Question
I have been suffering with neck and lower back pain along with severe
headaches for the last 3 years. Everyone thought it was a muscle injury, since
the muscles in my neck become very tense, and are nearly impossible t get
released. I finally got into pain management after being called a "drug
seeker" too many times. I was relying on my GP since I am uninsurable due to
epilepsy. I caught a break and finally got an MRI. The diagnoses is as such:

C5-C6 Central disk osteophyte complex at, which causes a mild/moderate
central spinal canal stenosis.

C3-C4 show a small central disk osteophyte ceomplex with no significant
stenosis & neural foraminal are patent.

All other disk are normal, everything else is normal (to summarize).

I am only 27, and my reading has showed that this happens usually around
50 and mostly in the lumbar section. I have never had a severe accident or
"neck trauma" head trauma, yes, but that was fairly minor (broken jaw).

So, the dr that ordered this is a pain specialist, when he told me my
diagnoses he said for $1,500 cash, I can get a single injection and be done
with pain for life. I don't but that, i though the execution used 3 injections :)
He also offered to send me to a chiropractor, been their before, no luck. He
offered acupuncture, that didn't work either. then he offered Massage
therapy, well, my wife is a massage and physical therapist, that didn't work,
but he told her in medical terms what to do. So, I have a physical therapist on
hand 24/7 (lucky me) and he put me on some arthritis medication, no
celebrex, something much stronger, and an extended release opiate. I think it
is called Opana ER, 10mg. Before i was on Norco 10, 3 a day. I also take
Soma, and then anti-seizures.

Obviously, this is all pain control, none of these methods will correct the
issue. I am young, so I am pretty worried, this came on fast, I also developed
minor adult onset scoliosis in a year, which surprised my doctor.

Ok, so pain is in check, and now I finally know why I am having all this pain,
and I know I am not a drug seeker, which I was starting to believe, that the
pain was just psychological.

So, what is the right medical path to fix this? If it is a spur, I hear they grow
back with surgery. What should I worry about, what steps should I take
beyond pain control, and will I have a normal life? I have a baby on the way.
Once again, 27 years old.

Answer
Dear Craig,

Sorry to hear about your spinal problems, and sorry it has taken me a week to respond to your question...network issues at my office.  Anyway, the degeneration you have acquired in the neck is most likely due to the fact that you have abnormal biomechanics.  What that means is that your structure and function is not appropriate, and therefore the joints are wearing out at an accelerated rate.

Although Pain management can help reduce pain, it will only mask the problem, and the degeneration will continue until you have no choice but surgical resolution, and you are right that the injection protocol is a series of three.  Not to mention, injections are not 100% effective in controlling pain...as a matter of fact, I have literally seen hundreds of patients who have had epidural and facet injections where the pain was not helped.  If you choose this option make sure that your physician tells you the success ratios he has had with patients like you in the past, and if he says over 90%, make him guarantee results, because there is no way that he can say that one shot will cure you, that is ridiculous!

With the fact that you already have some measure of spinal stenosis, you have a tough case.  If the stenosis continues, then you will most definitely will need surgical resolution to clean up the spurs and degeneration.  But there are other options to reduce the amount of pressure at the joint spaces into the spinal cord.

First you need to have the structure of the neck closely measured in relation to the normative data.  I know that there has to be an alteration of the normal curvature in some form.  Either forward head translation, straight neck, or reversed curve, and maybe a combination of all of those.  The experts in this field are chiropractic physicians, and yes the curve can be changed back to a normal presentation, it has been proven over and over.  Spinal adjustments will not change the structure of the curve, and specific tractioning protocols are needed to facilitate change in addition to spinal adjustments.  Moreover, specific exercise protocols are needed as well to reinforce the traction and help to control postural aberrations.  Your wife is more than qualified to carry out a functional and structural rehab protocol, and I would suggest that she needs to be present and educated on how structural rehab works, as it is not traditionally taught in physical therapy programs.  The best place to find information on the research, application and qualified chiropractic physicians to evaluate you is:  www.idealspine.com.

Conversely, intervertebral disk decompression techniques may also offer you some value.  Not because you have disk bulges, but because the technique may alleviate some pressure on the spinal cord by exercising the joint spaces.  realize though that if the spurs are large enough, they may hinder any rehab attempts concerning structural rehab or decompression rehab.  Posterior osteophyte complexes are actually a contraindication to traction when large enough.  The bottom line is the treating physician will have to decide if these technique can be utilized in your present condition...you may actually have to have the spurs removed first.

Now if you do need a surgical resolution to remove the spurs, you will still need to undergo the structural rehab.  Why?...  because the spurs will grow back like you had mentioned if you do nothing to correct the degenerative problem.  The surgery is just to address the spur itself, thereby eliminating the immediate cause of pain.  However, if you do not correct the underlying biomechanical issues, the spurs will come back over time.

Research the above options, and feel free to write me back for further information if needed.

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