[Rivervadas]

#34994

Hi Doc,
I’m still waiting on PM doc for injections and in the meantime my surgeon scheduled a bone scan to get more information on the c3-4 level where the disc is pretty severely degenerated.

The bone scan results came back showing these results:

Findings: Moderate radiotracer uptake localizing to C3-4 disc level, with moderate degenerative disc disease.

Disc prosthesis at C6-7. No significant radiotracer uptake at that level.

Radiotracer uptake localizing to the left C2-3 facet joint, associated with facet arthrosis.

Impression:

1. Moderate radiotracer uptake localizing to C3-4 disc level, associated with moderate degenerative disc disease.

2. Radiotracer uptake localizing to the left C2-3 facet joint, associated with facet arthrosis.

My symptoms are left sided upper cervical pain that extends down the neck and shoulder, over the clavicle into the chest and half way down my deltoid/upper arm. I have some of the same symptoms on my right side every once in a while but symptoms present mainly on the left side, about 90% of the time, constant pain, no numbness or tingling. I can’t really reproduce the pain with any sort of positioning. It just comes on if I do physical work, and gets worse throughout the day.

The MRI shows pretty significant disc bulge into the left foramina at c3-4 with some bulge on the right as well.

From your experience are my symptoms more consistent with disc bulge/nerve root compression or with facet issues?

[Donald Corenman, MD, DC]

#34995

Your symptoms could be generated by the C2-3 facet (“Radiotracer uptake localizing to the left C2-3 facet joint, associated with facet arthrosis”), radiculopathy by the foraminal stenosis from C3-4 (“MRI shows pretty significant disc bulge into the left foramina at c3-4”) or possibly from the degenerative disc at C3-4 (“Moderate radiotracer uptake localizing to C3-4 disc level, associated with moderate degenerative disc disease”).

If the pain is aggravated by head extension (bending the head backwards), the either facet origin or radiculopathy origin is most likely to blame. If flexion increases the pain, the disc is more likely the cause.

The best way to determine what structure is to blame is to first perform a facet block of the left C2-3 facet and keep a pain diary (see below). If relief is noted, RFA (rhizotomy) is the treatment. If minimal relief, then a selective nerve root block of C3-4 left. If relief and you have failed PT, then an ACDF of this level should yield relief.

https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/diagnostic-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

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.

[Rivervadas]

#34998

“ If the pain is aggravated by head extension (bending the head backwards), the either facet origin or radiculopathy origin is most likely to blame. If flexion increases the pain, the disc is more likely the cause.”

So what’s exactly is difference between radiculopathy (I’m assuming nerve root compression) or the disc being the source of the pain? How could the disc cause pain other than the nerve root compression it causes?

[Donald Corenman, MD, DC]

#34999

Structures that generate pain are bone, nerve, facet and muscle/ligament. Flexing forward will load painful bone (degenerative discs) and extending backwards loads painful facets and narrowing of the foramen (compressing the nerve-radiculopathy).

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.

[Rivervadas]

#35000

Is it common to see cases where the pain is just fairly constant and cannot necessarily be reproduced or worsened with any sort of movement? That is my case. What would that possibly indicate?

[Donald Corenman, MD, DC]

#35001

Hard to tell. Selective nerve blocks and facet blocks would be the next step. I would recommend facet blocks first.

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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