Dr Joshua, I have had Cervical Neck pain off and on for 10 years. (I am a nurse) In the past 6 months it has gotten worse. I saw my doctor when I developed numbness in my left ring and pinky fingers. I received epidural blocks, and the numbness went away. However the pain continues on. I have trouble sleeping, driving hurts, and does housework and lifting just about anything. I had a Myelogram done with the results as follows “C3-C4 mild right formanial narrowing secondary to small uncinate spur with flattening of the anterior dura. No significant nerve root sleeve defect is present. “ My question is, what does this mean, and does it indicate a need for surgery? Thank you so much,

Dr. Joshua’s Answer:

Whether you need surgery or not is a something to be discussed with your own doctor. Such judgements are based on history, thorough physical examination, and skilled interpretation of the radiology findings.

I’ll give you some information though. Myelogram is an invasive procedure and is not normally the primary examination for such problems - MRI is the modern examination of choice. However, the myelogram has provided the necessary information (it is definitely a good examination, when properly done, but it is usually reserved for situations where additional information is required after an MRI), and it seems that there were no findings that would explain your symptoms. If I had to make an educated guess based on the limited information available to me - I would guess that surgery is not needed.

First, the foraminal narrowing (meaning just that - narrowing of the “hole” through which the nerve root passes) is on the wrong side and wrong level compared to your numbness. Second, there was no nerve root sleeve defect meaning that the nerve root is not compressed anyway. Third, surgery is not the solution for neck pain. Neck pain as a rule cannot be relieved by surgery. Surgery is reserved for cases where there is radiating pain to the upper back / shoulder / upper extremity, a clear nerve root distribution of the symptoms, matching the radiology findings. Even then, observation and conservative treatment is almost always an option. Surgical treatment is required if there is a clear motor weakness, or symptoms of spinal cord compression.

These are the general principles. As I’ve said before, medicine and surgery are practiced on a case by case basis, so you’ll need to talk to your own doctor about your treatment options.

Neck pain is often muscular by origin. Local injections of anaesthetic+steroid to the trigger points may be of benefit. Also, a consultation with a physiatrist might be in order.

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