Question
QUESTION: My Dad's suffering from cervical spondylyosis since past 4 and half yrs. Latest CT scan says.Ossification of Posterior Longitudinal Ligament extending from C3 Level to C6 Vertibra it appears dark on T1 and T2 but better appreciated on CT Scan. Resultant moderate diffuse canal stenosis with cord compression is seen. Maximum thickness of ossified posterior longitudinal ligament is seen at c4 level is 5mm.

There is loss of normal cervical lordosis. C5 and C6 anterior osteophytes with mild decrease in inter vertbral disk space.

Physically he's suffering from inflammation starting from rear neck till foot..completely distressed..Please suggest something apart from surgery ..and if surgery then what are the risk factors involved..Should he opt for surgery now at the age of 62 or so..

ANSWER: Spinal surgery is almost always considered a last resort and is considered when the patient is experiencing progressive, severe neurological symptoms, especially loss of bowel and bladder control resulting from spinal cord compression or significant loss of function in the arms and legs. When spinal cord compression is significant, a decompressive laminectomy (removal of the back parts of the vertebra) may be performed.

Loss of the normal cerivcal lordosis is a very common finding and may not necessarily be a pathological condition. Degenerative changes (similar to those you mentioned) similarly may or may not produce symptoms. Typically, any structure (disc, bone, bone spur, ligament, or chemical inflammation) that causes compression or pressure against a neural structure (the nerve root or spinal cord) may produce symptoms.

For inflammatory and degenerative spinal conditions, some of the best results are often obtained with the use of anti-inflammatory medications, gentle manipulation or mobilization techniques if joint dysfunction or disc herniation is present, moderate exercise maneuvers performed by the patient to increase normal joint movement, and return to normal activities as soon as possible.

As for surgical risk factors or the appropriateness of of various kinds of spinal surgeries, I am not a surgeon and cannot comment on those.

I hope that this helps to answer your question.

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QUESTION: Dear Sir, Thanks a lot for the reply. I would request you to suggest best medication available in india and would be grateful if you can suggest a hospital or doctor whom we can consult. My Dad is a resident of Mumbai (India). Also he has done some physical excercises two years back, but some people have suggested that it is not good to do excercise at this stage of the problem. Can you also please suggest some saef excercise and he is of age of 62 Years.

Thanks.

ANSWER: The practice of chiropractic does not involve the prescription of drugs, so I can't recommend a specific medication to you. However, as a general observation, medical physicians typically prescribe corticosteroids to patients with inflammatory musculoskeletal conditions.

As a practitioner in the United States, I am unfamiliar with any practitioners, medical or chiropractic, in India, so I unfortunately cannot provide you with a referral. However, I would suggest locating a chiropractor in your area, or requesting that your father's general medical practitioner or his orthopedic specialist refer him to a physiotherapist for treatment and/or specific rehabilitative exercises, if appropriate, based on their evaluation of his condition.

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QUESTION: Thank you Sir for the reply.
Although your reply was quite helpful but still im pasting the entire CT and MRI scan of the report carried 6 mnths back as the earlier was not complete in itself(for more info).


MRI CERVICAL SPINE
Procedure: MRI of the cervical spine was performed using multiplanar, multiecho sequences. Screening of the whole spine was also performed.
Findings: Mild straightening of cervical spine with normal vertebral alignment is noted.
There is ossification of posterior longitudinal ligament extending from C3 level to C6 vertebra. It appears darkoi
Ti & T2 but better appreciated on CT scan. Resultant moderate diffuse canal stenosis with cord compression is
seen. Maximum thickness of ossified posterior longitudinal ligament is seen at C4 level is 5 mm
At C516 level, there is ligamentum flavum thickening also noted. There is signal abnormality in the cord
consistent with ischemia. Unco-vertebral arthrosis are also noted causing foramen stenosis The pre / paravertebral soft tissues appear normal.
Screening of dorso-lumbar spine is unremarkable.
impression:
1. Ossification of posterior longitudinal ligament extending from C3 to C6 vertebra causing moderate canal stenosis and cord compression.
At C5/6 level, there is additional ligamentum flavum thickening contributing to cord compression. There is cord signal abnormality suggestive of ischemia. Unco-vertebral artbrosis is also noted causing foramen stenosis

CT SCAN

There is loss of normal cervical lordosis.
C5 and C6 anterior osteophytes with mild decrease in intervertebral disc space.
Rest of the cervical vertebrae and interveing disc spaces are unremarkable. Posterior elements appear normal.
Bony spinal canal diameter is normal.
No obvious pre/paravertebral soft tissue abnormality noted.
No bony cervical rib seen.
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Basically he's experiencing more of inflammation rt from top to bottom. But he's physically otherwise active.
Please help.

Thanks..


Answer
Sir,

While this is in no way to be construed as the prescription of medical advice, as a general statement, spinal cord compression, canal stenosis, ischemia (impaired blood supply), and foraminal stenosis which produce symptoms, particularly progressive neurological symptoms, typically require surgery and not manual therapy as treatment.