In this video we will discuss the challenges of diagnosis and treatments for people whose MRIs show cervical disc degeneration. We will explore the questions, “is the MRI revealing the cause of the patient’s pain?” Whether the MRI may cause the person to undergo unnecessary neck surgery? Finally, we will look for the root cause of the cervical disc degeneration and the connection to damaged cervical spine ligaments.
An October 2023 research paper lead by the University of Utah and published in The neuroradiology journal (1) suggests that changes in cervical stenosis may be present in cervical spine MRIs but that may be missed or misinterpreted. The researchers suggest that there is considerable variability among radiologists when grading spinal canal and foraminal stenosis on MRI. So to start with, MRI interpretations are varied. However, there is limited research to suggest if MRI interpretations also are varied when it comes to identifying degenerative changes.
Many MRI and X-ray findings of the neck can show a cervical disc degeneration. However, many will not show the cause of disc problems, and other findings will erroneously identify a problem that doesn’t exist. One that doctors may be inclined to surgically “repair” and then be surprised when the surgery did that help that patient.
On our website we have many articles discussing this problem including: What does an abnormal neck MRI mean? Unnecessary surgery for cervical stenosis? In this paper we cite research that demonstrates how a cervical spine MRI could be read the wrong way. And The accuracy of MRI diagnosing upper cervical instability. Which cites limited research on addressing the problem of misidentified cervical spine MRIs.
Cervical ligament instability
What happens when a problem is seen on an MRI and that is not the problem that is causing a patient’s pain. We see cervical disc degeration as a problem of cervical spine instability. Damage to the discs and spine degeneration can be traced to neck ligament laxity or ligament incompetence. What does this mean?
Just as small screws are the weak link in a cabinet hinge, the weak link in the neck are the capsular ligaments of the facet joint. When these ligaments are injured or weakened, they compromise the normal cervical curve and joint movement.
This topic is so vast and we have a very extensive library of published research and articles. The links are below. In our article Symptoms and conditions of Craniocervical and Cervical Instability, I discuss that upper cervical spine instability is one of the most perplexing problems for patients and their doctors to figure out. Cervical instability can be a devastating, life altering health consequence. How does a health situation that is so complex and impactful on the entire body go undiagnosed by traditional medical doctors and health care professionals? There are too many symptoms that mimic other conditions.
Below I will list our published research discussing this problem.
Cervical spine degenerative disc disease starts with poor posture
When you spend hours hunched over a cell phone or at a computer with poor posture, the ligaments are stretched, leading to ligament laxity or incompetence. Over time, this results in ligament degeneration, known as ligamentosis. Ligaments are meant to limit joint motion and be strong like ropes; damage leads to abnormal forces and, ultimately, degeneration.
The facet joints are the bony attachments between vertebrae, surrounded by capsular ligaments. Excessive movement or instability in these segments, especially at C4-5—the fulcrum of flexion—often leads to disc degeneration.
Limitations of MRI findings
Flexion-extension MRIs can reveal instability, such as at C2-3, leading to disc degeneration. If an MRI shows disc degeneration and you have pain, instability is likely present. Digital dynamic radiography or motion X-ray is more effective than static MRIs in detecting this instability, as muscles may mask instability during static scans.
Below is an flexion extension MRI performed on one of our patients. The imaging reveals significant instability at the C2-C3 vertebral level. This instability is clearly visible in the MRI images, where the C3-C4 disc appears white, indicating a healthy amount of water content. In contrast, the C2-C3 disc shows no water content and is completely degenerated.
Nerve compression and cervical spine curve
Half of the nerve endings in the neck are in the ligaments from C0 to C2, the most mobile segment of the spine. These ligaments are already stretched out for quick head movements. Small muscles, called suboccipital muscles, also play a role. Pain and instability in this region are often not visible on a standard MRI but can be detected with motion scans.
In our center we have specialized X-ray equipment, including digital dynamic radiography (motion X-ray). While flexion extension MRI provides valuable information, it does not capture real motion in all planes. Motion X-ray allows for dynamic movement assessment, revealing instability that may not be apparent on static imaging. The movement of the bones during these studies provides reliable evidence of instability.
During dynamic imaging, the first pass may reveal minor instability, with subsequent passes often showing increased instability. This progression occurs because muscle tightness can mask instability when holding a static position, such as during a flexion MRI. The muscles may clamp down, obscuring true instability. However, when movement is introduced with momentum, the instability often becomes apparent.
Facet Joint Forces and Degenerative Disease
Excess force on facet joints, often due to slouching, stretches ligaments throughout the spine and pelvis. The number one cause of ligament injuries isn’t trauma or surgery, but slouching. When muscles are contracted, the force is on muscles, not ligaments. Muscles are much stronger than ligaments, so it’s important to engage them rather than relying on ligaments to support passive positions.
Ligament damage leads to rotational forces and ultimately disc degeneration. Injuries to facet joints put stress on discs, causing them to degenerate. The treatment to regenerate damaged ligaments is called prolotherapy—injections primarily targeted at the facet joints.
Ligament Damage and Treatment Options
We’ve published patient data on nearly a thousand cases, showing a strong history of clinical success with prolotherapy. Treatments stimulate ligament repair over four to six weeks, with sessions spaced accordingly. Some patients even stay for extended periods due to the severity of their cases.
Dynamic Structural Medicine Ross Hauser MD Review of Treatments for Cervical Spine Instability
Our published research
References
1 Costello JE, Shah LM, Peckham ME, Stilwill SE, Safazadeh G, Hutchins TA. Time for change? Radiologists highly concordant assessing change in stenoses on follow-up cervical spine MRI. The neuroradiology journal. 2023 Oct;36(5):588-92. [Google Scholar]