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  • Mueller
    Member
    Post count: 6

    Hello,
    I am not new to the merry-go- round of spinal surgery having had 3 lumbar surgeries(including fusion all at L 4-5 and one cervical fusion at C5-6.I now present with posterior bone spur C3-4 with pain into shoulder and left arm.Symptoms started last year and would come and go-one trip to ED thinking it was my heart-one trip to ortho-Negative MRI of left shoulder thinking it was rotator cuff.EPI steroid injection atC3-4 resulted in complete relief of symptoms with aching returning after24 hours.I am tired and ready for surgery.Do posterior bone spurs go away with time-why would I wait on surgery and live a life in bed and on medication.I once was a very active person -Visited an Orthopedic PA-pain clinic for injection and ortho spine surgeon-none of whom call me their patient-will be at the Vail Clinic as soon as I can get an appointment-The original question -Will posterior bone spurs of C spine dissipate with time?

    Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Sorry to hear that you are a skilled spine patient. Your journey to find that compression of the C4 nerve is the pain generator is a common one. The C4 nerve as you have found out not only radiates to the top of the shoulder but the anterior chest wall. Pain the chest, especially on the left side can mimic chest pain from a heart attack. In fact, this pain generated by the C4 nerve is called cervical angina.

    Your epidural steroid injection did relieve your symptoms which demonstrates more likely than not that your C4 nerve is the culprit. There is a question of specificity however in that the technique of the epidural injection typically covers about three separate nerves and is not specific to one nerve.

    If there is no other possible nerve involved (C5 comes to mind), then you have a diagnostic injection and can base a surgical decision on this. If however there is a possibility that C5 can be involved, you would need an SNRB (selective nerve root block- see website) to specifically implicate C4 as the pain generator.

    Except in unusual circumstances, bone spurs generally never disappear. However, nerve roots can adapt to compression if the compression occurs slowly.

    Dr. Corenman

    Mueller
    Member
    Post count: 6

    Thanks so much for the reply-I am not nuts then.I will probably have a fusion at both C3-4 and C 4-5 as C 5-6 is already fused and with a fusion on both sides it would only be a matter of time and I would be back- I think that would be under adjacent segment disease.I hope you will be making that decision -as I will be making an appointment as soon as office calls.The C4 nerve has been bothering me for over a year.

    Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Two of the questions are how degenerative the C3-4 disc is and if the spur that compresses the nerve is generated from the front (uncovertebral joint) or from the rear of the spine (the facet). If the disc is not too degenerative and the spur originates from the facet, you would be a candidate for a posterior foraminotomy. If the disc is significantly degenerative, you might need an ACDF or an artificial disc replacement.

    Dr. Corenman

    Mueller
    Member
    Post count: 6

    Pain in my arm and shoulder has decreased after EPI at C3-4-but pain in my neck has dramatically increased-the injection was Wednesday-I had very little neck pain before the injection.Is this common?I always got pain relief after the ESI in my lumbar region years ago.Any thoughts-?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Normally, an ESI will relieve neck or lower back pain as the steroid “calms down” the nociceptors (pain receptors) in the back of the annulus (disc wall).

    Why your pain increased is unknown as this is an uncommon result from an ESI. Pain increase could be from a volume phenomenon (the mass of the liquid injected causing a pressure injury). If that is the case, the pain should abate shortly.

    Dr. Corenman

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