[zookriz]

#8794

Hello Dr. Corenman,
Thank you for your time. To start, in the spring of 2012 I started having neck pain on my right side under my skull. I assumed I slept funny and just had a stiff neck. It never went away. I went to see my P.C. in the spring of 2013 after trying lots of over the counter anti-inflammatories and heat. I’m a bit afraid of anti-inflammatories because my mother suffered a perforated ulcer from them. My doctor immediately diagnosed it as muscle spams, wrote me a prescription for muscle relaxers, an x-ray and a blood test because I had other joint pain. I did not receive any results from the x-ray but after getting a copy for myself, I found I have a slight reverse curve to my neck. My ANA was 1/80 (not a big deal), My P.C. said I might want to think about a rheumatologist.
My first question is can a loss of lordosis cause muscle spasms or do muscle spams cause a loss of lordosis?
The muscle relaxers did not help, so I tried to deal with it.
The discomfort is disabling. I broke down and went to see a chiropractor that my husband uses. After my adjustment, I got dizzy and my blood pressure went up. He told me he should not do any more adjustment because of the bad result. I took lots more anti-inflammatories and tried to deal with it. He prescribed stretches and natural anti-inflammatories.
I decided to see a rheumatologist and after more neck x-rays and blood work he found basically the same results. My ANA was 1/160 a loss of lordosis and said it was muscle spams. I’ve been on a short term of steroids, two different kinds of muscle relaxers, and prescription anti-inflammatories. He also prescribed something to help me sleep because my pain keeps me up all night.
Nothing is remotely helping.
My pain is mostly under the base of my skull on the right and less so under my skull on the left. I get a sharp pain at the base of my skull if I look right with my head slightly cocked. The pain will remain several minutes after that movement and almost makes me nauseated. I have almost a constant headache from the base of my skull and up to my temples. Sometimes my ears or my jaw hurts. The discomfort gets worse when I shake around from riding in a car or on a mower, it also gets worse if I have to hold my head in any one position for very long. Resting my head in my hands seems to help a bit. Sometimes I feel like I can’t hold my head up anymore.
I’ve had normal view x-rays, open mouth x-rays and some where I’m facing away at an angle with my head turned. I also had a previous cervical MRI because of arm and wrist pain. The MRI showed a little something at c5 c6 but nothing to concerning.
My neck question is should I request a x-ray in flexion and extension, I’ve never had one. Could I possibly have an instability at c1 c2 or am I just dealing with muscle spams? How long is this going to last? Can a muscle spasm last over 1 year constantly? Should I go get another opinion from a specialist?
I forgot to mention that I have had many falls off of horses, once with my head contacting a rail fence and once landing me in the hospital for a few days. I had a accident at the beach boogie boarding, did a face plant in the sand and the wave took my body over my at a 90 degree angle, I heard a terrible crunch/crack and blacked out for a few seconds, and suffered a terrible headache. My point is in my younger days I was very active quite possible damaged something.
Thank you for your help,
Kathy

[Donald Corenman, MD, DC]

#8795

Muscle spasm is typically the result of a disorder and not the cause of the disorder. Your problem is not from “muscle spasm”.

Many times, degenerative facet disorders are missed by radiologists and this is what I assume that you have based upon your symptoms. There are a number of other possible origins of your pain but facets will be first on the list.

Yes, flexion/extension x-rays should be part of any work-up. Also, with disabling pain, an MRI should also be undertaken which it sounds like you have had.

C1-2 problems would be unlikely but possible. More likely, C2-3 or C3-4 problems in your case.

You need a consultation with a good spine surgeon.

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.

[zookriz]

#8802

Thank you and I’ll look into a good spine surgeon and let you know. It’s nice to think I’m not crazy and there might actually be an issue. I don’t want to spend a year taking unnecessary medications for muscle spasms and not fix the problem.

[Donald Corenman, MD, DC]

#8803

Let the forum know what is found please.

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.

[zookriz]

#8806

Here is a copy of my three reports.
FINDINGS: There is no fracture or subluxation. There is mild flattening and desiccation of the
intravertebral disc at C5-6 and C6-7. There is no significant cerebellar tonsillar ectopia. The craniocervical
junction is unremarkable. Retropharyngeal soft tissues are not thickened. Paravertebral soft tissues are
unremarkable.
At the C5-6 level there is a left far lateral disc protrusion with only mild foraminal narrowing. There does not
appear to be significant encroachment upon the exiting left C6 nerve root.
At C6-7 there is a posterior/central disc protrusion resulting in a ventral epidural defect. There is only mild central
canal narrowing at C6-7.
CONCLUSION:
1. Mild degenerative disc disease at C5-6 and C6-7 as described above
2. Left far lateral disc protrusion at C5-6 with mild foraminal narrowing
3. Posterior/central disc protrusion at C6-7 with mild central canal narrowing but no significant foraminal
Compromise
FINDINGS: The alignment is anatomic. There is straightening and reversal of the normal lordosis which
could be the basis of muscle spasm or positioning. There is no fracture or subluxation. There
is no significant degenerative change. The prevertebral soft tissues are unremarkable. The
odontoid is normal. C1 aligns normally on C2. The neural foramina are patent at all levels.
CONCLUSION: Straightening of the normal lordosis which could be on the basis of muscle spasm or
positioning.
Otherwise unremarkable cervical spine.
FINDINGS: AP, lateral, AP open mouth odontoid, and both oblique x-ray
views of the cervical spine were obtained. There is some
straightening of the usual cervical lordosis which can be seen with
muscle spasm. No acute fracture, vertebral compression,
spondylolisthesis, or intervertebral disc space narrowing is seen.
The prevertebral soft tissues, the odontoid, the facet joints, and
the spinous processes are unremarkable. The neural foramina are
patent. There is normal alignment of the atlantoaxial joints between
C1 and C2.
CONCLUSION: THERE IS SOME STRAIGHTENING OF THE USUAL CERVICAL LORDOSIS.
THE EXAMINATION IS OTHERWISE UNREMARKABLE.

Thanks

[Donald Corenman, MD, DC]

#8831

The MRI does not note degenerative changes at any levels but C5-6 and C6-7. These levels are unlikely to cause upper neck pain. You did have neck X-rays but unfortunately this series did not include flexion/extension X-rays. These additional films can be quite revealing as they are the only images that allow motion. All your other images are static (your neck is in one position only when the images are performed).

Your upper neck pain could be originating from the upper facets at C2-3 and C3-4. These facets generally will not demonstrate findings on MRI as the MRI can only resolve pathology down to about 2-3mm and facet inflammation can be microscopic (therefore not visualized on MRI).

If you want to determine if the upper facets are causing your pain, find a physician who would consider facet blocks of these levels (see the website for further details). You would need to follow the instructions for a pain diary (again-see website).

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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