Good morning! Knowing you all are not physicians, I do find that you offer terrific advice having been there and done that!

Over the past six months, I've had three sets of epidural at three levels, one round of facet injections at three levels, rhizotomies at three levels, and one purely diagnostic facet block injection at C6-7.

The following are my MRI results:

Cervical vertebral stature is preserved, with no acute marrow signal abnormalities. There are predominantly fatty (Modic type II) endplate degenerative signal changes especially at C4-C5 and at C6-C7, and there is anterior disc bulging/osteophyte formation at these 2 levels. No Chiari malformation is seen. There is degenerative disc signal loss at C3-C4 through C6-C7, with diminished disc stature especially at C4-C5 and C6-C7. The slightly small C2-C3 disc most likely is anatomic in nature. There are facet degenerative changes at several levels, most notably at the upper-mid cervical levels on the right. Straightening of the cervical lordosis could be related to patient positioning, muscle spasm or a chronic finding.

C2-C3: Normal posterior disc contour, and normal central canal caliber. Moderate right foraminal encroachment, predominantly secondary to right facet bony overgrowth. Patent left exit foramen.

C-3-C-4: Slight C3 on C4 spondylolisthesis, probably secondary to right facet hypertrophy predominantly. Associated posterior pseudodisc bulging, without a significant true disc bulge component, and with central canal caliber normal. Mild right uncovertebral joint degenerative change. Mild right foraminal encroachment. Patent left exit formen.

C4-C5: Mild posterior disc bulging, with osteophytic ridging about the vertebral bodies, and predominantly the right uncovertebral joint. Relatively normal central canal caliper. Minimal right lateral recess encroachment at the disc level. Moderate-severe right and minmal left foraminal encroachment.

C5-C6: Slight posterior disc bulge. Normal central canal caliber, and patent exit foramina.

C6-C7: Mild broad-based posterior disc bulging, with osteophytic ridging about the vertebral bodies, and bilateral uncovertebral joint degenerative changes. Mild central canal narrowing, and mild left lateral recess encroachment at the disc level. Moderate left and mild-moderate right foraminal encroachment.

C7-T1: Questionable slight posterior disc bulge on the T2 sagittal. Normal central canal caliber, and patent exit foramina.

I had a consult with an orthopedic surgeon a week ago. The appointment lasted no longer than 15 minutes. He said fusions should be considered at C4-5 and C6-7; however, due to a relatively good C5-6 level, it would require fusing all three levels, which he said he would not do. He recommended a diagnostic single facet block in C6-7, which he belives is causing "most" of my pain. The block provided minimal relief.

I had consult #2 yesterday with a neurosurgeon. The appointment lasted over an hour. He reviewed my MRI with me on the computer monitor to show and describe exactly what he believes is causing my pain. He gave me three options:

ACDF at C6-7, but said I needed to be realistic because the surgery may not improve my pain due to all of the other issues in my c-spine, and there was a possiblity of needing further surgery in three months or so.

Posterior fusion of C3-4, C4-5, C5-6, and C6-7. Even though this surgery is definitely a major undertaking, he feels it would take care of all the problems.

Posterior and Anterior fusion simultaneously in one procedure. This sounded like "belt and suspenders" to me, and I honestly don't remember everything he said about this!

I will be having a consult with another neurosurgeon next week.

In the meantime, I wondered if any of you would be so kind to give me any advice you may have. Thank you all in advance and sorry for the very lengthy post!

Kate