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Cervical Spine X-ray Findings - pls help or advice.

Hi, I would appreciate any advice if and what type of non-invasive treatment options i should look. 48yr, male, non-sedentary lifestyle, do yoga routinely, vegetarian, low on b12,iron; Live in very cold east coast NA region (temp -5 to -26 Dec-Feb).

I have been feeling pain in back/upper back shoulder, sometime in front of center of chest, and stiff neck and right shoulder pain...sometimes dizziness.

Doc did ecg and said most liklely muscular; Doc ordered X-ray (not MRI?) and findings are as following:
- cervical vertebral c1 to bottom of t1; normal height & vertebral body height are preserved
a. slight loss of disc height at c6-c7
b. bilateral neural foraminal narrowing at c3-c4 & c4-c5..seems pronounced on the right
c. mild right neural foraminal narrowing c5-c6

I have been really worries and read some forums and comments (e.g Gaelic) that every radiologist interpretations are different. I also read sometimes the conditions improve w/o major interventions.

could someone please advice; should i ask for mri to confirm/clarify findings, what these means (serious?), cause?, and what could i do to reduce the symptoms (started 6 weeks ago after/from the day in gym when weight training unconditioned) or how to treat it (yoga, massage, swimming, medications) or how to permanently remove the condition.

Many thanks in advance for your time/guidance and much appreciated. Looking forward to it.
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replied February 14th, 2013
Especially eHealthy

The slight loss of disc height could be due to early disc degeneration. This is one of the early signs. As the disc looses water content, it is not as able to withstand the compressive forces on it, and the disc tends to bulge outward (sort of like on underinflated tire). Thus, a decrease in disc height could be an early sign of DDD (degenerative disc disease).

You also have some narrowing of the neural foramina. The term foramen just means "hole". So, the neural foramina are the holes through which the nerve roots exit the spinal canal. If these are significantly narrowed, there can be pressure on the exiting nerve roots.

Unfortunately, cervical and thoracic x-rays are not really the best studies to look at these structures. Everything is basically done by inference, as x-rays cannot look at soft tissues directly.

So, if there is concern on a physical exam that there may be nerve compression in the cervial region (symptoms of nerve compression going down into the upper extremities) or significant DDD, then an MRI may be necessary.

Usually, an MRI will not be ordered until the patient has "failed" conservative therapy for at least six weeks. So, a short period of rest followed by gradual return to full activity, along with maybe some over the counter NSAIDs, heat/ice (patient preference), physical therapy for those patients who are significantly out of shape, massage, chiropractice, traction, whatever makes the patient better, is usually tried first.

If this does not significantly relieve the patient's symptoms or the patient develops worse symptoms or neurological symptoms, then an MRI is usually obtained. Nowadays, MRI have become a lot more common. When it was first developed (a few decades ago) it was only obtained for surgical planning. The surgeons relied a lot more on history and physical exam, but again, nowadays, patients prefer for the physicians to get all of the high tech imaging studies (and some of them are really cool).

Hope you are feeling better. Good luck.
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