[Randy]

#34949

Dr. Corenman:
I had an ACDF C4-C7 5 years ago for neck pain-(no radiation into arms). It was very successful.
However it did not take care of severe pain which goes down to the inside of each shoulder blade. The pain feels like “stabbing” in each side, and the location goes up and down at times between each shoulder.
A new MRI shows the ACDF at C4-C7 appears fine.
I also have pain in my neck what may be in the location of C3-C4, but then no pain below that until again the inside of both shoulder blades.

The new MRI also shows-“C3-C4: A nominal disc bulge, bilateral foraminal disc/spur complexes, and uncovertebral joint spurring are slightly more pronounced and produce mild central canal, moderate to severe right foraminal stenosis, and moderate left foraminal stenosis.

Question-could this C3-C4 be causing this pain going down into both shoulder blades? I did not think this dermatome was for that pattern? Thank you Sir.

[Donald Corenman, MD, DC]

#34950

Pain radiation into the shoulder blades is a common pain referral location for nerves C3-T1. It is not uncommon for the C3-4 level to radiate into the scapula. I would make sure that the fusion at C4-7 is really solid. An MRI can reveal that but also can give misdirection. Flexion-extension X-rays would be a better tool for evidence of fusion.

If solid fusion is noted, and you have “moderate to severe right foraminal stenosis, and moderate left foraminal stenosis”, a selective nerve root block at C3-4 with good temporary relief would give evidence of the pain generating capacity of C3-4 where you could do something about this surgically (or the injection calms down the area and can be used for treatment).

See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
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.

[Randy]

#34961

Thank you Dr. Corenman: I see that I can pay for a consult by sending you my MRI. I am going to do that. I’m guessing me having a flexion-extension x-rays as you noted would be helpful to send as well? Do I need a referral to have these x rays done? Last, can a nerve block be done on an area that is already fused to help determine if that is in fact a pain generator? If yes are epidurals able to be done on that fused area for relief?
Thank you again

[Randy]

#34962

—and would a ct scan be better than an Xrays?-or would both provide you the best information?-Thank you again

[lance85]

#34963

Hey,
I was also suffering from the back for a year now. My doctor suggested massage therapy. And now I had attended several sessions at https://www.physiomobility.com/massage-therapy-toronto-don-mills-north-york/. I feel better now maybe I don’t have any complications.
Could someone explain to me why the surgery is done and is that a permanent solution for neck pain?

[Donald Corenman, MD, DC]

#34968

A CT scan is the gold standard for fusion determination. X-rays are easier to obtain so I generally start there but if you can get a CT scan, that would be helpful. Surgery can be permanent at that level if you have a fusion and it heals solidly. An artificial disc replacement can be helpful in the correct circumstances but will eventually one day wear out (after all, it is a mechanical device) and need to be revised.

For lower back pain, if massage helps, then use that therapy as long as it works and is not too frequent.

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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