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What Does "reversal Of Norma Cervical Lordosis Centered Near The C4 Lever" Mean?

Posted on Sat, 5 Jul 2014

Question: Dr. XXXXXXX XXXX was recommended by Mr.XXXX of XXXXXXX Louisiana. I have had a CT with the following findings. There is slight reversal of XXXXXXX cervical lordosis centered near the C4 lever. Vertebral body heights are maintained but there is diffuse loss of disc space height with large ofteophytes at the levels of C3-C4 the C6-C7. No fracture is identifield prevertebral soft tissues are within normal lims. Impression Severe cervical spondylosis with slight reversal of normal lordotic curvature. No acute osseous abnormality is identified. Markeddly severe mutilevel acquired spnal stenosis. severe multilevel asymmetric foraminal encrochment on the basis of market uncovertebral and facet hypertrophy. Do you think from these findings that I would need surgery. the pain has gotten very bad and my neck hurts when I try to turn it either direction. Please give me your advise and if I should need to have surgery how soon would you recommend and would it be you, Dr. XXXXXXX XXX

Answered by Dr. Minhaj Syed (10 hours later)

Brief Answer:
conservative mode of management is the key.

Detailed Answer:
Hi,
I have gone through your reports thoroughly.First of all let me explain to you as to how bad your problem is.
Large osteophytes is a part of cervical spondylitis which may cause a little pain which in turn causes muscle spasm ( seen in the form of LOSS OR REVERSAL OF NORMAL LORDOSIS ).These findings are not much to worry about as they can be taken care of by
-- neck muscle strengthening exercises
-- Soft cervical collar
-- hot water fomenation
-- Local analgesic gel application
-- using a soft & small pillow

Diffuse reduction of disc spaces at C3-4 & C6-7 levels indicates mild IVDP ( Inter vertebral disc prolapse). Also wil be better with the above treatment.

Now comes the main cause of severe pain , i.e. uncovertebral and facetal hypertrophy causes narrowing of the neural foraminae which can cause nerve root compression which in turn can cause severe pain in the neck radiating to the upper limbs which at times can be very disturbing.However , even in such cases, results are good with conservative treatment with proper care.
-- Soft cervical collar
-- Physiotherapy
a) US Massage over the neck ( overcomes muscle spasm )
b) Intermittent cervical traction ( daily for about 2 weeks )
c) continuous cervical traction (can be done at home)
d) neurotonic medications

Please follow this treatment for atleast 2- 3 weeks .If significant relief is obtained, then please stil continue exercises and use of soft cervical collar further on. But if you don't get relieved off your pain , then SURGICAL INTERVENTION MAY BE NEEDED ( discectomy with nerve root release ). HOWEVER, I WOULD LIKE TO STRESS THAT IN SUCH CASES NON SURGICAL MANAGEMENT HAS PROVED TO GIVE GOOD RESULTS.So, please be patient and follow the conservative treatment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minhaj Syed (7 hours later)

What if, which I have, had all the above recommended treatments for 5 weeks with the physical therapy department at our local hospital with no help for the pain or the snapping and popping sounds and the pain I have in my neck. I also don't have good control of my right hand. It shakes and goes into a sleep mode several times a day. The cervical collar is of no help at all in fact most of the time when I wear it for any period of time I have a severe headache. I am on a medication called Mobic.Would you think I would be a candidate for laser surgery at the clinic in XXXXXXX Texas? Should I call for an appointment with Dr. XXXXXXX Won.

Answered by Dr. Minhaj Syed (2 hours later)

Brief Answer:
Please continue physiotherapy for another 2 weeks

Detailed Answer:
Hi,
Thanks for your query.
I still feel that you should give another atleast 2 weeks with extensive physiotherapy.Please ignore the popping sounds as this is not going to cause any harm to you.Cervical collar that you are using is probably a hard cervical collar which is very rigid and makes it very uncomfortable and may also cause headache.Please use a SOFT cervical collar.This is a little flexible and also comfortable and should not cause headache.These symptoms like giddiness and headache after use of collar is not uncommon but does settle down over a period of time(say a week) as your neck gets used to it.Until then you may experience such symptoms.These should not stop you from its use.PLEASE USE IT because it really works.
As far as the physiotherapy program is concerned , please follow these instructions.

1) Soft cervical collar all the time ( except while sleeping , while taking bath and
at time of physiotherapy ).
2) Intermittent cervical traction ( twice a day ----- may cause giddiness in some
but not to worry )
3) Ultrasound massage ( twice daily)
4) If you don't use a soft cervical collar , then the entire treatment may not be
effective since all the good that the physiotherapy has done to your neck and
cervical spine is spoiled due to lack of rest because of absence of collar.
5) While sleeping supine , please sleep without a pillow
6) Whatever you do , be it working on a system / cooking , please do so with
your soft cervical collar on.This effect will not be evident in a day.It may take
about a week for you to experience the difference but only if you follow my
advice sincerely and with good faith.
7) Losing your right hand control is also symptomatic representation of the same
disc prolapse with cord compression and nerve root compression.
7) Tablet MOBIC is an analgesic.It is a good medicine but i would prefer a
medicine with added muscle relaxant ( thiocolchicoside ) as an ingredient.
8) I therefore sincerely advice you to continue with the conservative mode of
treatment for somemore time.
9) Since you have done a CT SCAN in which the cord , roots cannot be commented upon competitively , i advice you to get an MRI SCAN of your C-SPINE done.This can confirm our diagnosis and will also give a clear picture which will help us deal with this alot better.

please do follow my advice and please get back to me with more doubts and questions so that i can make you feel better both medically and mentally.

Hope i have answered your question.
Wishing you a speedy recovery.
DR.SYED MINHAJ XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Minhaj Syed (22 hours later)

I have sent reports and MRI disk to Dr. XXXXXXX Shah today by priority mail and Dr. XXXXXXX my family doctor, has sent by Fax my reports. Dr. Shah's office called me Wed. afternoon and requested this so he could look them over then call me and set up an appointment. My question is as follows: I have a small problem with my food going down the
esophagus. It seems like it sort of stacks up and slowly goes down. Could the disk in my neck be pressing against the esophagus causing this and in the past few days is pain has increased.

Answered by Dr. Minhaj Syed (31 minutes later)

Brief Answer:
This is not because of disc problem.

Detailed Answer:
Hi,
Thanks for the question.
This problem of the food stacking up and going down slowly CANNOT BE DUE TO YOUR DISC PROBLEM. IT IS IMPOSSIBLE. The disc moves posteriorly (towards the back) but the oesophagus is anterior (in front).Hence it cannot compress your oesophagus.
Please consume food which is a little soft and not very solid & hard.Drink lots of water.This should take care of it.
Please be assured that this is nothing to be worried about.

Hope i have answered your question to your satisfaction.
regards.
Dr.Syed Minhaj XXXXXXX

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Yogesh D