Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Help deciphering radiology report of c-spine xray?

I am in the process of trying to get disability benefits reinstated and it has been a looong year with no income. One of the reasons insurance closed my (short-term!) claim is that there was not enough objective evidence of Spondylitis. I'm HLA-B27 NEG, of course, and on MRI there has not seemed to be enough evidence.

Coincidentally last week I was in a car accident where someone simply changed lanes into my vehicle while on the freeway - clocked directly into my right front wheel ! So I got c-spine Xrays to rule out any new damage . . . and got this fascinating (I think) report!:

COMPARISON: 11/27/2007

"There is new prominent reversal of normal cervical lordosis, with new 2mm anterolisthesis at C3-4, C4-5, and C5-6. Mildly reduced disc height is present at C4-5 and C5-6. New severe right facet arthopathy at C3-4 results in new moderate right foraminal stenosis. Left C4-5 and C5-6 facet arthropathy have also increased in the interval, with increased uncovertebral osteophytosis resulting in mild to moderate Left C4-5 and mild left C5-6 foraminal stenosis. C1-2 articulation demonstrates atlantodental degenerative marginal osteophytosis, increased in the interval Paraspinal soft tissues are unremarkable."

My primary care referred me straight to my rheumatologist, who I am seeing later this afternoon.

Does anyone recognize any of that language above as being spondylitis-related? I often get wishy-washy answers from my rheumatologist so I was hoping to do some homework before I see him. . . thanks!

What jumps out at me is the reversal of cervical lordosis. I think that means the reversal of the normal curve of the neck, which is something that seems common in spondy.

Thanks! I'll do some more research. And I think I need to change rheumatologists. Upon receiving the report he didn't seem interested. When I asked if any of those things indicated some form of Spondylitis he said, "It shows a worn-out neck" and left it at that.

Blargh. I have the next rheumy lined up it's just that:

1) He's geographically a bit harder to get to and
2) I'm terrified of changing rheumys while waiting for the disability insurance company to rule on my appeal. And I'm racking up lawyer fees the whole time while I wait. Sigh.

Loss or reversal of cervical lordosis does often occur in Spondyloarthropathy patients. However, it is a common condition in the general public as well. The loss of lordosis takes place primarily due to muscle spasms, posture, and head/neck position. It is not diagnostic of Spondyloarthropathy. The other things you listed are commonly associated with Degenerative Disk Disease and Osteoarthritis. That is not to say that you don't have Spondyloarthropathy, just that this cervical x-ray does not provide any proof of Spondyloarthropathy. If you were already considering doctors, by all means, make the change. But I would not let his comment about a "worn out neck" force a change.

Since you were in a car accident, you probably had a cervical necklace, right? Paramedics always put them on in case of a fracture. If your xray was taken at that moment, then you have a 100% chance of having a straight neck from the equipment... Otherwise I must agree with Stormy. Only osteoarthritis and degenerative disc disease, i.e. a "worn-out neck". Don't blame your rheumy for their medical knowledge, but rather on the way they do not give more details. It does not mean they are not good however. Nothing is ever black or white in medicine. So doubting your diagnosis may be a sign of wiseness, not ignorance.