Question
QUESTION: Hi Shawn!

I was wondering if you would be able to explain the following radiological report I just received. Unfortunately the doctor did not explain very well.
Here is what the report says:
There is a slight curvature convex to the right which may be positional in nature. The overall verterbral alignment is otherwise maintained.
Ther are mild to moderate degenerative changes along the mid to lower cerrvical spine, with disc space narrowing and osteophytic neural foraminal encroachment most prominent at C5-6, with potential compromise of the exiting C6 nerve roots.
While the open mouth view is suboptimal, with the odontoid process obscured by radio-opaque dental materials, no fracture is detected. The reason I had x-rays done was because I woke up last week and could hardly move my neck, side flexion (left)was particularily difficult so I went to a walk-in-clinic the following day because I have woken up in the distant past with a kink in my neck but this seemed different and the pain was getting worse. I was shoveling our driveway the night before had back pain but not really more than usual for me(I was diagnosed with fibromyalgia 10+years ago). I continue to have pain in both my neck and lower back but hope it will get better soon, life must go on! BTW the doctor is sending me for a CT scan or possibly a MRI but would like to know in the meantime what the x-ray results mean in terms of cause, prognosis and treatment in layman terms.
I look forward to your response and I thank-you in advance for kind consideration and time.

Sincerely,

Wendy J

ANSWER: Dear Wendy,

Slight curvature convex to the right = the neck is not straight, and has a minimal scoliosis...not really a big deal, especially considering the fact that you were in pain and that could have affected the position of the spine.

Osteophytic neural foraminal encroachment.  this is degeneration of the spine where extra bone is being laid down on the vertebra.  Specifically there are small bone spurs that are reducing the amount of room where the spinal nerves exit the spinal column.  This can result in nerve root pressure/inflammation/pain.  Compromise of the c6 nerve root would manifest with possible pain in the forearms on the thumb side.

Disc space narrowing occurs as the disks degenerate.  Over time the disk material loses its water content and becomes more fibrous in nature.  Abnormal wear on the disk structure will tend to wear it down which results in a loss of height.  This contributes to the bony degeneration described above and the small nerve root exit holes.

The odontoid is a special process on the second vertebra in the neck, that is specifically looked at on the open mouth view...appears to be normal according to report.

Bottom line here is that you have degenerative disk and joint disease in the lower neck.  this sometimes causes problems, and sometimes does not, but is the result of abnormal function and wear over time in relation to gravitational stress/ abnormal posture and movement. The MRI is a good choice for further imaging if the doctor suspects a bulging or herniated disk to be the cause of the problem.  If you are having pain that radiates into the shoulders or arms, then the MRI should be performed.  

Otherwise these are the types of problems that chiropractic physicians excel at treating.  Spinal adjustments will help to normalize joint function, reducing muscle spasms, and reducing pressure on the disk and nerves.  I work on patients just like you everyday and help them reduce pain while increasing function.  Medical treatment of your condition will most likely be pain meds and muscle relaxers which will help, but will not address the cause of the problem, only the symptoms.  

From the initial results of your x-ray, conservative approaches should be utilized first, however. I also would have done a thorough orthopedic examination of the neck structure as well...not sure if that was done.  It would include manual testing of the joints, muscles, measuring your active range of motion, deep tendon reflexes, and neurological function to the arms/hands/fingers.

Nutritional consideration would be joint support formulas, omega III fatty acids, and anti-inflammatory enzymes.  If you have questions about this, feel free to write back and I would be happy to explain it at length.  In the mean time, check out my website.  It has a glossary section to look up terms and view pain patterns, descriptive anatomy of the spine with illustrations, and will help give you a good understanding of what to expect from a good chiropractic clinic/physician.

Good Luck Wendy!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

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

QUESTION: Hi Shawn,

Thanks so much for your detailed answer to my question. Quite frankly you have provided me with more information than I have received from the walk-in-clinic doctor, the family doctor who is covering for my family. doctor who has taken a extended leave of absence (she was amazing and very thorough)and most recently the Sports Medicine doctor I saw today.

I have to say I am feeling quite overwhelmed by the pain I continue to experience. By mid afternoon and evening the pain in my C-spine and into my left shoulder gets really bad. It feels almost like a knife tearing into that area.

The sports medical doctor is referring me to a chiropractor for Functional Integrative Therapy. He wrote on the referral C-Spine Myofascial pain. He also checked to see if the nerves in my spine are affecting my arms/hands and apparantly they are not.

The fam. doctor has referred me for an MRI and to see a orthopedic surgeon which I guess is not really necessary based on the Sports doctors findings.

