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  • kristina76
    Participant
    Post count: 8

    Hi Dr. Corenman,

    I am a PT, thought now not working due to severe chronic pain. I was wondering your thoughts on the safety of C1-2 facet rhizotomy? I’m considering a rhizotomy of C2-3, C4-5, but I have significant nerve like pain palpable at the facet region which feels higher to me than C2-3. When I have C2-3, C3-4 blocks, it seems some of the pain is higher and isn’t getting completely hit. I have difficulty turning my head left, which I know much of this motion occurs at C1-2, and I have a lot of cracking, shifting of the OA joint and C1-2 joint, headaches, and spasms just under the occiput. My pain doctor is insisting pain can’t be coming from C1-2, which does not make sense to me, and he does not treat this area. Have you seen patients safely have C1-2 rhizotomy?

    Thank you for your time!

    Kristina Jaeckel

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Remember that nerve from C2 and C3 go up the back of the head so unlike the rest of the spine where pain radiates down the spine, C2-3 and C3-4 have pain that radiates up to the head. Disorders of these two levels will have some tenderness above the origin of the actual facets.

    If you have a C1-2 AP X-ray (open mouth odontoid-OMO) you can normally see the C1-2 articulation and determine if there is facet disease. An MRI or even a CT scan should be good enough to visualize this articulation. I have rarely seen the Occiput-C1 joint ever involved but I do occasionally see arthrosis of C1-2 (last one on Monday).

    I would worry about a C1-2 rhizotomy as the vertebral artery is right there and the greater occipital nerve does not follow the path that the other spinal nerves do (large anterior branch with motor and sensory and a small recurrent branch that innervates the facet). Now, if you had a C1-2 block that gave you great relief (and no block at the same time at C2-3 or C3-4), then maybe you do have facet syndrome but I have not referred out any C1-2 for ablation. There are times that this joint may need to be fused if it causes excruciating pain but I have done this fusion only once in 35 years for this disorder.

    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.
    kristina76
    Participant
    Post count: 8

    Thank you for that prompt and detailed reply! This forum is so helpful to so many. I have had all of the tests you mentioned, which only shows some minimal facet degeneration, but I still have severe nerve pain and muscle spasms/joints cracking. Maybe it’s more damaged facet nerves/capsules then actual degeneration? The only other question I had was could other nerves be involved that are being missed? I’ve never had any selective nerve root blocks. What is the highest upper cervical nerve root that can be blocked? If I had damage to the upper cervical nerve roots, how would it present differently than damaged medial branches? I don’t have much tingling or loss of motor control, just pinpoint palpable pain at c2 region (like a bad tooth when you press on it), headaches, cracking, spasms, difficulty turning my head left. If a nerve root is blocked and that seems to be some of the pain source, how is that treated? I don’t have visible stenosis or nerve root compression on my recent exams.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Without any imaging findings of nerve compression, you don’t have nerve pain from impingement. There are three pain generating possibilities: facet generated pain, disc generated pain and finally, chronic radiculopathy. A SNRB can identify chronic radiculopathy but unfortunately will not treat it (generally-but occasionally some relief can be gained by an injection). Facet generated pain can be treated by ablations (rhizotomy) and disc generated pain by ACDF.

    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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