Question
QUESTION: The VA sent me to a hand specialist for a neck problem. He ordered an MRI, told me the findings were significant and that I needed a neurologist, then referred me to a neck specialist. My appointment isn't for another 3 months and I have no ideal how to interpret this MRI. I am in a lot of pain and am very worried. Could you please tell me how bad this is? Thank you so much.

Posterior fossa and brainstem demonstrate 2 mm tonsillar ectopia. No cord edema.
C2-C3 Right foramen mildly narrowed from facet spur.
C3-C4 Left foramen moderately narrowed from facet and uncovertebral spurring.
C4-C5 Left foramen is mildly narrowed from uncovertebral spurring. 2 mm anterolisthesis. Severe left facet arthrosis.
C5-C6 Moderate bilateral foramnial narrowing, mild central and right paracentral canal narrowing from diffuse asymmetrical disc bulge and uncovertebral spurring. Focal effacement of ventral CSF in the right paracentral zone. Moderate disc height loss.
C6-C7 Minimal canal and left foraminal narrowing from asymmetric bulging disc.

ANSWER: Hi Liz,

Remember, these findings need to be correlated with your pain location(s) and other examination findings to be clinically significant.

Posterior fossa and brainstem demonstrate 2 mm tonsillar ectopia. No cord edema.

- No problems, 6 or more would be.

The rest:

When the say foramen, it means an opening. The opening is for a nerve to go through in this case. If there is narrowing of a foramen, there can be pinching of a nerve. This can cause local neck pain as well as pain referred into the shoulders, arms and hands. The opening or foramen can be narrowed by different means. A bulging, herniated or degenerated disc, and an outgrowth/bone spur/arthrosis of a facet joint or uncovertebral joint. The joints help the spinal bones glide. Disc herniations or bulges can be in the center (central) or to the left or right side (paracentral), which would be asymmetrical. They can be small (focal) or large (diffuse). The spinal canal can be narrowed by a disc herniation or outgrowths of bone which push into the space. This may cause effacement or pressure of the spinal cord covering, which can effect the flow of the fluid (CSF) in the spinal cord covering. Anterolisthesis describes a forward slippage of the spinal bone.

This is a general explanation of the findings. With the combination of findings, there can be an overlapping of symptoms and it can be difficult to narrow down which ones are the direct cause of your problem. This can often be done with injections or selective nerve blocks. Now, you can get a better idea when reading the report of what they are talking about. I would guess the hand symptoms would be from the C5/6 problem and that could effect the thumb and first finger or two side of the hand.

You can see more about these problems by looking at these 2 pages which best describe what the findings indicate:

1) Disc Herniation - http://www.necksolutions.com/neck-herniated-disc.html
2) Facet Joint Syndrome - http://www.necksolutions.com/facet-joint-syndrome.html

This will show the structures mentioned in the report to get a better visualization, pain patterns, along with some treatments commonly used. In any event I do hope you can get some relief soon and am sorry to hear you have to wait 3 months - does not seem very helpful. Obviously it is not good, and removing the pressure as soon as possible would be very beneficial. When concentrating on the cause of your hand problem, this should not be that difficult, However, if you have tried other therapies like traction, manipulation and other physical therapies without relief, injections should be done as soon as possible. It also depends on how long the problem is there. If it is more recent, aggressive anti-inflammatory medications can help. If it is long standing, injections are usually done prior to any surgical consideration. Injections may locate the exact cause as well as relieve the pain.  

Best regards,

Dr. Steve
http://www.necksolutions.com

---------- FOLLOW-UP ----------

QUESTION: Thank you SO much!
I don't have a hand problem. The VA doesn't always get things right:)
I've been going to PT but it has not included traction or anything that has helped. It is a long standing problem that has gotten worse.
Am I correct in thinking that the injections and nerve block only reduce the pain? Is there anything that helps slow progression other than surgery? Do I need a neurosurgeon? They have me scheduled next with a Dr. whose expertise is listed as Orthopaedic Surgery, Spinal Surgery, Orthopaedic Spine.
I will read up on the links you provided. I really appreciate your response. At least now I know what lies ahead.

Answer
Hi Liz,

Glad to help.

If you have not had traction, you might give this a try. If having someone lift your head gently from your shoulders feels good, traction might help to give you some needed relief and there are very good home products to use. If you have access to a chiropractor, that may be worth a try.

The injections can help diagnose the problem. They can reduce the pain, some short term and some can provide longer term relief, however; it can help narrow down the problem, so if you need a surgical procedure, it can be minimally invasive. They usually combine an anesthetic and a steroid anti-inflammatory in the injection, so the potential for relief is there.

If they find the main problem is the severe facet joint problem at C4/5 on the left side, a procedure similar to an injection called Radiofrequency Rhizotomy can provide great relief without surgery.

Slowing the progression is very difficult when it is advanced. In general, proper ergonomics, traction therapy, some exercises and chiropractic adjustments can help in theory.

The need for surgery I cannot say, that has to be made by a surgeon. It depends on level of pain, disability, previous responses to therapies and a specific pain generator identified. Evaluation by the Orthopedist next week should be beneficial and I hope it will provide you with an option that will really help.

Dr. Steve
www.necksolutions.com