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I forgot to add that I commonly hear my heart pound in my neck and head like I have a hangover headache. It is so loud when I lay down every night that it makes it hard to sleep. Is this common or related to a narrow canal or something else. Or perhaps is not related at all.
Thanks.You might have cervical stenosis based upon your measurements but there is much more to make that diagnosis. The angle of the cuts on the MRI can minimize or maximize the appearance of the narrowing. The type of image acquired also makes a big difference as some sequences minimize and some maximize the appearance. You might have congenital cervical spinal stenosis (you were born with a narrowed canal) but this might not translate into symptoms.
Stenosis causing cord compression generally does not cause headaches. Patients who come into the office with significant myelopathy (dysfunction of the cord from severe compression) almost never complain of headaches.
The physical examination will go a long ways to rule in or out myelopathy. WIthout symptoms and findings on examination, you probably would not have myelopathy.
The “pounding” you feel in your head is not related to your cervical spine. You might have hypertension (high blood pressure) or something else cardiac wise. You had a previous MRI of your brain that you reported was normal so an aneurysm (weakness of a blood vessel wall) can be eliminated.
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.Hi Dr. Corenman,
It’s been a while and I wanted to give an update on my situation.
First, I have had several cervical disc injections for my two herniation’s at c5-6 and c6-7. They gave decent relief but only lasted a few days. The doctor decided to try the facets next. I then had a right side cervical block done c3-c7 I believe. Great relief 90%+. The effects were supposed to last 2-4 hours but the pain started coming back before I even left the building. My P.M. doctor decided to do the rhizotomy on the right. It had no effect what so ever. Why is that?
I recently had my left cervical facet block done but only received minimal relief so I decided against the rhizotomy procedure.
I have been having bilateral knee pain since last spring, it’s not always constant but when I get the pain it’s bad, it usually happens when I stand a lot. An x ray of my knees came back negative and the MRI of the right knee came back negative. I then had a lumbar x ray which only showed some undeveloped ribs and only 4 lumbar vertebrae.
To add to the mix my upper back is hurting bad, with burning sensations in shoulder blades, in between the shoulder blades and the shoulders themselves. I also have a very strange, painful thumping, snapping noise when I move my left shoulder blade, like it’s rubbing on my rib cage.
When I lay down before I fall asleep I get weird sensations then my legs and sometimes my whole body has a violent reflex reaction. It usually happens 2-4 times before I fall asleep. Is this a sleep thing or a nerve reaction?
I like to think I’m proactive and have been doing a lot of research, I’m not a doctor nor should I self diagnose but I don’t want to sit on the sidelines not understanding what’s going on. When I looked at my cervical x ray down at the shoulder region (I could only see one view) I swear there are several herniations. My husband looked and agreed. Now I know you can have herniations even severe ones with no symptoms but I brought it up to my doctor and he laughed at me and told my that is was not herniations I was seeing. It only concerns me because I’ve learned upper back herniations can cause neck pain.
My PM doctor told my of another disc procedure that can be done but I have to go see another specialist to do it. Should I continue on the cervical disc journey or should I be concerned with my upper back? Most of the procedures are only helping a minimal amount or they don’t last. I don’t know which direction to go in. I want to be able to be able to play with my kids and get back to life and I’m getting no where fast.
Thank you for all you time and thoughts,
KathyHaving only 1/2 hour of relief from the facet injections is not considered a positive diagnostic block. The IV medications you were probably given (narcotics and muscle relaxants) can mask lack of relief for that period of time. The fact that you walked out of the building (in what I imagine is a short period of time) without relief would mean to me that the facets injected were not part of your pain generator.
I am unclear why your C2-3 facets were not targeted as these facets are commonly implicated in upper neck pain and headaches.
Knee pain does not have to be mechanical. Inflammatory conditions can also cause this type of pain (rheumatoid arthritis, lupus, spondyloarthropathies among others). A work-up might be something to consider.
Your quote “To add to the mix my upper back is hurting bad, with burning sensations in shoulder blades, in between the shoulder blades and the shoulders themselves. I also have a very strange, painful thumping, snapping noise when I move my left shoulder blade, like it’s rubbing on my rib cage” sounds like a thoracic problem. There is a disorder called “snapping scapula” where the smooth bony surface of the scapula develops a spur and rubs agains the ribs when moving. This would need to be diagnosed by an orthopedist familiar with this disorder.
