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Dr. Corenman – First, I want to thank you for such an amazing website and being so generous with your time in helping so many of us suffering.
I’ve had two head traumas from my days of motorcycle racing/coaching. Last one was nearly 3 years ago and have had serious problems since. First treated for post concussion syndrome which included passive PT for cervical ‘stiffness.’
Main issues have been occipital neuralgia and referred otalgia which has been excruciating (electric shock type inner ear pain). While my MRI came back with generally normal findings(osteophytes at C6-7, loss of curvature, and mild spondylosis) they were looking for right arm pain instead of left ear pain thanks to a very disinterested physician and PA that I went to see.
This pain has taken me from a very high functioning worker and athlete to disability and refractory to all pain meds. My pain management doc has performed diagnostic SNRB of C2 and C3 in different sessions both of which confirmed nerve roots as ‘pain generators’.
My question is what are the next steps/options? Does physical therapy even make sense or do I have the neurosurgeon “clean it out” as the PM puts it since he’s convinced of the compression?
Again my sincere thanks for providing such a generous resource.
Chris
Generally, base of skull pain and headaches can be caused by facet syndrome of C2-3 and C3-4. There does not have to be frank arthritis (but generally arthritis is present) This disorder might not be picked up by the surgeon or radiologist if they are not looking for it.
If you have had SNRBs of C2 and C3 with good temporary relief, consider facet blocks. It is highly unusual that there could be compression of the C3 root and C2 cannot easily be compressed. If these blocks also yield good relief, you could be a candidate for rhizotomies (burning of the small sensory roots-medial branches on an outpatient basis).
The facets at occiput-C1 and C1-2 can occasionally become arthritic so be on the lookout for that disorder too.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Amazing that you’ve gotten directly to the issue despite dozens of specialists telling me how puzzling and unique this was and even referred out for craniotomy for MVD (geniculate neuralgia).
When I say ear pain, I mean drop to my knees in fetal position for several minutes to an hour. When shorter duration, it’s a constant ‘tic’ as I have these 10/10 (pain level) electrical bolts to deep inner ear that do not have well defined triggers.
Thank you for answering and I understand this is general information only.
BTW – I failed to mention X-rays showed, what you suspected, moderate+ arthritis in C spine.My pain management physician discussed facet blocks in the affected area, but spoke more of their diagnostic ability for surgical consideration vs. what he described as short term relief of rhizotomy given the level of regression in my activities (and inability to work). I used to work 80 hours/week and am not a malingerer. My goal is full return to work and whatever recreational activities that are possible. Won’t rhizotomies need to be repeated annually, or at regular intervals given the nerves’ regeneration?
Are surgical interventions not recommended given the rarity of C3 compression despite these crippling symptoms?My hope is a more permanent solution while avoiding disability and chronic pain — is this unrealistic?
Thank you again as I’m in complete awe of this site. If this is something you think worthy of a cross country trip to your office, I will contact your office and schedule an appt asap as I trust your judgment implicitly given your breadth of experience.
Many times the pain you complain of is degenerative arthritis of the facet joints. Rhizotomy can be effective for short term (one year) or even long term. It really depends upon patient response to the rhizotomy. The alternative to rhizotomy is fusion so obviously try rhizotomy first.
I do not do long distance consults at this time. You would have to come see me in the office.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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