Donald Corenman, MD, DC
Post count: 8427

You report pain in the cervical spine centrally. The lumbar spine pain most likely is from another source. The upper extremity symptoms seem to be variable. First, which symptoms are worse, the neck or the arms? If the neck, what is the percentage of neck vs. arms? 70/30, 80/20 or? What makes the neck pain worse? Does time of day make a difference? What is the intensity of the pain on a 0-10 scale?

The X-rays can be revealing. You note significant degeneration of C4-7 and straightening of the normal lordosis curve. Straightening of the curve is typical with degenerative change of the discs. The discs are trapezoidal in shape and wear of these discs will straighten the spine.

I will assume that you have already had substantial treatment in the form of physical therapy, chiropractic and other forms like acupuncture and medications. You report that injections have failed to give you relief.

If you have failed everything and the symptoms are disabling, you might be a candidate for a work-up for surgery. First, facet injections might be in order. The cervical facets can generate central neck pain. Temporary relief of your pain with injection of the facets may make you a candidate for ablation of the nerves that send signals from the facets (rhizolysis).

If that procedure gives you no relief, then you might be a candidate for fusion surgery. First, the range of motion of the C4-7 levels on flexion- extension films has to be very limited or there has to be instability present. Some surgeons would then use a test called a discogram to test discs above. This test would have to be negative (no pain generated from the discs above). You would then need a long talk with your surgeon regarding surgery, the expectations, the potential results- both good and bad.

Dr. Corenman