Your complaint “When I lay down before I fall asleep I get weird sensations then my legs and sometimes my whole body has a violent reflex reaction. It usually happens 2-4 times before I fall asleep. Is this a sleep thing or a nerve reaction?” I cannot comment on.
In general, you should not have procedures performed unless these lead to a diagnosis. You could have fibromyalgia so look into that disorder. Fibromyalgia is a diagnosis of exclusion so make sure everything else is ruled out before you consider that diagnosis.
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.Hello Dr. Corenman,
Another update on my cervical situation. I am continuing with the pain management doctor who is a neurologist. He is getting more concerned. My pain is increasing in my shoulders and my headaches are continuing. On his last examination he says I have hyper reflexes, 2-3 beats of clonus (which I’ve heard can be normal), I have a hyper jaw jerk reflex, I don’t know what this indicates.
I also had an epidural in c1-2 c2-3 area on the right side. It helped for about a week. My doc sent me for a neurosurgical consult since my central herniation is on the cord now and my kyphosis has increased some. He also believes my c5 c6 herniation, may be causing my left shoulder problems. I have had the electric sensations on the left in my neck but they stopped at my collar bone and didn’t continue down my arm. I have pain in both shoulders and upper back all the time but the left is worse. I have what you described as snapping scapula syndrome, a very disturbing sensation. The first surgeon said I should get a spinal stimulator. My pain doctor didn’t think this was a good idea and sent me for a second surgical consult. The second doctor suggested a 2 level discectomy and fusion claiming that the hardware would also help with the kyphosis and sent for a bone scan. The scan came back fairly normal, symmetric degenerative arthrosis of the shoulders, sternoclavicular joints, wrist, hips, knees and feet. There is a minimal thoracolumbar scoliosis. After my follow up with the second surgeon he suggested a one level discectomy fusion for c6 c7, the central herniation. He said he thinks it would be wise to do the minimal. I asked about my left shoulder and after he examined it he said it could be being caused from my neck at c5 c6. I also expressed my concerns about the neuro’s finding that I was hyperflexic. He agreed that I was and also said I was positive for Hoffmans. I do not have any signs of mylopathy or numbness anywhere but my exams tell my something is going on and it seems to be getting worse.
Do I wait this all out, hoping I never progress to weakness, numbness or mylopathy? How long can you stay on pain medications? I’m on hydrocodone SR 10 mg 4 x day and Celebrex 200mg 1 x day.
The surgeon said it’s a 50/50 thing that surgery will help me.
Since I have a very narrow spinal canal, I’m afraid of the stimulator and scarring. Have you found this to ever be an issue?
My chiropractor wants me to use a denneroll to try to fix my kyphosis. Is that even possible?
My primary doc said the sleep reflexes I am having at night are hypnic jerks or myoclonic jerks, is this concerning?
Not one of my doctors believes I have Fibromyalgia.
Thank you for your time and I look forward to your response.
KathyYou have some symptoms that could be from the facets at C2-4 as we discussed before. The epidural at C1-3 might confirm this but you would need facet blocks to be accurate in the diagnosis.
Having hyperreflexia and clonus could be “normal” as part of your make-up but needs to taken in consideration when a diagnosis is constructed. A hyperactive jaw jerk reflex would indicate non-cervical origin as the nerves that innervate the jaw are cranial nerves that do not exit the skull.
Bone scans are generally not helpful in cervical diagnosis.
A one level fusion at C6-7 might be helpful if there is significant compression of the cord. Shoulder pain can be generated from C5-6 or C6-7. The way to diagnose this is with a selective nerve root block and a pain diary (see website for more information).
How long can you stay on pain medications? It depends upon your genetics. If you have a non-surgically treatable condition that is chronic, there is a possibility to stay on a low dose of meds for a long period of time. I have some patients out 15 years that take a small fixed amount per day and never deviate from this level. Most patients cannot do this however.
Simulators are used when there are no other options such as medications or surgery.
No mobilization or manipulation will help the cervical kyphosis but may afford some relief of symptoms. This roll may also increase symptoms.
Stimulators implanted in the cervical spine are concerning if the spinal canal is narrowed as these stimulators take up some room that is needed for the cord.
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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