[Donald Corenman, MD, DC]

#26803

Unilateral neck pain generally occurs from facet, nerve or rarely disc. Your findings on MRI don’t point to nerve compression but nerve pain can occasionally occur from nerve injury due to a virus or other agent. I disagree with your pain doc regarding facet generated pain. I have commonly seen facet mediated pain in 30 year olds. Nonetheless, the other potential pain generators could also be in play.

It is not wrong to start with an intracanal epidural (ESI). I would still have on the table a fact block if you don’t gain good results from the ESI.

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.

[BRONCOFAN1]

#26805

Just wanted to post a note to concur with Dr Corenman… I am 39 and had an ADR for a terribly painful degenerative disc this year after 6 months of conservative treatment. Cleared up a lot of the symptoms but left me with a persistent ache right over my c5-6 facet on the right side and some of the same kind of aches you describe on both sides. If it weren’t for Dr Corenman I’d still be wondering what it could be because neither my surgeon nor pain management recognized it was probably facet pain. Be persistent if you think that’s what it is – I had to force the issue to get a medial branch block and just had an RFA yesterday.

Kevin

[geno71]

#26807

Thanks for the reply doc. I was a bit surprised when he suggested an ESI over mbb. He told me that I really don’t want to go down the RFA path unless I have to. His thought was that since I had left arm and shoulder without any neck pain back when the issue first started in 2014, that was indicative of disc pain. The thing is now my pain is local to my neck with nothing radiating to my arm or shoulder. Does the local tenderness when pressing on the back of the neck give any clues of disc or facet origin of the pain?

Also, I’m assuming if there is no nerve compression involved, the only way the ESI would help is if there is some nerve pain coming from the disc itself? Is it possible to have nerve pain that is somehow caused by the disc itself without compression?

[geno71]

#32584

So I’m still dealing with this chronic neck pain issue. Just to recap, the symptom appears to be sore achy muscles on both sides midway to lower part of the neck on both sides but most pronounced on the right. Pain is lowest in the morning and worst at night. In general pain is lower when lying down than sitting/standing. Muscle relaxants/NSAIDS/Oral Steroids do not relieve the pain. Palpating of the neck muscles as well as the tops of shoulders feel tender.

I went to another PM doc last summer and he sent me for a SPECT-CT which the results are below. His view was that if the issue was facet or even disc related, something would show on this test. The test did not show any abnormal uptake in the cervical spine. Based on the test, the PM doc was thinking the issue is purely muscular in nature and wanted to start with trigger point injections into the neck. I decided to hold off on that treatment because I had previously had TPI in the tops of my shoulders from another doc and they did nothing to help. Does the SPECT-CT shed any additional insight into a possible cause of my pain? The only other thing I noted in the scan was the additional uptake in the AC joints.

TECHNIQUE
A total body bone scan was obtained in standard projections with additional views obtained of the
cervical, ribcage and skull. SPECT CT images of the cervical in the standard projection were
performed. A low dose attenuated CT scan was obtained for localization purposes.
CT was performed with one or more of the following dose reduction techniques: automated exposure
control, adjustment of the mA and/or kV according to patient size, or use of iterative
reconstruction technique. Total DLP (mGycm)= 109

COMPARISON
No comparisons

TOTAL BONE SCAN FINDINGS
The total body bone scan shows multiple patchy areas of increased activity seen throughout both
sides the ribcage, both sides the mandible left greater than right as well as the right
supraorbital region. Rest of bone scan shows some activity involving the AC joints. Both kidneys are identified.

TOTAL BONE SCAN IMPRESSION
1. Abnormal bone scan showing multiple areas of osteoblastic activity seen throughout both sides
the ribcage. The patient gives no history of trauma. This are indeterminate could related to
old remote trauma and or if the patient had no trauma than pathological etiology would have to be
consideration. This may need further clinical evaluation
2. There is increased activity involving both sides of the mandible left greater than right
consistent with periodontal disease
3. Focus of increased activity involving the right supraorbital region of the skull.
This indeterminate. May need further clinical evaluation.

SPECT CT SCAN FINDINGS
The SPECT scan shows no abnormal areas of increased activity seen involving the cervical spine
particular the articulating facets or posterior elements

There is intense activity seen involving the left side of the mandible posteriorly as well as the
right side of the mandible also posteriorly.

The rest of the SPECT scan localizing images show no bony lesions identified. Upper lung zones
that are imaged appear normal. There is no adenopathy identified.

SPECT CT SCAN IMPRESSION
1. Coronal SPECT CT of cervical spine
2. There is significant activity involving both sides the mandible posteriorly compatible with
periodontal disease. Oral dental evaluations advise
3. No addition pathology otherwise

[Donald Corenman, MD, DC]

#32586

SPECT-CT are an older test that uses technecium 99 to tag bone uptake in fast reproducing bone. This test still has some value but has been supplanted by the MRI STIR images which yield similar information. A negative test (no uptake) means this is probably not a bone problem.

You stated; “His view was that if the issue was facet or even disc related, something would show on this test. The test did not show any abnormal uptake in the cervical spine”. He is correct but only with regards to bone involvement. If the disc was torn, the facet capsule was injured or the nerve was compressed, there might be no uptake.

The pain generator apparently has yet to be determined.

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.

[Author]

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