Everyday we get many emails. Some of these emails concern neck pain. In many of these emails the person asking a question sends me their cervical neck MRI findings. That is all they send: A cut and paste of their MRI report. They never say what their pain is like, how this neck pain is affecting their day to day quality of life, or any other glimpses into how this chronic neck pain is hurting them. The email that they send me is all about their neck MRI. Our own clinical findings and that of researchers is that maybe your neck pain should not be all about your MRI.It should be about you.
As many of you are already aware, MRI interpretations can be a long, hard to understand, somewhat frustrating thing for a patient to see and read. The MRI may also seemingly describes a lot of problems with a lot of terminology that can be considered frightening. This may, for many, cause unneeded anxiety and fear. I have been doing regenerative medicine for more than 20 years. Over the years we have been blessed to have helped many people with their neck pain. I have seen patients with varying degrees of degenerative cervical spine disease trying to avoid surgery, I have also seen patients after a cervical neck surgery with more challenges than before the surgery who, unfortunately, may have had a surgery that they did not need. The one thing many of these people had in common was a cervical neck MRI that suggested a lot more problems than the patient was actually having.
Is the neck MRI really showing what my problem is?
Interpreting MRIs can be challenging. In a recent study from March 2019, (1) researchers found the most prevalent MRI findings were:
- Cervical foraminal stenosis (77%)
- The foramen is the gap or passages between the vertebrae that the nerves pass through. If this passageway is made narrower by bony overgrowth there is obviously less space for the nerves to pass through. Over time this passageway can close up enough that the nerves are “pinched.” Why does the bone overgrow? Bone overgrowth can be caused by spinal instability. When the cervical spine is unstable, loose, or wobbly, neck moves in an unnatural motion. Cervical neck instability is generally caused by stressed, weakened and damaged spinal ligaments.
As bad as it may look on an MRI, cervical foraminal stenosis, may not be causing the patient any problems: We have seen this clinically and researchers have seen it and reported it in their published studies:
In the Clinics in orthopedic surgery,(2) surgeons wrote: “Cervical foraminal stenosis is one of the degenerative changes of the cervical spine; however, correlations between the severity of stenosis and that of symptoms are not consistent in the literature. Studies to date on the prevalence of stenosis are based on images obtained from the departments treating cervical lesions, and thus patient selection bias may have occurred.”
The surgeons suggested that the patient was treated based on what the MRI said, not what they patient said was wrong with them. Perhaps this is why when people send me an email, some never suggest what their symptoms are, only what their MRI said. In this study, the surgeons also suggest that patients may have been sent to surgery that was suggested based on the bias of the MRI interpretation. A surgery the patient may have not needed at all.
Returning to our initial overview of most prominent MRI readings, next came
- uncovertebral arthrosis (74%)
- This is wear and tear damage occurring at the uncovertebral joint or Luschka’s joint, located on each side of the four cervical vertebrae at C3 to C7 in the cervical spine. This is where bone spurs most commonly develop.
- and disc degeneration (67%)
- This is of course are the problems herniated or pinched nerves.
Do these problems indicate surgery? Research: “It is difficult to rule out the possibility of bias; radiological findings may influence surgeon’s decision making.”
Let’s look again at the study in the Clinics in orthopedic surgery.
- “Cervical neuromuscular disease is manifested by symptoms in specific neuromuscular regions of the upper limbs, and radiating pain is mostly caused by cervical nerve root compression due to stenosis of the cervical vertebrae. In the presence of progressive neurological deterioration, intractable pain, signs of myelopathy, fracture, instability, or ligamentous injury, and bone anomalies or destruction are associated with surgical indications.
- “However, (this can all be) asymptomatic. To determine the affected level that requires cervical spine surgery, the patients undergo neurological and physical examinations and then both CT and magnetic resonance imaging (MRI); if the results do not match, additional neurophysiological testing is required to determine the affected level. However, if neurological examinations are performed after radiological examinations, it is difficult to rule out the possibility of bias; radiological findings may influence surgeon’s decision making.”
Sometimes surgery is recommended. But should it be for you?
