[Pinales]

#11303

Hello Dr. Corenman,

I contacted you first in 2011 and again in 2012. My problem with upper cervical dysfunction is not resolved. Would you please answer another question:

My MRI shows osteophytes in C2, C3 and C4, one enters the spinal cord.
My major paresthesia, pressure, and burning is in the occipital region and on top of my head. My neck is very restricted in all directions. My shoulders, and the trigemenial regial of my head are also tight. Also have unilateral tinnitus on the right side.

My questions: I’ve had three nerve blocks with little result. Could this be because only one nerve is relieved and I am still feeling the others?
Shouldn’t I at least feel numbness?
A new pain specialist wants to do another facet block. Is there good reason to agree or will it still be futile? Do nerve blocks sometimes not work in the upper cervical area?

The neurosurgeon wants a nerve block to verify what is seen on the MRI. Otherwise, he will do nothing. He said then it would be easy to “clean it out.” Aren’t there many reasons for this type of dysfunction? I’m afraid he won’t look for all of them…just remove the osteophyte. He is a chief neurosurgeon at a prominent teaching hospital.

This has now lasted more than five years and has strongly impacted my life.

Thank you, as usual, for any response.

Judith

[Donald Corenman, MD, DC]

#11308

Osteophytes normally develop from the disc space or the facets. I will assume that the osteophyte does not “enter the spinal cord” but does project into the spinal canal.

Osteophytes are due to degeneration of these structures. Pain is generally related to the erosion of the facet surfaces and “grinding” of these ridged surfaces agains each other.

The facet blocks you mention generally are diagnostic but not therapeutic. This means that the lidocaine (numbing agent) injected should give you 2-3 hours of relief as you have numbed these structures. Long term relief which is a function of the steroid also injected is more uncommon.

If you obtained short-term relief from the injection in the first three hours, this was a diagnostic block meaning the structure injected was the pain generator. In this case, the next step normally is a rhizotomy or burning of the sensory nerve that supplies this joint.

“Cleaning it out” may not give you the relief that you desire.

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.

[Pinales]

#11313

I certainly still had symptoms. My thought is that with more than one area affected that there would not be significant relief? Correct? But I should have still felt some numbing, right? With all the symptoms, I didn’t notice the relief and certainly didn’t notice any numbing.

Do cervical blocks sometimes just not work?

Yes, when he said “cleaning it out” it made me nervous…but he is supposed to be a very well known neurosurgeon. Maybe, I need to get my courage up and talk to him. He is very confident when he speaks and it is hard to question him.

Thank you so much for such a quick response. I hope I am not emailing you another five years from now!

Judith

[Pinales]

#11314

I should add that with one of the nerve blocks, my tinnitus stopped for an hour or so.

Thanks again.

[Donald Corenman, MD, DC]

#11326

Tinnitus is related to the acoustic nerve which does not exit the skull. There are some cervical disorders that can affect tinnitus but the temporary retreat of this “noise” does not help diagnosis.

If you underwent the nerve block and had absolutely no temporary relief for three hours, most likely the structures injected were not part of the pain generators. There is the slight chance that the block was not performed correctly but I will have to assume that this injectionist “did a good job”.

Now if you had partial relief (40-50%), then possibly you have more pain generators and only some were anesthetized.

You need to talk to this surgeon and he must be able to give you good answers that make sense to you. Don’t be awed by his position.

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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