My neck pain and headaches have been getting worse lately, and I noticed that they are significantly worse when I am upright for longer periods of time. I also started getting headaches that are either (or possibly both) occipital neuralgia or trigeminal neuralgia. After some research, I discovered that sometimes these symptoms can be due to craniocervical instability (CCI) which is common in people with connective tissue disorders. To see if CCI is causing any problems, they use an upright MRI.
I talked to my neurologist about it, and he agreed an upright MRI could show us something that my supine (flat on my back) MRI had not. He found a place nearby that did them, and filled out the orders for me.
First of all, no one talks about how extremely painful these MRIs are if you have anything wrong with your back or muscles. This was, hands down, one of the most painful imaging tests I have ever had. You have to sit perfectly still and totally upright for about 30 minutes (at least for the cervical MRI set). I was in excruciating pain for several days after the test.
My results did not show any problems related to CCI that I had been worried about – Chiari malformation, bone shifting that pinched on the spinal column or brain, etc. However, there are a lot of other problems in my neck that were not there in the MRI I had a year and a half ago. We’re not sure if some of them just weren’t visible in a supine MRI or if they really have all happened in the past two years. Either way, it’s frustrating.
There are seven vertebrae in your neck, and they’re labeled C1, C2, … C6, C7. There is no disc between C1 and C2, but all the rest have discs in between them. Discs are a semi-rigid exterior (rubbery) with a fluid filled interior; they cushion the vertebra, allow your spine to be flexible, and help distribute pressure through your back. Discs are labeled by the vertebrae they’re between: C2/3, C3/4, … C5/6, C6/7. There is a disc between C7 and your first thoracic vertebra, and that one is labeled C7/T1.
The spinous process is the part you can feel when you run your finger down someone’s back. Muscles connect to the spinous process, which is why we don’t look like we have spines down our back. The discs sit on the vertebral body (C1 and C2 have different anatomy and do not have a vertebral body which is why they do not have a disc), and that is the part of the vertebra that supports weight. The vertebral foramen is where the spinal column runs, which consists of a fluid filled sack that surrounds and cushions the actual spinal cord. The nerves that run into your body from your spinal cord (every single nerve in your body is connected to spinal cord, that’s why spinal injuries can be so severe), exit through the transverse foramen (plural: foramina). The transverse process is the part of the vertebra that connects your vertebra together and keeps them in a nice column.
The Good News
I do not have any spinal stenosis (narrowing of the spinal column) or pinching of the spinal cord, and no changes in my bone marrow or anything like that. I also no longer have a pinched nerve – two years ago one of my discs was bulging into the transverse foramen and pinching a nerve that ran into my right shoulder. Disc C2/3 is perfectly healthy. Unfortunately, this is where the good news ends.
The Bad News
Discs C3/4 through C6/7 are all moderately to severely desiccated. Yes, discs C3/4, C4/5, C5/6, and C6/7. As I mentioned above, discs are supposed to be fluid filled. Desiccation means “to dry thoroughly” or “dry up” (from dictionary.com). Therefore, four of the five discs in my neck are moderately to severely dehydrated. When discs dehydrate, they are not as efficient at absorbing shock and pressure, nor as effective at lubricating the joint. In the below image, the blue arrows point to the desiccated discs in my neck; you can see the desiccated discs do not have a light center like the other visible discs in the image.
Desiccation can cause disc space narrowing (meaning, the disc is starting to collapse, which narrows the space between the vertebrae). Thankfully, that hasn’t started to happen to all of the discs. Unfortunately, the disc space has started to narrow at C4/5 and C5/6. This technically isn’t degenerative disc disease yet. My physical therapist was saying that your discs have phases: minor disc desiccation, moderate/severe disc desiccation, early degenerative disc disease, and then degenerative disc disease. I have early degenerative disc disease in my lumbar spine. We will be working on my neck, and hopefully can slow the progression of the disc degeneration.
The vertebral bodies at C5/6 and C6/7 are also developing bone spurs and have “minimal endplate degenerative change.” The endplate is the flat surface of the vertebral body that the disc sits on top of. These bone spurs are on the vertebral bodies facing in towards the disc space. Sadly, this is the beginning of arthritis in my neck. It’s not to the point where it would be called arthritis yet, but it will head that way. There’s not a whole lot we can do about it, other than try to keep my neck loose and flexible in a safe way.
I also have three bulging discs in my neck. Luckily, all minimal. The bulge at C4/5 is the smallest. The bulging discs at C5/6 and C6/7 are the same size. All three of the bulging discs are bulging in towards my spinal column, but none of them are pressing on my spinal cord and none are narrowing the neural foramina (the transverse foramina in the graphic above). Bulging discs can definitely be fixed via proper exercises and lifestyle changes.
We’ll continue with physical therapy, with a greater focus on my neck. Neck pain can dramatically impact quality of life, so we will be focusing quite intensely on my neck in the hopes that I can postpone the pain as long as possible.
I really didn’t want this MRI to show as much as it did. I’m grateful we found it now, while it’s in the early stages of everything, but I’m frustrated. These findings mean I will have some level of pain in my neck for the rest of my life.
I will not be getting a neck brace. Braces, on any joint, cause your stability muscles to deteriorate. The longer you wear a brace, the more your body requires that brace. I only have soft braces, with the exception of my silver ring splints and a few of my wrist splints, that I only use for added stability during exercise or during injury. And I can tell that if I wear them too long, my joints are weaker and hurt more when I take them off.
Hopefully, through the use of exercise and lifestyle changes, we can significantly minimize the impact these findings will have on my daily life!