This is a good question and one that certainly needs to be answered inside an examination room. However, returning to our initial overview of the most prominent MRI readings, let’s look at the least prevalent finding:
- nerve root compromise or compression (2%)
Now if you are in that 2% there is a strong chance that you are suffering from cervical radiculopathy or pain from the nerves. In theses cases surgical options may have to be considered, but, a second opinion looking for non-surgical options may also be warranted.
In my article on this website: Why do patients rush to cervical neck surgery? Fear of disability? Fear of opioid addiction? I write that I regularly see patients who have been told by another doctor that they need a neck surgery to prevent the further degeneration of their cervical spine. Some of these patients are very frightened by what their doctor told them. Some were told that if their symptoms progress they could risk permanent damage to their ability to function maybe to the point of paralysis. I show that research has strongly suggested that many patients decide on cervical fusion surgery because they fear a progression of their problem that will lead to permanent disability. However, follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time.
Treating cervical ligaments to restore neck stability
In our office, treating chronic neck pain begins with the repair and strengthening of cervical ligaments. Our treatments, discussed below and demonstrated in the video are Platelet Rich Plasma Injections and Stem Cell Therapy injections. Ligaments are the connective tissue that hold your cervical spine vertebrae in place and your neck in its correct anatomical alignment. When your ligaments are weak, they can no longer hold the neck in proper alignment. When the neck is not in alignment the vertebrae can pinch nerves, constrict arteries, put pressure on your esophagus among other problems that may cause the myriad of symptoms people relay to us in their emails.
Injecting the platelets or stem cells right along the ligaments or on the facet joints. This can help restore neck stability and reduce or eliminate pain. I have had this done to my neck to help alleviate my neck pain.
C1-C2 instability and a reverse curve
Of the many emails that I get are ones which discuss C1-C2 cervical spine instability. Many emails will talk about chronic upper cervical subluxation at C1-C2 and a reverse curve. The normal curve of the spine is shaped like a backwards “C.” If you have a problem with your neck, Lordosis is probably a word you are very familiar with. When your curve went from a natural “C” shape to a reverse curve you were probably told you had a reversed lordosis or your neck had become Kyphotic. Your neck is now curving in the opposite direction. This may be causing a lot of pain. Some of the pain maybe from muscle spasms. As the muscles are trying to stabilize the spine, the extra workload causes spasms.
When the spine is moving towards a reversed curve, adjacent segments may show cervical disc degeneration at lower levels such as C2-C3, C3-C4. These are the problems which will lead many people to a cervical spine fusion.
Our treatments to restore cervical neck stability by repairing and regenerating the neck ligaments
Many patients with these problems will talk about dizziness or even Bell’s Palsy. They also talk about 2 – 3 times a week chiropractic adjustments. When the patient says they are having success at the chiropractor with their cervical lordosis and their symptoms of dizziness, we know that we can have a realistic expectation that we can help.The chiropractic is helping because the vertebrae are pushed back towards a natural alignment. The reasons that the patient needs to see the chiropractor 2 – 3 times a week is because the the adjustments are not holding. We do get many referrals from chiropractors to help their patients by strengthening the cervical ligaments with our injection treatments.
Platelet Rich Plasma injections
PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of cervical spine ligament instability.
Stem cell injections
Stem cell injections involve the use of Bone Marrow derived stem cells.The stem cell treatments help restore ligaments strength by causing the regeneration of ligament, tendon, cartilage and bone regeneration.
In our articles we discuss these treatment options
- Neck pain and its relationship to TMJ
- Cervical spine degenerative disc disease and surgery
- Whiplash and hyper-extended injury
Do you have questions? Ask Dr. Darrow
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician.Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.
1 Jensen RK, Jensen TS, Grøn S, Frafjord E, Bundgaard U, Damsgaard AL, Mathiasen JM, Kjaer P. Prevalence of MRI findings in the cervical spine in patients with persistent neck pain based on quantification of narrative MRI reports. Chiropractic & manual therapies. 2019 Dec;27(1):13.
2 Ko S, Choi W, Lee J. The Prevalence of Cervical Foraminal Stenosis on Computed Tomography of a Selected Community-Based Korean Population. Clin Orthop Surg. 2018 Dec;10(4):433-438. doi: 10.4055/cios.2018.10.4.433. Epub 2018 Nov 21.