There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

The main site has all the formal medical articles and videos for you to research on.

Not a candidate for physical therapy

I'm 44 years old and I've had an aching neck and shoulders that stirs up chronic migraines for at least 10 years. I also had a bad fall 3 years ago that caused me to go to my gp, but he never had my neck xrayed. On 10/22/18 my c5-c6 disc extruded onto my spinal cord. It was a new kind of pain and a couple weeks later I went to my gp because of the pain/weakness/tingling in my arms and severe pain in my neck. They took xrays, which led to an mri on 11/13/18. There was some sort of mix up with my referral, and I ended up calling my gp's office because weeks had gone by and I hadn't heard from anyone. I eventually talked to my gp, and she said I need surgery and that my neck's "a mess" and I'm "not a candidate for physical therapy", so I'm waiting to hear back from a neurosurgeon. Hopefully this week, because the disc herniated 6 weeks ago and I've been having a very hard time functioning with the pain and weakness. 

Anyway, I was hoping to be able to at least try physical therapy and wasn't expecting to have to go straight to surgery. I haven't really had my mri explained to me, and waiting for the neurosurgeon seems to be dragging on forever. 

Here's the mri results I got. I've tried to decipher it all but don't have anything to compare them to, so if anyone has any input or insight, I'd be grateful to hear it. I'm sure I'll hear more from the surgeon, but I'm not sure whether I should try and get some other third opinion from someone who's not a surgeon? 

Cervical vertebral body height and alignment is normal. Atlantooccipital and atlantoodontoid relationships are preserved. There are Modic type II endplate degenerative changes at the C3/C4 level. No aggressive osseous lesions. The cervical cord is normal
in signal. Visualized paravertebral soft tissues are unremarkable.

C2-3: Unremarkable..

C3-4: Shallow broad-based posterior disc osteophyte complex effaces the ventral thecal sac resulting in moderate central canal stenosis. No significant foraminal stenosis.

C4-5: Moderate posterior disc osteophyte complex effaces the ventral thecal sac resulting in flattening of the ventral cord and moderate central canal stenosis. Facet arthropathy and uncovertebral joint hypertrophy contribute to mild to moderate right 
foraminal stenosis. The left neural foramen is patent.

C5-6: Moderate broad-based posterior disc osteophyte complex with a central disc extrusion. There is effacement of the ventral thecal sac and flattening of the ventral cord resulting in moderate-severe central canal stenosis. Uncovertebral joint 
hypertrophy contributes to moderate right and mild left foraminal stenosis.

C6-7: Unremarkable.

C7-T1: Unremarkable.


Moderate multilevel cervical spondylosis as detailed above. 

At the C5-C6 level there is a broad-based posterior disc osteophyte complex with a central disc extrusion that flattens the ventral cord and results in moderate-severe central canal stenosis. Moderate right and mild left foraminal stenosis at this level.



  • LizLiz Posts: 9,699

    Hello howl 

    Welcome to Spine-Health 

    No one on the Spine-Health patient forums is medically qualified or permitted to provide any advice or recommendations on any diagnostic test. However, the following key words can always be applied.


    MILD Treated with conservative measures such as Physical Therapy and mild medications. Many times these situations can be cleared up and the condition can be resolved.


    MODERATE Some more treatments may be needed, ie Spinal Injections, Ultra sound and stronger medications. Always a possibility of more aggressive treatment if the conservative measures don't help 

    SEVERE Need for stronger medications. The requirement for surgery may be necessary


    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Are you a candidate for injections?

  • advertisement
  • howlhhowl Posts: 11
    edited 12/03/2018 - 8:52 AM

    Thank you Liz and L4_L5. The gp said the injections wouldn't help either, and I really need surgery. All I've had for medication/treatment so far is ibuprofen and flexeril. Heat and cold packs. I tried prednisone pills in the beginning, 2 weeks after the disc herniated, but I can't tolerate it and only made it through one dose (I've taken it many times over the years due to asthma and my reactions to it have gotten worse and worse). 

  • I would question the GP’s authority if I were in your shoes because a GP is not a spine doctor.

    The person I listen to is the neurosurgeon for stuff like this, not a GP.

  • Thanks L4_L5. Ya, I'm not really trusting much these days. 

    Here's the results from the xray I had on 11/2/18.

    X-Ray Results:

    TECHNIQUE: 5 views of the cervical spine were obtained.


    SOFT TISSUE: No prevertebral soft tissue swelling is seen.

    BONE: There is preservation of the vertebral body heights. There are multiple level of uncovertebral joint degeneration, worse at C3-4.

    FACET: There are multiple level of facet joint degeneration. No facet dislocation is seen. There is mild right C3-4 and mild to moderate right C5-6 bony foraminal narrowing. The left foramina are not very well seen. There is narrowing at the left C3-4, 
    C4-C5 and C5-6. The degree of narrowing is not clear. If the patient symptoms are not relieved with physical therapy, consider MRI of the cervical spine for further evaluation.

    SPINE CURVATURE: Appears unremarkable.

    DISC SPACES: Moderate to marked C3-4 and moderate C5-6 disc space narrowing is seen.

    IMPRESSION: There is evidence of lumbar spondylosis is noted. Finding suggestive of bony foraminal narrowing. If the patient's symptoms are not relieved with physical therapy then consider MRI for further evaluation.

  • advertisement
  • Update:  I met with a neurosurgeon today and it looks like I'm having a 2 level Mobi-C ADR at c4-6. I have canal stenosis at c3-4 also, but the surgeon thinks we can leave that alone for now because the bone spurs have basically already fused it, and he recommended going with the 2 level ADR and keeping my mobility while I can.

    I'm doing some research on 2 level Mobi-C tonight just to be sure it's what I want, but the surgeon seemed great and I've talked it over with my spouse and I'm planning on calling back tomorrow morning to schedule the surgery for as soon as possible. 

  • nutcase007nnutcase007 United StatesPosts: 953
    howl - I'd suggest you discuss the trade-offs of any facet deterioration at the proposed ADR replacement sites.  I had tried to get my neurosurgeon to implant some ADRs in my neck (I'm fused from C2 to C7) in attempt to retain some mobility, be he told me that when his patients have facet deterioration, he does not recommend ADRs.
    Every surgeon has different criteria for ADRs and I'm not questioning your surgeon's recommendations, but it could be worth having that conversation.  I hope you are a candidate for ADRs.  I do miss the mobility.  The facet side of my cervical spine was trashed by severe whiplash plus multiple discs were ripped from the vertebra.    

  • howlhhowl Posts: 11
    edited 12/13/2018 - 11:14 AM

    Thanks for the input, nutcase :)  Sorry to hear about your injury, that sounds rough. Hmmm, I'm not sure how bad my facet deterioration is. He did mention my nerve stenosis, but didn't think it looked too bad. I guess I'm looking at it like it's worth the risk to keep my mobility for now. Maybe my c3-4 will need addressing down the road, and maybe the facet joints will be a problem, at which point I might need fusion. But I'm only 44 and would really like to keep my mobility as long as possible. I don't mind some pain (I'm soooo used to it), but the myelopathy is seriously diminishing my quality of life, and I believe this surgery will correct that. My c5-6 canal stenosis looks to be the worst, and that should be taken care of by this surgery. My biggest hope is for the weakness in my arms to go away.

    My 2 level artificial disc replacement with Mobi-C at c4-6 is scheduled for next Friday, 12/21. I'll post how it goes in the recovery thread. 

Sign In or Join Us to comment.