Question
QUESTION: Dr.,I just got my MRI done of the cervical spine.I am 41 years old.I have been suffering from a few years frm severe pain and strain on my right arm and shoulder. Recently went to a neurosurgeon with all my earlier reports and was recommended an MRI. The report has come and I want to know what does it mean?
The report says :-
Mild degenerative spondylotic changes are seen in the cervical spine with marginal end plate ostrophytes aand desiccated intervertebral discs. The C5-6 disc shows postero-central to right foraminal disc extrusion with annular tear causing mild thecal sac indentation,narrowing of right neural foramen and abutting right exiting nerve root.Subtle flattening of the ventral surface of right half of the cord without causiing any signal change. Minimal diffuse bulged at C4-5 and C6-7 levels with a small focal protrusion at C6-7 level causing minimal thecal sac indentation without compressing exiting nerve root.
Thanks.

ANSWER: Hi Manisha,

Sorry to hear about your problem.

The report indicates degenerative changes in your cervical spine (neck). These changes are indicated to be mild and it is usually categorized as mild, moderate and severe. Spondylotic changes refer to spondylosis, which are these changes in the front part of the neck bones rather than the back portion. This means there is loss of height of the bones, loss of fluid inside the disc which sits between the bones (desiccated intervertebral discs) and irregular surfaces of a thin layer of bone that sit on the top and bottom of each bone (end plate). As a part of the degenerative process, due to the instability of the structures from this degeneration, the body attempts to stabilize the area by forming bridges between the bones (osteophytes) which are outgrowths from the bone. The process itself can be a normal part of aging, and I see no problem in the process itself other than the results from the mechanics of it causing pressure on sensitive structures like nerves. It is like the foundation of a house beginning to deteriorate and problems resulting from that. This is different from, lets say, termites which eat away at the house, which some degenerative conditions can be similar to and again, I do not see a problem like this indicated in the report. You can see a picture of the details regarding the structure we are talking about at the top of the article cervical spondylosis.

Moving on to the herniations; the disc between the 5 and 6 bones in the neck is extruded and this can mean different things depending on the Radiologist that evaluates the MRI. However, there is a pushing out of the inside of the disc into the sensitive nerve structures. It is like a jelly doughnut, where the jelly (nucleus part of the disc) pushes through the outside of the doughnut (annulus part of the disc - annular tearing). If there is a tear in the outside of the doughnut, the jelly can come out. This, in and of itself can be painful and cause inflammation. At this level of the neck, there is narrowing of the neural foramen (a hole from which the nerve exits) and this puts pressure on the nerve at the right side. Typically, pain would be in the neck and the right shoulder, because this is the area that the 6th nerve goes to and the disc between the 5 and 6 bones will compress the 6th nerve root. You can see pictures of this at the neck herniated disc page.

The other findings regarding the 4-5 and 6-7 levels appear to be minimal and not causing any compression of the nerves (radiculopathy). There are some mild pressure on the covering of the spinal cord (thecal sac) which runs down the center of the bones and this appears to be without pressure that would cause symptoms. A more significant problem in this area would indicate changes (signal changes) and the symptoms would tend to be different than what you are experiencing. So, at this point, they would be considered incidental findings - findings that are not causing problems.

So, what I mainly see in this report is a herniated disc at the 5-6 level, pinching the 6th nerve which directly corresponds to the pain that you are experiencing. Further pressure on the nerve may cause symptoms into the arm. Hopefully, treatment directed at the problem will prevent this and, in many cases, the disc will heal without further complications. There is an article on treatment of a herniated disc and this talks about some options for treatment.

One more thing; just because there is a herniated disc that corresponds to your symptoms, does not mean there can not be a problem with the shoulder. As a part of differential diagnosis, you should also have orthopedic testing of the shoulder itself to check for the muscles and tendons around the joint known as the rotator cuff muscles. A problem here can cause similar symptoms and it is not unusual to have both problems at one time.

Well, I hope this helps you understand the report better.

All the best!

Dr. Steve

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

QUESTION: Thanks for such an early response Dr.Steve. But I woyld like to ask another question....I went to an orthopedic surgeon today and he says that at this point we can only treat this with mild physiotherapy and a short course of steriods as I am in a lot of pain right now. According to the orthopedic all these are short term solutions ,he told us that the only long term solution would be to go in for something called a fusion surgery...what I want to know is
1. Are steroids safe if taken for a short duration of one week and will they really help in curing me of pain ( I am quite scared of taking steriods as I have heard quite a few people advising against steroids)
2. Will it really be better if I go in for this fusion surgery as I really want to get rid of this excruciating pain forever...this constant throbbing pain has spoiled the quality of my life...I really,really wamt to get rid of it...will this surgery really help me?
3. Do you think the orthopedic surgeon's analysis is correct?
4. How safe is the fusion surgery?
Thanks.
Manisha

Answer
Hi Manisha,

Actually, I do agree with the surgeon that a short course of steroids are appropriate. On a personal note, I have taken them 3 times for herniated discs and would do it again without hesitation. In fact, if you go to Medrol Dose Pack, you can see the actual box from one of the steroids that I took. It worked very nicely to remove the inflammation and I needed no further treatment. Additionally, a short course of mild physiotherapy might be helpful, with the steroid being the main mode of treatment.

Regarding the surgery; you are not there yet. Give the medication and therapy some time and see how it goes. I would be very optimistic and not worry about surgery at this point. It seems the surgeon is doing the right thing instead of rushing into a surgical procedure. Ruling out other therapeutic measures is the right approach as surgery, if not an emergency, would be the last method of choice. The more you can rule out other methods, the more likely the surgery will be successful. So, I would have great confidence in your surgeon.

I hope the steroids and therapy solve this problem for you and I think it is the right approach.

Kind Regards,

Dr. Steve