Question
Hello Kind SIr,

I have had three back surgeries already and wish to know a bit more before I see my pain medicine Dr. for a MRI he scheduled for me - i went through him to get Mr and wish not to be on meds all the time. Briefly the MRI Impressions read as follows: Cervical Spine with and without contrast: C3-4 demonstrate facet changes and uncoverabral osteophytes, right greater than left. Bilateral neural foraminal narrowing. Level above previous fusion (C5,6 &7) demonstrates degenerative disc changes. There is a diffuse bulge with a small focol area of increased T2 signal consistent with an annular tear which appears to touch cord. The level below prior fusion which appears to be C7-T1 demonstrates degenerative changes with mild bulge. C3-4 with uncovertable osteophytes.

MRI Thoracic Spine
Degenerative changes noted in lower thoracic spine with Schmororl's Nodes. There are minimal bulges. Appears to be left precentorial protrusion at T8-9 which minimally indents the ventral thecal sac. Mild loss of superior endplate height of T5 with normal marrow signal consistent with an old degenerative benign compression deformity.
MRI LUMBAR w/ w/out contras:
There is a diffuse bulge noted with granular tissue seen surrounding the left S1 nerve root. There are lateral osteophytes noted with bilateral neural foraminal narrowing - right greater than left.
L4-5 demonstrates a diffuse bulge with mild facet degenerative changes and ligamentum flaxum laxity. L1-2 demonstrates degenerative disc changes with a diffuse bulge which slightly indents the ventral thecal sac. Mult-level severe osteoarthritic and degenerative disc changes seen mostly at L5-S1 but also L4-5 and L1-2.

I know this is alot Dr. I have been in pain management for 4 years now and sick of it and have tried to make a go of it off of all medicines. I get to hurting so bad seemingly everywhere that I do not even know how to explain to Dr. when he asks the now horrifying question: How do you rate your pain? Where is it? What kind of pain is it?

Any suggestions for me kind sir? I know that this pain dr. will keep throwing meds at me and feel like an Ortho Surgeon will want me under the knife - neither of  which sound very great right now, HOWEVER - this is making my life a shambles and want my life back as best I can. I am only 45 year old man, otherwise healthy with much to live for. I have increasing weakness in my arms and hands (left more so), my mid back is constantly throbbing, lower back constantly in pain and for some reason lately - my feet feel like they are on FIRE!

Please drop a word of advise - thanks!~

Jeff  

Answer
Jeff,
 There is a lot going on in this MRI.  I hope I can help give you some advice that will help relieve some of your symptoms.  Since you have had a fusion at C5-C7, it is very common for the joints above and below the fusion to have additional stress and wear and tear.  This is because they have to make up for the lack of movement lost at the fusion site.  I don't know what you do for a living, but #1 is that you have to work on your posture.  Since you have a fusion at  C5-7, it is very important to know what muscles impact your posture and therefore your neck.  Throughout your day you should be stretching your chest muscles  and your biceps.  You should strengthen your posterior scapular muscles, mainly your lower traps, shoulder external rotators and rhomboids.  By strengthening those muscles and stretching the others, it will help reduce your pain and can help with your weakness in your arms.  Weakness in your arms can come from neural narrowing mentioned in the MRI, but it can also come from bad posture.  Bad posture can cause muscles to be pulled out of alignment, which causes them not to work normally and can create weakness.  Your mid back pain can be caused by your pecs being to tight causing an anterior tipping of the shoulder blade.  When that happens, the rhomboids, muscles between your shoulder blades become stretched and can cause a throbbing feeling.
  Your lower back shows some arthritic and degenerative changes according to the MRI.  You have some bulges or herniations of discs but not specific mm has been given.  Your lower back may be in constant pain because you don't have enough strength and support from the gluts and abdominal muscles.  One of the hip external rotator muscles called the piriformis can cause your feet to feel on fire if it is irritated.  If you carry your wallet in your back pocket, immediately remove it.  If you sleep on your side, put a pillow between your knees and ankles to keep your hips and knees in a neutral position.  Strengthening your gluts will help support the back and help alleviate some of your pain.
   I know this was a lot. I hope this helps you understand a bit more.

Martin