[Chuck]

#20236

Dr. Corenman
Hope your well sir.
Thanks for your response to my first question, again it was much appreciated!!
Dr C, I’m puzzled by an ongoing issue post the rear ended collision years ago that left me with several sites of damage throughout my neck c4-c7 levels all were effected and their symptoms pretty standard for the sites of injury but no other levels were affected and no facet problems ruled out. while trying to forego surgery with SNRB at c5 root that has helped with the vast majority of symptoms to include the one my doctor seemingly puzzled by: pre injection being right neck pain and bilateral shoulder pain radiates but there was a few months of vast unpredictability and severity in my neck pain that without warning would migrate into my head and cause me to be bed ridden nausea and vomiting on occasion and would last days at a time, all either coincidentally or not we’re improved w my SNRB.. Though I’m told cervicigenic head pain is upper level related, and not my case..?? So I’m confused as my neck pain and shoulder pain moderate to severe in range on occasion create a debilitating unpredictable no warning kind of head pain and resulting domino effect. Any thoughts as to why?? I know he’s mentioned soondylosis, retrolisthesis, nerve compression etc c5 radiculopathy Dx is cervical sprain and displacement of cervical spine without myelopathy but my neck is bad enough on its own, I can’t nor can my provider whether he just hasn’t shared w me, what causes the head symptoms why? How that makes sense for my associated levels? It coming on 1.5 years after the injury as a new development that doeseny correspond w my disks but is real and is very severe when it does happen which thankfully hasn’t for 6 months until now..?? Let me know ur thoughts. It’s miserable. Thank you.

[Donald Corenman, MD, DC]

#20240

You note an “SNRB at c5 root that has helped with the vast majority of symptoms”. You then state “symptoms to include the one my doctor seemingly puzzled by: pre injection being right neck pain and bilateral shoulder pain”.

You then note “neck pain that without warning would migrate into my head and cause me to be bed ridden nausea and vomiting on occasion and would last days at a time, all either coincidentally or not we’re improved w my SNRB”. Finally you state “Though I’m told cervicigenic head pain is upper level related he’s mentioned soondylosis, retrolisthesis, nerve compression etc c5 radiculopathy”.

FIrst, let me assume that the most problematic level is at C4-5 where you have some root compresssion. This would be the C5 nerve root. This nerve will cause pain that radiates into the shoulders and down the upper arm but not below the elbow. Nerve compression or even disc degeneration can cause neck pain so all your neck and shoulder symptoms fit with C5 nerve irritability (radiculopathy).

Your headaches could be caused by C4-5 degenerative changes but C4-5 generally does not cause headaches in 90% of patients. Nonetheless, that means 10% of patients can have C4-5 generated headaches. Typically, neck pain generated headaches are caused by C1-3.

If you received a nerve block (SNRB) that immediately gave you headache pain relief (see pain diary) along with neck and shoulder pain relief, there is some evidence that this level is also producing the headache. I will state that if you developed relief-not immediately but after at least 12 hours, this could be the steroid effect and not related to pain generation at that level of injection. This effect can cause pain generators not near the local injection to be relieved and a false-positive test (relief leading to a false conclusion that the area injected is the area of pain generation).

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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