Your symptoms could be generated by the C2-3 facet (“Radiotracer uptake localizing to the left C2-3 facet joint, associated with facet arthrosis”), radiculopathy by the foraminal stenosis from C3-4 (“MRI shows pretty significant disc bulge into the left foramina at c3-4”) or possibly from the degenerative disc at C3-4 (“Moderate radiotracer uptake localizing to C3-4 disc level, associated with moderate degenerative disc disease”).
If the pain is aggravated by head extension (bending the head backwards), the either facet origin or radiculopathy origin is most likely to blame. If flexion increases the pain, the disc is more likely the cause.
The best way to determine what structure is to blame is to first perform a facet block of the left C2-3 facet and keep a pain diary (see below). If relief is noted, RFA (rhizotomy) is the treatment. If minimal relief, then a selective nerve root block of C3-4 left. If relief and you have failed PT, then an ACDF of this level should yield relief.
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.