I have a patient referred for cervical traction with this history - Left side neck pain and left side head pain of about four years duration but increased intensity in past six to eight months. Medical history includes rheumatoid arthritis, CVA in February 2006 with nearly 100% recovery, TIA in November 2006, syncopal episode of undetermined etiology in February 2007, basilar aratery stenosis, osteoporosis, osteopenia, right LE DVT 5-10 years ago, bilateral TKA (2003 and 2004). Medications include plavix, low dose aspirin, lasix, prednisone, methotrexate, lipitor, fosomax, potassium, folic acid, & humira (bi-weekly). Percocet and vicodin are taken as needed. CT scan report of cervical spine - malalignment of C1 and C2 with chronic degenerative change and narrowing of the atlantoaxial joint on the left side with sclerosis. There is discrepancy of the distance of the odontoid process and lateral mass of C1, wider on the right side than the left side. MRI report of the brain (apparently this included part of the proximal C-spine) - posterior displacement of the upper cervical spinal cored, medulla oblongata, and to a lesser extent the pons. There is apparent destruction of the dens of C2, and the anterior ring of C1 is not well demonstrated. x-ray report of the cervical spine - grade I anterolisthesis of C2 on C3 (3mm) and C3 on C4 (2mm). Lateral offset of the right lateral mass of C1 (about 4mm). Also of interest - the patient has rather fragile skin that tears or bleeds with adhesives or pressure. This patient saw a neurosurgeon who determined with examination and imaging studies there is no proximal cervical spine instability. The neurosurgeon considers the odontoid changes to be cystic from the RA. Tha patient relates pain in the neck and left side of the head like the left side of her head is going to "explode" with severity at 10/10 , usually worse with prolonged sitting (especially in an automobile). The pain is variable from 0/10 to 10/10 in the past 48 hours. Usually gets relief if lying down for about 30 minutes. Wears a soft cervical collar most of the time. Based on conversation and prior to having further information regarding the imaging studies, I sent her home until I could review the imaging or other test results. Any thoughts?
Cervical traction is requested by the patient's rheumatologist.
Also forgot to mention age - 72 years.
MRI report of cervical spine barely mentions proximal cervical spine - only that "the craniocervical juncion is intact." Also, the MRI mentions C2-C3 anterolisthesis and disc bulges/protrusions at C3 to C6 levels.