Question
Hi Doctor! I am 39 year old Female but if what I am reading correctly it sounds like I have a neck and lower back of a 90 year old. As I really feel. I already had injections three in my lower back and Two in my neck. No help! In extreme pain and can not take any anti inflammatory's due to High Risk of Ulcers. Also had a full body bone scan and arthritis was detected in hips knees, hands and feet. I am being made to believe that the pain is all in my head and that I have fibromyagia! I need help it hurts so bad and my lower back is just as bad. These big words I am lost. Appreciate any help with this. Can a person have this much stuff looks like something is wrong and not be in pain? Thank you in advance for your time and consideration.

MRI:

intervetebral discs: Disc degeneration and disc space narrowing at c5-C6 with edematous degenerative endplate marrow change.

Individual Disc levels:
c2-c3 mild left uncovertebral hypertrophy. No sign. narrowing of the central canal or neural foramina.

c3-c4 mild disc bulging with bilateral uncovertebral hypertrophy. Mild narrowing of the right neural foramen.

c4-c5: disc bulging with left greater than right uncovertebral hypertrophy, and possibly a small associated left paracentral disc protrusion. Mild narrowing on the central canal with indentation of the left ventral cord, as well as mild right and moderate left neural foraminal narrowing.

c5-c6 disc bulging and endplate spurring with billateral incovertebral hypertrophy. Mild narrowing of the ventral canal as well as moderate to severe right and moderate left neural foraminal narrowing.

c6-c7 small central disc protrusion. No significant narrowing of the central or neural foramina.

c7-t1: no sign. disc bulge or herniation.

Answer
Hi Kalina,

You have got a lot going on and I would certainly believe you are in pain. First of all, you are in a similar positions as I. I too have very advanced degenerative findings on MRI studies and have been suffering for a long time. A large percentage of what you see is related to genetics. There are genetic factors, and more are being discovered all the time, which predispose one to early degenerative changes. A part is also related to loading history - accidents, heavy lifting, certain sports, even cumulative trauma like sitting for years and working at a computer... Most likely, a combination of genetic factors and loading history can lead to this condition. Some will say everyone has these findings on MRI, however, if I have tires that are rated at 50,000 miles and they are worn out at 20,000 miles, something is wrong. The pain is real and a lack of understanding amongst many health care providers is frustrating and only adds to the pain. This type of chronic pain can lead to depression. Some will say the depression will lead to chronic pain, and this is sometimes the case, however; it's the old question - what came first, the chicken or the egg?

I can review the specific details regarding every finding, which is mostly anatomical, things like uncovertebral joints which hypertrophy - a part of the vertebra (spinal bone) which forms growths due to the degenerative process, which can cause nerve irritation and there is a good picture of this at the top of the cervical radiculopathy page.

However, in such a forum, I would like to address a finding which concerns me the most and one which may provide a window of opportunity to address your symptoms in a new way. That finding is "edematous degenerative endplate marrow change". I would venture to say this finding may also be in your lumbar spine (lower back) also.

This finding is known as a Modic Change and, if it is type 1, there is something that can be done. The description as to what type of modic change is not clear; however, it may be discerned by a Radiologist. The type 1 modic change is associated with an infection in the bones and is why there is a description of edematous, which is swelling - similar to liquid found in a blister. These findings are responding to antibiotic therapy. I know you have stomach problems, so there are some issues regarding this and the treatment usually calls for 100 days of antibiotics.

So, we need to find out what type of modic changes are going on and we are specifically looking for type 1. Then we need to know if you can tolerate a long term antibiotic treatment. Please have your doctor look at this link < href="http://necksolutions.com/pain/back-pain/study-proposes-antibiotics-as-possible-n>Study proposes antibiotics as possible new treatment for some types of chronic low back pain</a> and there is enough information there to clearly indicate a possible course of action that can help. When this is the case, type 1 modic changes, nothing else is going to help.

I hope this helps. I know you were probably wanting details regarding the specifics of all the findings, and I can do this if you would like to contact me again, however, I wanted to suggest a course of action that might actually help your condition that others may not have suggested.

Kind Regards,

Dr. Steve