[mikeymike]

Here is my story and if someone can help understand my issue it would be greatly appreciated.

MRI results as follow
MRI SPINE CERV W/O CONTRAST
FULL RESULT: PROCEDURE: MR imaging cervical spine without contrast.
TECHNIQUE: Multiplanar, multisequence MR imaging of cervical spine was performed without contrast.
INDICATION: Interscapular pain.
COMPARISON: None available.
FINDINGS: The visualized portion of the pons, medulla, and Vermis are normal. The cervical cord is unremarkable. The bone marrow does not show and significant abnormality.
C2-C3: Negative
C3-C4: Negative
C4-C5: Small to medium size focal left paracentral disc protrusion and/or osteophyte compressing the anterior left thecal sac. No significant foraminal stenosis.
C5-C6 level: Medium to large left posterolateral focal disc protrusion and/or osteophyte compressing the anterior left thecal sac.
C6-C7: Mild annular bulging disc. No foraminal stenosis.
C7-T1: Negative

IMPRESSION:
1. Degenerative disc disease at C4-C5 and C5-C6 as described

Here is what has been done: My pain level before starting the below, most days pain was at worst 8 to 10 but probably the majority of the time was 6 or 7
1. 5 weeks Physical Therapy and seen improvements. Pain levels down to about 4 most of the time. Using traction and all the other tools there.
2. Epidural steroid injection I believe at C6-C7 with maybe a little better but not real sure.

I just talked to the Physician Assistant two days ago and he says it is kind of up to me what the next step is sense we really do not know if the injection helped. I could get another injection, or do a diagnostic thing where they stick little needles in areas and test the nerves or live with it until I am ready for surgery.
I told him I am having issues with pain in the shoulders as the neck is a little better. Could my shoulders be contributing to my neck issues and he says probably not. I sit at a desk all day. On the weekends my pain is much less and when I return for work on Monday it starts getting bad.
I have changed my posture and got a good ergo chair now but have only been using the chair for about 3 days. The neck muscles will not loosen up. I take muscle relaxer and Mobic at night. I feel I am getting better but don’t know what to do next.

If you were me what would you do?
also i will try and attach a sample pic of MRI

[Jomar]

[I told him I am having issues with pain in the shoulders as the neck is a little better. Could my shoulders be contributing to my neck issues and he says probably not. I sit at a desk all day. On the weekends my pain is much less and when I return for work on Monday it starts getting bad.
I have changed my posture and got a good ergo chair now but have only been using the chair for about 3 days. The neck muscles will not loosen up. I take muscle relaxer and Mobic at night. I feel I am getting better but don’t know what to do next.]


YES it might be the main culprit..
I suggest reading on our thoracic outlet syndrome forum for help & tips on chronic neck, shoulder issues.
Could be the dreaded Forward head/forward shoulder postures often caused by much desk & repetitive work . many other causes & factors also.

these links should be very helpful & feel free to post there if you have questions.
http://neurotalk.psychcentral.com/thread84.html
http://neurotalk.psychcentral.com/thread125577.html
http://neurotalk.psychcentral.com/thread135.html

[ginnie]

Hello. I too have had neck issues. What you are doing is spot on. Keep up the PT at home Mike. Do all conservative things first as you are doing. Surgery is always the last thing you want to do. The emg test that you are considering, just tells them what you already know, that there is a problem. My docs agreed it really wasn't necessary as the MRI showed them what they needed to know. The steroid injections are iffy at best. Sometimes they work for folks sometimes they don't. If they don't don anything for you, don't do anymore. Sometimes doctors do them as they don't know what else to do to help. There is some risk with the injections. I had Ketamine infusions before too. They did work for me for a period of about 4 months. It was the pain specialist that said I need to go for the surgery.
You do have areas that are touching the nerves, so the pain you are experiencing is from that pressing on the nerve sac. Have you gotten more than one opinion?? That is important to do.
I hope you can find the right solution, to make your life easier. It isn't much fun to live with the pain. Let me know how you do, and if you have any questions. ginnie

[mikeymike]

I really do not have a second opinion as I guess i am not sure how to do that. I guess i would have to go back to my primary doctor and get a referral from him and go see another specialist. I did show it to my chiropractor and he kind of said yeah you have bulging discs and I can help. I have heard that one before. Although when i did first couldn't take the pain and he had got me some relief from adjustments and acupuncture after about two months of it. Then i felt pretty good and kind of stopped going. I guess i really need to find another specialist and have them look at it. Thanks for your responses

[mikeymike]

"The steroid injections are iffy at best. Sometimes they work for folks sometimes they don't. If they don't don anything for you, don't do anymore"

You said dont do anymore if they did not work. I was just wondering since they did the injection between C6-C7, do you think if they went up higher to like C4-C5 with another injection if I might get better results. I am just trying to decide whether or not to get a second just to see. I hate needles and it was a very easy process but I hear so mant horror stories. Thanks

[ginnie]

