Question
Hello Dr. Anzalone,
I am a 49 yo male who has had various neck symptoms for nearly 25 years. For the most part it's been quite tolerable, and intermittent. This spring it seemed worse, and it seemed more intense, but still tolerable. I had x-rays ten years earlier, but my doc said he really didn't see anything wrong, other than my posture was slightly bad. He said I should pull my head back and try to stand more straight, even though I look perfectly normal to everyone else. My new x-rays revealed: moderate disc space narrowing at c5/c6 with mild c5 retrolisthesis and small marginal osteophite formation. Posterior disc space narrowing at c6/c7. Mild uncovertebral joint degeneration C3-c4 on the right and bilaterally at c5-c6. Right c5-c6 and left c5-c6 neurofaminal stenosis. I have no radicular symptoms.

After 4 weeks of P.T., I was released with no restrictions, and my doc prescribed napraxen as needed. My therapist advised me to start resistance training, so I joined Gold's Gym. I also decided to explore Chiro, and made three visits.

I was informed that I had "phase 2" degeneration, and "stacking" of the vertebra i.e. loss of normal lordosis. Obviously, my goal is to do whatever I can to curtail the inevitable effects of this malady. The Chiropractor claims he can "fix" me , and restore the curve in 8-12 months. He uses the Gonstead technique. He wants to do more x-rays in a few months to compare. He said in 8 years or so the bones will fuse and no one will touch me then. I did ask my PCP for advise, but he just said" Dr.xxx is a good Chiropractor and gets good results".

I am very frustrated and confused, because of all the contradicting information I have found on this. What benefit will Chiropractic care provide me, and how should I incorporate it into my long term strategy? I would appreciate your opinion, advisement,or thoughts.

Best Regards,
Russ

Answer
Russell,

First, if you are no longer having any neck symptoms, you don't need to pursue any further therapy.

If you are having continued but improved symptoms, conservative therapy is appropriate. By this, I would refer to physical therapy, home exercises, or spinal manipulation on a symptomatic basis.

If you are having continued but worsened neck symptoms, an MRI of the cervical spine would be the next appropriate step to further quantify the degenerative changes which the plain-film x-rays revealed, as well as potential disc bulges/herniations and narrowing (stenosis) of the neural foramina (the spaces where the spinal nerves exit) or the spinal canal. See this link for additional information on cervical disc disease:

http://www.webmd.com/pain-management/features/neck-pain

And this one on cervical spondylosis:

http://www.mayoclinic.com/health/cervical-spondylosis/DS00697
A number of proprietary chiropractic techniques claim to effect changes to spinal curvatures. However, as far as I have researched, there is nothing in the scientific and peer-reviewed clinical literature to show that doing so effects any significant health benefit. In my opinion, and in the opinion of other evidence-based chiropractors, the radiographic exposure to ionizing radiation with the repeated x-rays that are taken with the use of these various proprietary techniques does not outweigh the benefit of monitoring minute changes of spinal curvature, if such changes can actually be produced. I have posted a number of responses to similar inquiries on this site and have cited specific scientific references to support my statement in those posts.

Based on the degenerative changes that your x-rays have shown, you may wish to speak to your primary care physician about having an MRI and then possibly being referred to an interventional pain management physician for a consult to determine if you are a good candidate for a cervical epidural spinal injection (see this link below for more information on that):

http://www.spineuniverse.com/treatments/pain-management/cervical-epidural-inject

I would also recommend continuing chiropractic care with an evidence-based, musculoskeletal-based chiropractor in your area. I find the claim of being able to "fix" a spine with that level of degenerative change highly questionable, at best. You may be able to find a more evidence-based chiropractor on the West Hartford Group's website (I belong to this group of chiropractors who seek to reform and improve the chiropractic profession by practicing according to the best available clinical evidence and rejecting unsubstantiated chiropractic dogma and belief systems):

http://www.westhartfordgroup.com/LocateaDoctor2.html

I hope this helps to answer your question. In short, chiro, but with the right chiro. And there's nothing wrong with taking an interdisciplinary approach to your health care.