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About Dr. Nekessa Remy
Expertise
I am able to answer questions regarding chiropractic treatment, physical rehabilitation and musculoskeletal injuries. This involves conditions such back and neck pain, headaches, joint pain, athletic injuries, overuse injuries, sciatic, carpal tunnel and other nerve-related conditions. Various therapies including, nutrition, medical acupuncture, laser therapy, soft tissue therapy (Active Release Technique), orthotics, workplace ergonomics, postural exercises and active rehabilitation.

Experience
10 years experience in athletic rehabilitation and exercise therapy. 7 years experience as a certified kinesiologist working in motor vehicle accident rehab. Clinic chiropractor at Genesis Massage Therapy Center. Graduated from Canadian Memorial Chiropractic College (CMCC). On the board of Directors of corCare Management (Car Accident Injury Management Group)

Organizations
Ontario Chiropractic Association Canadian Chiropractic Association Canadian Chiropractic Protective Association

Education/Credentials
Currently enrolled in the Fellowship of Chiropractic Rehabilitation Sciences (CMCC) Metrix Certified In home Assessor Graduated Magna Cum Laude from CMCC Diploma in Acupuncture from McMaster University Graduated with an Honors Degree from University of Western Ontario Certified Personal Trainer

Awards and Honors
Doctor of Chiropractic degree from CMCC Diploma in Acupuncture from McMaster University Honors Degree in Kinesiology from the University of Western Ontario

You are here: Experts > Health/Fitness > Back and Neck Injury/Chronic Pain > Chiropractors > cervical spine

Chiropractors - cervical spine

Expert: Dr. Nekessa Remy - 10/26/2009

Question
My father got into an accident January of this year I posted a question earlier but due to character limit have to post another. This one is about cervical spine; the report is as is below. Can you please inform us of what the situation looks like? Thank you. A noncontrast MRI scan of the cervical spine was obtained. There are moderate degenerative changes from c4-7 including disc and ligamentum flavum hypertrophy. This is causing multilevel central spinal stenosis. In particular, the c4-5 level shows a small left central disc herniation causing mild to moderate cord impingement. Bilateral neural foraminal narrowing is also seen with possible impingement of the exiting nerve roots. The c5-6 shows osteochondral bar abutting the cord. Moderate bilateral neural foraminal narrowing is seen with possible bilateral nerve root impingement. The c6-7 level shows mild central spinal stenosis and moderate to severe bilateral neural feraminal narrowing with probable impingement of the exiting nerve roots. The C3-4 level shows mild to moderate degenerative changes and mild central spinal stenosis. The visualized upper thoracic spine shows minimal degenerative changes. The c3-4 level shows a tiny central disc herniation abutting the cord. Impression: Diffuse degenerative changes most pronounced in the lower cervical spine. This is causing multilevel spinal stenosis and multilevel neural foraminal narrowing and probable nerve root impingement. In addition the c4-5 level shows a broad based small central disc herniation causing mild to moderate cord impingement without myelomalacia. The c3-4 level shows a tiny central disc herniation abutting the cord.

Answer
First of all, the injuries described in this MRI are most likely not due to the car accident. Degenerative changes such as stenosis and foraminal narrowing occur overtime and were probably exacerbated from the trauma of the car accident. The degeneration occurring in the spine is the result of wear and tear to the joints/vertebra which make up the spine. This results in damage to the disc. There is a disc between each of the vertebra in your spine. The intervertebral discs are designed to absorb pressure and keep the spine flexible by acting as cushions during body movement. The discs are similar to shock absorbers. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses, or provide the movement needed to bend and twist. With degeneration the disc lose water, decrease in size thus allowing the vertebra above and below the disc to become closer together. As the space between the vertebrae gets smaller, there is less padding between them, and the spine becomes less stable. The body reacts to this by constructing bony growths called bone spurs (osteophytes). These bone spurs are responsible for the stenosis found in your fathers spine. Stenosis is a condition which involves narrowing and compression the spinal cord and nerves as they exit the spine, this can cause severe pain. The nerves exit the spine via a "whole" in the spine called a neural foramin. Stenosis will cause the foramen to become smaller, thus placing pressure on the nerve.
Disc herniations result from a bulge in the disc. The disc usually bulges backwards into the spinal canal which will place pressure on the the nerves of the spine, once again causing pain. Please keep in mind that MRI does not dictate the amount of pain your father is experiencing. Many people suffer disc herniation but experience no pain. In terms of treatment, Im not sure how much pain your father is in or how he is functioning. If he is able to function somewhat, with minimal restrictions I would recommend conservative therapy first. As a chiropractor I would focus on traction, which is a manual way to relief pressure on the spine as well as other therapies designed to reduce muscle tension and nerve pressure . Massage therapy and or physiotherapy may also be helpful as may yoga and pilates based exercises. For more invasive forms of treatment, I would consult your family physician. Treatments may include a steroid injection, disc replacement, surgical fusion etc.

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