Back side pain from neck to head.

Consult neurophysician

The brain MRI is reassuring in that it shows no recent stroke or major vessel blockage. It shows chronic age-related small-vessel changes and mild cerebral/cerebellar volume loss. However, the cervical-spine screening has an important abnormality at the C1–C2 (atlanto-axial) joint, at the top of the neck. The report describes abnormal soft-tissue thickening, erosion of part of C1 and irregularity of the C2 dens, with mild pressure on the spinal cord. Possible causes include infection, inflammatory tissue such as rheumatoid pannus, or severe atlanto-axial arthritis. C1–C2 inflammation and erosion can sometimes produce instability, so this should not be managed only with pain medicines or physiotherapy. The absence of abnormal signal inside the spinal cord is reassuring, and these conditions are often treatable, but the exact cause must be established promptly.

Please arrange an urgent consultation with an ortho surgeon, preferably today or within 24 hours, taking the MRI films and report. A dedicated cervical-spine MRI with and without contrast and a CT scan of the C1–C2 region may be required to evaluate the soft tissues, bone erosion and stability. MRI with and without contrast is generally recommended when spinal infection is suspected. Tests may include CBC, ESR, CRP, renal function, rheumatoid factor and anti-CCP. If she has fever, chills or appears unwell, blood cultures should be taken as part of the infection work-up

Until reviewed, avoid forceful neck exercises, traction, massage, chiropractic manipulation or sudden neck movements. Do not self-start steroids or antibiotics. Go immediately to the emergency department if she develops fever, rapidly worsening pain, arm or leg weakness/numbness, difficulty walking, falls, hand clumsiness, loss of bladder/bowel control, difficulty swallowing or breathing. These can indicate spinal-cord involvement.

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