Unfortunately I have to wait until next Wednesday March 26th and in the meantime I continue to suffer. Pain meds and relaxants are not helping!

You mentioned nutrional supplements can you give me more details and what exactly I would ask for in a health food store. Also any thoughts or suggestions based on recent events would be most appreciated.

Thanks ever so much Shawn! This is a great website!

Wendy Jardine

Answer
Dear Wendy,

Nutritional supplementation is something I have found to be extremely important for not only maintaining a functional body,  promoting health, improving function, reducing endocrine system dysfunction and symptoms, but also in helping patients greatly reduce pain.  You see if the body does not have the chemical substrates it needs for proper biochemical function, it cannot perform the normal internal reactions, communication, or metabolic processes to function properly.  If there is an injury as well or chronic pain, these functions continue to deteriorate and result in further system wide compromise.

Most people are aware that there are thousands of research studies which have proven the efficacy of utilizing nutrition for normalizing body chemistry, and in the treatment of diseases like cancer, heart disease, gallbladder dysfunction, Alzheimer, diabetes, etc... but many are unaware that musculoskeletal conditions benefit as well.  There is so much published research out now, that the facts are unquestionable.  The reason many do not know about how effective nutritional considerations can be is that, it is not a big money making industry like pharmaceuticals are, so it isn't promoted as widely.  

Considering musculoskeletal issues such as joint degeneration, pain, and inflammation, there are a few key nutrients to point out such as anti-inflammatory enzymes, glucosamine sulfate, methylsulfonylmethane (MSM), vitamin C, antioxidants (bioflavanoids, vitamins a-carotenoids & lutein,c,e-tocopherols & tocotrienols, selenium, CO-Q-10, polycosinol, grape seed extract, etc...) the list is enormously large.  The point here is that antioxidants reduce and often prevent cellular damage by limiting tissue oxidation, therefore your cells age slower and degenerate less (all cells).  Combined with the fact that antioxidants are also anti-inflammatory and work hand in hand with enzymes, they can be very potent.  Then add in the cartilage repairing properties of Glucosamine Sulfate and the joint lubricating property of MSM, and you are further reducing stress and friction in the degenerative joints/disks.  Moving on zinc is known for its ability to specifically repair disk damage, magnesium is vastly protective or nerve and brain tissue, and B-complex vitamins drive metabolic processing of foods for energy and repair as well as help regulate proper nerve function, and this is just a start.  Not to mention that omega III fatty acid supplementation is vitally important for neurological function, inflammation reduction, and other systemic processes. So what should you add, some of it, or all of it?

The recommendations I have for my patients is to start with a custom multivitamin, and then add a few key nutrients depending on their specific needs.  I recommend metabolic testing to determine their overall physiological need first, and it is easy and inexpensive to get tested right in your own home.  I utilize a company called Ideal Health for this because they have partnered with the two best laboratories in the country for metabolic testing (metametrix labs) and supplement formulation (HVL Douglas Labs).  Then we move on to a few key additional products.  In your case I would recommend a vitamin C complex to help with collagen synthesis which is how the body repairs damaged muscle, tendon, ligament, cartilage etc..., and then a good joint support formula with the glucosamine, MSM, and anti-inflammatory enzymes.  This is a good basic approach without needing to buy 10-15 separate products.

I encourage you to check out www.idealhealth.com because you can buy directly from them, they ensure quality by exceeding all US standards for pharmaceutical quality products, and have international certification for purity and potency...the highest standard.  I recommend you get testes with the PRIVA TEST for the custom formulation (CUSTOM ESSENTIALS), and then add the FLEX CAPS, and IDEAL C-PLUS.  This is enough to establish a very comprehensive nutritional support, and I would stay on this program for 6 months.  you can probably eliminate the C-Plus products at that time, but I would encourage you to stay on the other two for long term.  I utilize the same products with my family, patients, and I take them myself.  I re-test myself every year to see if my metabolic profile is changing so that my formula can be changed. The Ideal Health website will ask you for a referral before you order, feel free to use my name, and you will have access to tons of information on the site as well as a custom report will be generated and sent to your house for you to read...they are very well written and easy to understand.

Hope this helps Wendy, Check out the Ideal Health website, and I encourage you to get tested so that you know the nutrients you take are working for your metabolism and are actually absorbed in the body. Bare minimum get the FLEX CAPS as well...you need the joint support. If you would like more information on dietary changes specifc to inflammtion reduction and detailed information on the nutrients I have mentioned, e-mail me though my website, not allexperts, and I will be happy to send you informational reports and articles I have written for local publications that go deeper...they are too large and contain graphics that the allexperts site will not support.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net