[Donald Corenman, MD, DC]

#22054

I would assume that the injections were of the C3-4 and C6-7 levels that gave you such good relief. It is interesting that the C6-7 level would have been chosen as this is a fused level (expecting no pseudoarthrosis) and should not cause any pain. Now if the C7-T1 level was injected instead, this would confirm that both the levels above and below are pain generators.

I would assume that C3-4 is painful as even before your C4-7 fusion occurred, this level was quite degenerative. The third occipital nerve (lesser occipital nerve) can cause headaches around the ear and the greater occipital nerve can cause headaches from the base of the skull to the top of the eye.

The new MRIs will be helpful. X-rays focused on the C7-T1 level looking for cervical degenerative spondylolisthesis will also yield clues as to the health of this level.

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.

[Bea491959]

#22055

I just called my doctor to find out what levels he did the Radio-frequency injections on. He performed injections on C3/C4 and 3rd occipital nerve. I am not sure which one, but if i had to guess, it was the greater one because the headaches do sometimes go into the eye and have NEVER gone into the ear.

[Bea491959]

#22056

After reading up on the 3rd Occipital nerve – I am not sure if he did the lesser or the greater. Diagrams I have seen show that the greater is more at midline of the skull, where the lesser is in the neck area.
All Radio-frequency injections were done on the neck itself, not in the skull.

So far, these injections have not worked, which I don’t understand why, if the diagnostic nerve blocks were a success.

What are the treatment options at this point?? I cannot get the pain under control and it never goes below a 5.

When I asked the Dr. what his thoughts were as to why I am still in so much pain, he replied – severe arthritis and muscle weakness.

I cannot wait for the new MRI, HOPEFULLY, it will give us answers.

[Donald Corenman, MD, DC]

#22072

If the injections were successful in temporarily eliminating your pain, this confirms the location of the pain generators. Now, if you had injection of the nerve itself at the base of the skull (either greater or lesser occipital nerves), it is uncommon to perform a rhizotomy or ablation of the nerve itself. This would cause a numb spot on your skull which many people find disagreeable.

If the facet was injected giving pain relief, then a rhizotomy is generally effective in about 70% of cases. This of course means that 30% will not have relief. You can repeat the rhizotomy if you choose. I will say that technique is very important and some injectionists are more precise than others.

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.

[Bea491959]

#22198

Dr. Corenman,

I got the results from the latest MRI for Cervical and Thoracic

Cervical:

C 2/3 – Disc desiccation, no herniation or spinal stenosis

C3/4 – There is disc desiccation, disc narrowing, posterior disc bulging and bony ridging slightly more prominent to the left of midline. There is effacement of the anterior subarachnoid space w/o cord deformity.

C 4 thru C 7, fusion

C 6/7 – Minor right and left lateral disc bulging and ridging is present (THIS IS NEW SINCE 2014 MRI)

C 7/ T 1 – Disc desiccation, no disc herniation or stenosis

Thoracic:
Findings:

There is disc desiccation and disc narrowing seen from T 1/2 through T 9 /10.

There is mild posterior disc bulging without cord impingement or stenosis from T 2/3 through T 7/8.

There is a small left paracentral disc herniation at T 8/9 without cord impingement or stenosis.

I went for my follow-up appointment with pain management doctor last Friday, and all he wants to do is increase my pain pills, add Valium, and offer me more shots. He wants me to think about BOTOX injections (set of 31 shots all the same day).

I am tired of being a human pin cushion and I do not want to be doped up all the time.

Can you please offer me advice on what to do, how to proceed?? Should I see another doctor for a 2nd opinion?? If so, do you know of any out here in central NY??

Thank you,

Bea

[Donald Corenman, MD, DC]

#22536

Typically, many radiologists do not comment regarding degenerative facet disease. The fact that you have DDD at C2-3 would make me suspicious of degenerative facet disease at this level which could cause occipital headaches.

A second opinion is always something to consider. I cannot recommend specific physicians at this time.

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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