Question: Hi was diagnosed cevical spinal stenosis (MRI) and possible fibromyagia in last three years as a slowly degenerating condition over 25 years, has been called chronic fatigue M.E. poly arthritis (but little swelling of joints) just moderate pains to nearly all joints and muscles, chronic clinical depression with suicidal thoughts has developed over years along with moderate to severe anxiety that is common but varies.. Currently on 150mg Lyrica twice daily, Pristique 100mg once daily, Clonazapam 2mg once nightly and Panadien forte (30mg codiene 500mg paracetamol) now using up to six per day. Pains and fatigue have been moderate to severe past few months and increasing so exercise does not seem to help and common headaches radiating form right base of skull up over and behind right eye. circadian rythem varies consistently, severe lack of libido, motivation energy and drive. Bowel movement difficulties with variable rectal pain. urine usually normal but occasionally must wait for minutes before flow but usually ok once starts,sometimes slow. Have had on nerve root sleeve cortisone injection in neck two years ago but feel like i need three in one hit. possible central passage slight impingment and three exit foramina problems. I visit GP regularly and have been an out-patient at pain clinic at Sir XXXXXXX Gardiner Hopital. Perth Western Australia for over two years although little has changed and is worsening. Neurological surgeon suggests surgery may be an option one dat but wish to wait as long as possible. Had adverse reactions to Tramadol and Lithium for depression was unsuccessful with rapid weight loss resulting. Original cause possibly as result of work place accident where neck was compresessed forward and to the side. Can you suggest who the top specialists are in this area in Australia as I feel I need a second opinion. Unfortunately I am a public patient and have bee on disability support for approx thirteen years

Dear Dr Bain,
I live in Perth Western Australia and not Sydney in New South Wales. My diagnosis to-date requires the second opinion and recommendations of a neurological surgeon and pain management specialist (I know that)not an Orthopedic surgeon or Rheumatologist as my rhematoid count is nil (as is my thyroid normal and testosterone levels). I do not consider I have any major general Arthritic problems although it may feel as if I have at times along with considrable generalised poly-myaglic pains but as I have already explained I have very little swelling.
I do hope you can provide me with some information of value.
If you are unable to please arrange to have my credit refunded or notitify me immediately of your intentions that I may take immediate appropriate actions Following you will find the summary of the radiolologist's report which is now dated over two years and further deterioration has occured.
Kind Regards
XXXXXXX

CLINICAL DETAILS
Long history of previous trauma in right C5/6 foraminal stenosis.

FINDINGS
Mild degenerative retrolisthesis between C3/4 and C6/7. Otherwise
normal cervical spine alignment.

C1/2 and C2/3: Normal.

C3/4: Broad right central disc protrusion with uncovertebral joint
hypertrophy. Central canal is patent as is the left neural foramen.
Moderate to severe right foraminal stenosis, with possible
impingement of the right C4 nerve root.

C4/5: Small-moderate focal left paracentral protrusion indenting the
anterior thecal sac. Left uncovertebral joint hypertrophy. Mild
central canal narrowing. The neural foraminae are patent and in
particular, there is no significant right foraminal stenosis.

C5/6: Advanced disc degeneration with moderate posterior disc bulge.
Mild left and severe right uncovertebral joint hypertrophy with
probable impingement of the C6 nerve root.

C6/7: Moderate disc degeneration and prominent bilateral
uncovertebral joint hypertrophy. There is moderate to severe left
foraminal stenosis and similar changes on the right. There may be
impingement of the both C7 nerves root at the neural foramen.

C7/T1: Normal disc contour. Mild bilateral uncovertebral joint
hypertrophy. No significant spinal stenosis or neural impingement.

Normal appearances of the posterior fossa as well as the cervical and
upper thoracic cord. The paraspinal soft tissues are normal.

COMMENT
Multilevel spondylotic changes within the cervical spine with disc
protrusions at C3/4 and C4/5. Disc protrusion and C3/4 and
right-sided uncovertebral joint hypertrophy at C5/6 and C6/7 with
possible impingement of the right C4, 6 and 7 nerve roots. Clinical
correlation is required.









CLINICAL DETAILS
Long history of previous trauma in right C5/6 foraminal stenosis.

FINDINGS
Mild degenerative retrolisthesis between C3/4 and C6/7. Otherwise
normal cervical spine alignment.

C1/2 and C2/3: Normal.

C3/4: Broad right central disc protrusion with uncovertebral joint
hypertrophy. Central canal is patent as is the left neural foramen.
Moderate to severe right foraminal stenosis, with possible
impingement of the right C4 nerve root.

C4/5: Small-moderate focal left paracentral protrusion indenting the
anterior thecal sac. Left uncovertebral joint hypertrophy. Mild
central canal narrowing. The neural foraminae are patent and in
particular, there is no significant right foraminal stenosis.

C5/6: Advanced disc degeneration with moderate posterior disc bulge.
Mild left and severe right uncovertebral joint hypertrophy with
probable impingement of the C6 nerve root.

C6/7: Moderate disc degeneration and prominent bilateral
uncovertebral joint hypertrophy. There is moderate to severe left
foraminal stenosis and similar changes on the right. There may be
impingement of the both C7 nerves root at the neural foramen.

C7/T1: Normal disc contour. Mild bilateral uncovertebral joint
hypertrophy. No significant spinal stenosis or neural impingement.

Normal appearances of the posterior fossa as well as the cervical and
upper thoracic cord. The paraspinal soft tissues are normal.

COMMENT
Multilevel spondylotic changes within the cervical spine with disc
protrusions at C3/4 and C4/5. Disc protrusion and C3/4 and
right-sided uncovertebral joint hypertrophy at C5/6 and C6/7 with
possible impingement of the right C4, 6 and 7 nerve roots. Clinical
correlation is required.

Yours sincerely,

Dr XXXXXXX Koh,
Consultant Radiologist

Radiologist: Dr E. Koh
Open FITWeb: WWW.WWWW.WW

thank you for your reply
Do you think that any further clinical tests could be performed here in Perth as visiting Sydney would be very difficult for me but I do understand there is very good facilities there.
I am already considering another follow-up MRI scan here in the near future and i will ask my GP about what you suggest of serum negative rhumetological disease and maybe ask if any tests can be performed here.
the only one time I saw a rhumatologist about eight years ago, all he did was prescribe 25mg prednisolone but I was very nervouse and moody and dropped to 5mg daily for five years until being advised to stop as the side effect were detrimental.