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  • AvatarLowBack
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    Post count: 7

    Dr. Corenman,
    I have had shoulder and scapular pain for almost a year. i had an mri last year and this is what it said. 2020(mri)
    C4-C5: Right posterior T2 hyperintense annular fissure with a
    small associated right paracentral disc protrusion measuring
    approximately 0.7 cm craniocaudal, 0.3 cm AP and 0.9 cm
    transverse, contacting and mildly flattening the ventral cord,
    with mild canal narrowing. The dorsal CSF space is preserved. No
    cord edema or other intramedullary cord signal abnormality is
    seen. No significant neural foraminal narrowing.

    2021 mri
    I had a c5 nerve root injection in august which did not help. the pain slowly got better on its own four months after the shot but not never fully resolved. several weeks ago i started developing more scapular and neck pain and fullness in my ear. i got another mri at another facility and this was the report.
    c4-c5 level shows broad based subligamentous disc extrusion, flattening of the right ventral cord. it measures 5x7x3 in crauniocaudal, transverse and AP dimensions respectively. there is moderate canal stenosis right of midline. There is obliteration of the of right ventral csf, mild foraminal compromise, mild facet hypertrophy and crowding existing nerve root.
    c5-c6 shows 3mm posterior bulge. small central annular tear, mild canal stenosis no cord compression or nerve root impingement.

    my question is, i am a dentist and i have no weakness just scapular and right sided neck pain and spasming of the upper back which causes some awful head aches. no appreciable weakness, and per my read the MRI’s look similar except for a new bulge at c5-c6. is this progression of disc herniation or could there be some facet pathology? If this is continued disc pathology thoughts on operative treatment ADR vs fusion for someone who is always using their hands?

    Appreciate your time and thoughts

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7956

    “shoulder and scapular pain for almost a year” but you don’t note what side it is on. I assume right side (“associated right paracentral disc protrusion” at C4-5).

    You then note “I had a c5 nerve root injection in august which did not help”. You probably did not keep a pain diary which can be helpful to identify the root as a potential pain generator. https://www.neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

    You can determine the cause of the pain by discriminatory injections into the facets and then repeat the nerve root. If it is the facet, you can do a radio frequency ablations (RFA) an outpatient procedure. If it is the disc causing pain, you most likely would need an ACDF or an ADR.

    See:
    https://www.neckandback.com/treatments/diagnostic-therapeutic-neck/
    https://www.neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/
    https://www.neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
    https://www.neckandback.com/treatments/anterior-cervical-decompression-and-fusion-acdf/
    https://www.neckandback.com/treatments/artificial-disc-replacement-adr-for-cervical-spine/

    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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