I would be concerned if a patient had a rhizotomy at C2-8. It is uncommon for more than 3 levels of facets to be pain generators in my experience. None the less, the complete rhizolysis of the medial branches of the entire cervical spine did not give you pain relief so we can safely say that the facets were not your pain generator. If you had your EMG after the rhizotomies, it is to be expected to have positive sharp waves in the cervical paravertebral muscles as this would be from the destruction of the medial branches.
Muscle strength generally follows the EMG. That is, if the biceps is weak on physical examination, I can generally assume that the EMG will show positive sharp waves and fibrillation potentials of the C6 nerve. This is why I rarely order an EMG of the cervical spine. I would never operate only on an EMG but I would operate with motor weakness of a particular nerve root.
Since we can rule out the facets as pain generators, the pain most likely lies with the discs. The discs generally cause 70% of axial neck pain so this would make sense.
Cervical epidurals in my opinion can be used every 4 months. Epidurals are more effective for arm pain (from compressed roots) than for neck pain (degenerative disc disease) but still should be tried for both conditions.
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.
