try(but be careful, it can cause diarrhea..try slow release magnesium). Vit. B Complex is good for nerve health and might help too. And if you can't get into a pain management doc quickly, you can go buy a soft neck collar at any drug store and it helps relax the muscles too by holding the head up for the muscles. Ask the pharmacist to assist you in finding one that helps the most. That will remind your boss that you have a bad neck too.

And I'd be straight forward in asking your boss about a pain management doc(but see the one your PC suggests) and even another spine surgeon as you just don't feel comfortable asking him to be your doctor. Just tell him it feels as if you are taking advantage of him and you don't want to do that. As they say..massage HIS ego. You just can't ask him to help you medically and to employ you...that is just too much to ask of him. So ask his advice and then do what you want...he'll be flattered you asked.

I'm really sorry you hurt so badly. I remember having to work right up to surgery and it was hard. Those last 3 weeks before surgery I was working 12 hour days 6 days a week to get ahead. Kept telling myself I'll be so much better afterwards but it was he!!. We really don't understand how much we use our necks until every nod hurts.

hugs.........Jenny(fused C3 to T1)

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