Question
I am a 30 year old healthy female. I visited a chiropractor and after the x-rays the results were that: discs 2,3, and 4 are fused together (might have happened at birth), I have bone spurs on the opposite side of my spinal cord, disc 5 looks as though it is shifting towards the spinal cord, arthritis in my neck, and a little bit of scoliosis on my right side. I am a marathon runner and love surfing. The chiropractor told me to abstain from these activities and is very concerned with my neck because he has never seen anything like this in his 22 years of practice. I am concerned about my fitness. I workout everyday and do not want to stop. Do you have any suggestions?  

Answer
Dear Lalita,

Yes the fusion happened in utero, and no this is not a huge deal.  It is called a congenital block vertebra, and is considered an anatomical variant of the development process while your spinal cord was developing. Block vertebra occur due to a lack of separation of the embryonal components that form the vertebra and intervertebral discs.  I have three or four patients like this in my clinic, and I have only been practicing for 4 years...not to mention that your condition is so common in the public that it is one of the first things we learn about in our radiographic anatomy courses.  Congenital block vertebra is always tested on our national board examinations as well.

Now, I don't know why the chiropractor told you that it looks like the disk is shifting toward the spinal cord, because you can't see the disk material on an x-ray, only the space in which it is located.  This could only be determined on and MRI.  You may have disk degeneration at that level, which would be shown by a thinning of the disk space, but there would not be a shift (disk bulge) visualized.

The arthritic changes you have described are common in these cases because of the fact that the vertebra which are fused get no motion, therefore the adjacent vertebra have to move more to accommodate normal range of motion in the neck.  this can lead to instability over time due to the ligaments losing their elasticity, and that is why the arthritic changes occur..due to the abnormal movement patterns.  The neck can still be adjusted without worry, because the vertebra are fused in the front at the bodies, not in the back where the joints are, and patients such as yourself do fine with chiropractic care.

If you were in my practice, I would not be too concerned about this. Yes it is an issue, and you will have continued degeneration faster than a normal 30 year old, but that is the reason to get periodic care in the neck to establish proper motion whenever possible and to lessen the degenerative changes.  I would also not be placing you under any restrictions unless I found some significant problems on MRI...and depending on your symptoms and clinical examination, I would probably order the MRI to further evaluate the C5 disk appropriately, as well as the others.

Don't freak out Lalita, I am sure you are going to be fine, you just need to monitor and manage this.  Think about this, you have been alive for 30 years with this anatomical variant, you are active and athletic with years of pounding on your spine, and it is just now being found. I don't know what prompted your visit to the chiropractor, probably neck pain, but I would recommend on getting the MRI if for nothing more than piece of mind.  That way you will know the actual conditions of the disks, and the relationships of the arthritic changes to the cord and the nerve roots.

Feel free to follow-up with me if you want/need to.

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