Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I need a third opinion regarding the condition of my spine. Please advise.
Hello,
Welcome to icliniq.com.
You have not mentioned anything about clinical symptoms and the duration, and why you need a third opinion. Based on one gross cross-section T2 sagittal plane cut, there is a straightened cervical spine, with some degenerative osteophytes and some mild reduction in disc spaces at multiple levels. There however, is not much of a central canal narrowing or disc bulge impinging on the cervical cord. I however, cannot say anything about a more lateral disc protrusion. What is your actual query, and what medications are you on? I will like to know the answers to be able to help you further.
Patient's Query
Thank you doctor,
I will share some additional MRI files with you. I had them uploaded and received a reply from another doctor. However, I did not clearly understand why he recommends the surgery that he said I needed.
I have burning pain every day for six months inside the red circle. Which injury is causing pain there? I am currently taking Cyclobenzaprine, Celebrex, Voltaren sodium topical gel, and Nortriptyline. One doctor said that I needed cervical stabilization surgery. Please guide.
Hello,
Welcome back to icliniq.com.
The films you have sent (attachment removed to protect patient identity) show lumbar scoliosis, straightened or even reversed cervical lordosis, and some degree of encroachment of the spinal canal, but axial cuts would have been more helpful.
Now coming to the reports, the MRI (magnetic resonance imaging) of the cervical spine and the lumbar spine have pathology mentioned. Still, it is the next that is responsible for the burning pain between the shoulder blades, the marked red area.
You will need surgery only if there are persistent pain and failure or conservative treatment. I am not sure what is the exact treatment that you are taking. I hope you have had wash modalities. Are there any improvements or worsening? What about Pregabalin and Duloxetine? Have you not been started on those? What about different muscle relaxants, neck collar, and manual therapy?
Patient's Query
Thank you doctor,
With this chat feature, I do not have an option to upload the MRI images. Would you like me to send them through the other method? That way, you can review in detail and advise what you think is the best next step for me?
Yes, I think that a neck collar would be helpful. I have had persistent pain with cervical kyphosis for the past two years. But now it has improved, but the muscles around the neck and shoulder are in constant spasm so much that it looks like a huge mass on my neck and shoulder. So the doctor thought it was a tumor. My right hand is constantly numb and tingling and often cold to the touch. I suffer from migraine headaches as well. What are your thoughts on the thoracic MRI report?
Hello,
Welcome back to icliniq.com.
Sorry, there is no way to share the films with me except through this portal. The thoracic spine appears to be showing signs of degeneration and disc bulge. The thoracic cord does not show any myelomalacia changes.
You can try the neck collar for worse periods of spasm but not when your neck is without spasms. You should also see a manual therapist helping with the myofascial release and strengthening the neck muscle. Finally, the Pregabalin and Duloxetine refill help with the pain. In the marked red area, the pain is coming from the neck, and that is where you need to focus. Trigger spot injection can be tried with Lignocaine.
Patient's Query
Thank you doctor,
I will send you the MRI images. Please give me all the details and tell me if surgery will help my condition.
Hello,
Welcome back to icliniq.com.
It took some time looking at the lot, including the axial cuts, and it only clarifies that surgery is, in my opinion, not currently indicated. The only thing to add is flexion and extension views the cervical spine should be done to rule out any instability, and that may be the only thing that is not visible.
There is no mention of any radiculitis in your history, and neither is there any mention of that in the MRI report (attachment removed to protect patient identity).
Also, instead of getting panicky, I am sure your treating doctor will address all the issues as I cannot examine you and assess your symptoms fully. The surgery decision can be opined upon if there is a clear mention of why the surgery is being done, the intended benefits, the surgical procedure, the complications, and the likelihood of recovery.
Patient's Query
Hi doctor,
Thank you for your kind help.
Hello,
Welcome back to icliniq.com.
You are welcome. Keep in touch for further doubts.
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Orthopedician and Traumatology
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Orthopedician and Traumatology
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