Is cervicogenic neural coupling “real”? In other words, can “cervicogenic” headaches, facial numbness, etc. really be explained by cervical spinal neurological issues (nerve entrapment for example).
Facial numbness cannot be explained by cervical spine problems. The facial nerve exits through the skull directly into the face and bypasses the spine. Occipital headaches however can be generated by the neck. The greater and lesser occipital nerves originate from the neck and travel over the head to the top of the eyes and ears.
There are a handful of patients I have who think that facial numbness originate from the neck as they have neck pain associated with facial symptoms but I have not been able to make a neurological connection between these two structures. There is some evidence that there are cranial nerve nuclei (the origin of these nerves) that may descend into the upper cord at C1 or C2. Even if this is true, there is no evidence of cord compression that will affect these nuclei in patients who connect facial numbness to cervical spine issues.
Can cervical spinal problems (stenosis, foraminal narrowing leading to root compression/entrapment, etc.) also account for lower limb symptoms (i.e. tingling and numbness in the toes, loss of cutaneous sensation)? Again, both neurologists contend that this is not “anatomically” possible!
These neurologists may not understand the question as I see this pattern every week. This symptom pattern is produced from myelopathy (see website) and these symptoms are common. When the cord is compressed and malfunctioning, legs can become weak with strange symptoms such as paresthesias (pins and needles), weird cutaneous symptoms (cold water trickling down the leg or bugs crawling on the skin) and numbness.
Parkinson’s disease is a disorder of the substancia nigra within the brain and can cause many weird symptoms. I am by no means an expert on Parkinson’s disease but I do have patients with this disorder. The stiffness and change in gait associated with Parkinson’s disease can abnormally load the spine and magnify any spinal disorder that is not previously symptomatic.
Your MRI report of “Moderate C5-6 and C6-7 and mild C4-5 central canal stenosis, based on disc/osteophyte complexes, with slight indentation of the anterior aspect of the spinal cord at the C5-6 and C6-7 levels. No evidence of myelopathy.
c) Mild to moderate left and moderate to severe right C5-6 and severe right and
moderate left C6-7 neural foraminal narrowing” could be an indication of the beginnings of myelopathy but the radiologist is not too concerned about this compression.
What are the findings of your physical examination? Do you have long tract signs (hyperreflexia, clonus, Hoffman’s sign, imbalance, incoordination)? Do you have the typical symptoms of myelopathy (see website)?
Dr. Corenman
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.