Get the other referral and go back to your primary care physician to do it. This is extremely important, and something I failed to do the first time around. I paid a terrible price for that error.
I also would tell you NOT to go to any chiropractor, even if you believe in them. Sometimes they can make a situation worse. You must have a neurologist clear you for that type of spine work. Again this is important Mike. These disks once they become squished, should be dealt with by professional neurologist or orthopedic surgeon/ doctors only. Get clearance from them before you go back to a chiropractor.
About the injections. I am not all that thrilled with them. For some people they give some temporary relief. Ask your doctor if an injection above as you mentioned if it would give some relief.
Usually if one does not work, the whole series doesn't. The risk is there to some degree with them, so I shied away from them when the first two on me didn't work. That was it for good.
What did work for me was Ketamine infusions. My spine was really bad however as I reversed the curve of the cervical area. These infusions worked for about 4 months each with next to complete relief. Again it is a needle but it didn't hurt a bit. They use fluoroscopy as well. Start to research the various things that are available to you, and get to see that other physician. There are folks on this site who can help you with your MRI and the terminology on it. Learn all you can and act cautiously in your choices. I hope some resolution can be found. ginnie

[Sitke]

Hi, how are you doing?

I totally relate to the neck muscles not losing up!

I had a cervical steroid injection and it has helped my neck probably 60% but I now have pain/tingling/numbness in my left arm/fingers and left ankle/knee.

I can tell you sitting makes my neck worse for some reason, also have had pain across both shoulders, my therapist says posture of course is very important but I'm sitting as perfectly as I can, bought a new computer chair etc and some days it's agony.

Are you going to try to see another specialist?

My Dr says I don't need to see one which is so frustrating as this pain was horrendous for months and months and finally only after the injection am I getting some kind of relief.

Am back in PT but feel it's doing nothing, feel better very soon!

[mikeymike]

Sitke

I am doing okay i guess. It just depends on the day! The more active i am, it seems i feel better. But as soom as i am back at the desk on Monday symptoms start flairing up. I do sit with good posture now and have a good chair with a neck roll. I have only been using the new chair for two weeks so i am sure it will take alot longer to get any benifit from it.

The last time i went in to see my ortho doc he kind of left it up to me whether i wanted to do another injection or maybe a EMG. I thought about it for a week and called there office back and wanted to go ahead and try one more injection, but my insurance only approved one so i have to wait for another approval.

I have been thinking about looking into the laser spine institute in Oklahoma City but I really dont know much about them or anything yet. I am going to wait on the next injection and go ahead with it. After that i will go to my primaty doctor and have him give me another referrel. The main problem is that i live in Kansas and there probably aint that many great surgeons here.

I hope we find total relief.

[mikeymike]

Well I have talked to two more places about the neck.

I first got my second opinion from Laser Spine and they say that i have three herniated discs and I would be a candidate for their surgery!

I also just went to a new orthopedic surgeon yesterday and he took x-rays and looked at my MRI.

He says that he don’t think I am anywhere near surgery yet. He thinks a lot of it is muscular and that I need more PT.

It sure is weird that 3 different places have three totally different diagnoses.

I do feel that this last one seems right I am hoping, my muscles are always very tight and I have sit at a desk for 10 years now doing engineering work and have lost a lot of muscle strength.

The PT I was going to had gotten some pretty good results just not 100%. I am really hoping he is right, because that is what my body has been telling me.

Thanks everyone! I will keep you updated.

[Dr. Smith]

Hi mikeymike,

Originally Posted by mikeymike

It sure is weird that 3 different places have three totally different diagnoses.

That's why they're called medical opinions.

I agree that conservative (PT, PM) is—excepting in certain specific circumstances—always the way to go first, and surgery not even considered until all other options have been exhausted/failed.

http://neurotalk.psychcentral.com/post1014835-57.html

On Goggle, it sometimes helps to preface search criteria with the words "scholarly" or "study".

This is no longer necessary; searches of this type can now be facilitated via Goggle Scholar.

...my muscles are always very tight and I have sit at a desk for 10 years now doing engineering work...

BT-DT, They don't let us out much, do they?

Originally Posted by mikeymike

If you were me what would you do?

If I were you (having been where you are), I would look into/consider myofascial trigger point therapy (MTPT).

I'd been told surgery is not an option for me due to severe osteoarthritis in my entire spine. MTPT was suggested/recommended to me by my first PM doctor, and for me, it's been a game-changer for the better. My therapist is a certified myofascial trigger point therapist (it does make a difference) who is also an MTPT instructor. She showed us how to continue treatments at home (saving us a small fortune not covered by our insurance). My neck now has nearly full range of motion—better than before, and the therapy (when done) reduces my pain levels by several points, and can alleviate/reduce cervicogenic headaches that result from the muscle tension in my neck.

Other PM modalities that have been successful (for me) to different degrees: PT/stretching exercises (I do several times/day, and they help), TENS, traction (over-the-door unit).

Injections never did squat, and usually made me sick/worse.

Doc