Skull base, neck, should and arm pain on left side

///Skull base, neck, should and arm pain on left side
Skull base, neck, should and arm pain on left side
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  • jrsigurl
    Participant
    Post count: 2

    Hi Dr. Corenman,
    I found your site while trying to understand the C-Spine MRI which I had taken recently. I have been having pain for about 1.5 years now, the pain begins in my head at the base of the skull and down to the neck on the left side. The pain radiates down my shoulder and into the left arm. I had sinus surgery, septoplasty and submucous resection of turbinates 2 years ago and have been having increasing symptoms of this nature and other pains since the surgery, dry nose and eyes, ears popping and ringing mostly on the left side. The pain in the back of my head is always in the same spot more to the left and I can feel pressure that sometimes alleviates or gets a little dull after taking pain medication and antibiotics. I have asked the ENT if I had a CSF leak or some other injury during the surgery and they replied that I do not have a CSF leak and stated I would know if I did. I’ve never had a CSF leak so I don’t know how I would automatically know. They told me to see my primary Dr which I did and he said I had spondalysis which I don’t understand how I can suddenly develop that. The ENT suggested another surgery which I am not eager just to have another surgery without understanding or getting a true diagnosis. I have since seen a neurologist and am waiting for diagnosis. I would like to know what questions to ask to help determine if I had/have CSF leak, nerve damage or some other injury which I suspect is a result of the surgery.

    Thank you in advance for your time.
    Val

    Donald Corenman, MD, DC
    Moderator
    Post count: 6700

    I have only base knowledge of intracranial disorders so my information will be limited. CSF leaks cause base of the skull headaches when upright and go away with lying down. Facet disorders will also cause headaches that are worse with loading (upright posture) and go away with off-loading (lying down).

    Symptoms of preexisting but asymptomatic facet disorders can be triggered by surgery as if you are asleep, you cannot protect your neck. Positioning can aggravate these disorders. Sinus surgery can also trigger cranial nerve disorders such as trigeminal neuralgia which can sensitize you.

    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.
    jrsigurl
    Participant
    Post count: 2

    Thank you for your response. I did receive a C-Spine report which I am hoping you can give an opinion as I believe these issues are a result of the sinus surgeries I had. It indicates the following:

    Ossesous Structures: There is anterior subluxation of the right lateral mass of the vertebral body C2 relative to C1 measuring 1.3 mm. The left atlantoaxial joint demonstrates normal alignment. Vertebral bodies C2 through C7 demonstrate normal alignment. There is mild reversal of the normal cervical lordotic curve, which may reflect positioning, muscle spasm or spondylotic changes. There is disc height loss with endplate marrow changes at the C5-C6 level, consistent with degenarative disc disease. To a lesser extent, there is also degenerative disc disease at the C4-5 and C6-7 levels.

    C2-3: At this level, there is a minimal 1.9 mm broad based disc bulge, which minimally encroaches on the anterior subarachnoid space. No significant central canal stenosis or neural foraminal encroachment is apparent at the C2-3 level.

    C3-4: At this level there is a minimal 1.0 mm broad based disc bulge which appears to nearly abut the anterior cervical cord and results in mild central canal stenosis. The neural foraminal are patent bilaterally at the C3-4 level.

    C4-5: At this level there is a mild 2.50 mm broad based disc bulge which abuts the anterior cervical cord and results in mild central canal stenosis. Primarily as a result of unconvrtebral joint spurring. There is mild left neural foraminal encroachment at the C4-5 level. The right neural foramen is patent at this level.

    C5-6: At this level there is a minimal 3.1 mm broad based disc bulge, ecentric to the left which nearly abuts the anterior cervical cord. There is mild ligamentum flavum hypertrophy with overall mild central canal stenosis. Primarily as a result of unconvertebral joint spurring, there is moderate left neural foraminal encroachment at the C5-6 leel. The right neural foramen is patent at this level.

    C6-7: At this level there is a minimal 4.4 mm broad based disc protusion, which abuts the anterior cervical cord. There is mild ligamentum flavum hypertrophy with overall mild to moderate central canal stenosis. Primarily as a result of unconvertebral joint spurring, there is moderate bilatural neural foraminal encroachment at the C6-7 level.

    C7-T1: At this level there is a minimal 2.0 mm broad based disc bulge, which encroaches on the anterior subarachnoid space. No significant central canal stenosis is apparent at this level. Primarily as a result of uncovertebral joint spurring, there is mild bilateral nueral foraminal encroachment at the C7-T1 level.

    Spinal Canal and Contents: The cervical cord demonstratoes intrinsically normal signal.

    Adjacent strucutres: There is partial visualization of the maxillary sinuses. There is extensive mucosal thickening withing the right maxillary sinus, consistent with severe sinusitis. There is also a 0.9 cm fluid level within the dependent portion of the left maxillary sinus, consistent with acute sinusitis. The inferior aspect of the sphenoid sinus is visualized and also demonstrates mucosal thickening.

    Thank you for your time,

    Jrsigurl

    Donald Corenman, MD, DC
    Moderator
    Post count: 6700

    If your head is not perfectly straight in the CT scanner, you will have some rotation of C2 on C1. This could explain the finding “There is anterior subluxation of the right lateral mass of the vertebral body C2 relative to C1 measuring 1.3 mm”. I don’t think this is a really significant finding.

    Your findings of “disc height loss with endplate marrow changes at the C5-C6 level, consistent with degenarative disc disease. To a lesser extent, there is also degenerative disc disease at the C4-5 and C6-7 levels” can cause symptoms. See: https://neckandback.com/conditions/cervical-degenerative-disc-disease/

    This might also have significance; “there is moderate left neural foraminal encroachment at the C5-6 leel. The right neural foramen is patent at this level. C6-7: At this level there is a minimal 4.4 mm broad based disc protusion, which abuts the anterior cervical cord. There is mild ligamentum flavum hypertrophy with overall mild to moderate central canal stenosis. Primarily as a result of unconvertebral joint spurring, there is moderate bilatural neural foraminal encroachment at the C6-7 level”

    See: https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/.

    I think is this concerning also: “There is partial visualization of the maxillary sinuses. There is extensive mucosal thickening withing the right maxillary sinus, consistent with severe sinusitis. There is also a 0.9 cm fluid level within the dependent portion of the left maxillary sinus, consistent with acute sinusitis. The inferior aspect of the sphenoid sinus is visualized and also demonstrates mucosal thickening”.

    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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