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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    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.

    https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
    https://neckandback.com/treatments/diagnostic-therapeutic-neck/
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

    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.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8660
    #34967 In reply to: MRI Result |

    You note: “I’m so afraid to go work. I had an episode after a heavy workload. I was profusely sweating, dizzy and weak….I have quite a few of these episodes ever since that day”.

    You then note pertinent MRI findings of:
    C3-4 Disc osteophyte complex contacting and minimally indenting the ventral margin of the cord to the left of midline. Mild central canal stenosis.
    C4-5 Diffuse posterior disc osteophyte complex contacting and mildly indenting the cord with mild central canal stenosis. Mild left foraminal stenosis.
    C5-6 Diffuse posterior disc osteophyte complex with left uncovertebral spurring. The complex contacts and mildly indents the cord with mild central canal stenosis. Severe left foraminal stenosis.
    IMPRESSION: Multilevel disc osteophyte complexes with mild cord impingement. Small focus of hyperintense T2 signal within the cord at C3-4. probably representing myelomalacia.

    This means your central canal which houses the spinal cord is too narrow causing cord compression and some injury. This is especially noted at C3-4. You need to be examined for signs of myelopathy and definitely need a spine surgeon’s consultation.

    See :https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

    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.
    chris_dee
    Participant
    Post count: 2
    #34964
    Topic: MRI Result in forum NECK PAIN |

    Hi Dr. Corenman,

    I had an MRI done but still have to see a spine doctor. There is a lot of medical terms and I have been Googling them, trying to understand what they mean. I am certified nursing assistant since 2002. I had an episode after a heavy workload and so afraid to go to work. I was profusely sweating, dizzy and weak. I thought I was going to faint, I had to sit down. I have quite a few of these episodes ever since that day but not as bad. I would appreciate it if you can explain my MRI result. Thank you so much!

    C2-3 No disc herniation, central canal stenosis or foraminal stenosis.

    C3-4 Disc osteophyte complex contacting and minimally indenting the ventral margin of the cord to the left of midline. Mild central canal stenosis. No significant foraminal stenosis.

    C4-5 Diffuse posterior disc osteophyte complex contacting and mildly indenting the cord with mild central canal stenosis. Mild left foraminal stenosis.

    C5-6 Diffuse posterior disc osteophyte complex with left uncovertebral spurring. The complex contacts and mildly indents the cord with mild central canal stenosis. Severe left foraminal stenosis.

    C6-7 Shallow disc osteophyte complex. No disc herniation, central canal stenosis or foraminal stenosis.

    C7-T1 No disc herniation, central canal stenosis or foraminal stenosis.

    IMPRESSION: Multilevel disc osteophyte complexes with mild cord impingement. Small focus of hyperintense T2 signal within the cord at C3-4. probably representing myelomalacia. Mild central canal stenosis.

    Randy
    Participant
    Post count: 4

    Thank you Dr. Corenman: I see that I can pay for a consult by sending you my MRI. I am going to do that. I’m guessing me having a flexion-extension x-rays as you noted would be helpful to send as well? Do I need a referral to have these x rays done? Last, can a nerve block be done on an area that is already fused to help determine if that is in fact a pain generator? If yes are epidurals able to be done on that fused area for relief?
    Thank you again

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    No CRPS is good. With your symptoms still intense and present, a new MRI is warranted.

    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.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Pain radiation into the shoulder blades is a common pain referral location for nerves C3-T1. It is not uncommon for the C3-4 level to radiate into the scapula. I would make sure that the fusion at C4-7 is really solid. An MRI can reveal that but also can give misdirection. Flexion-extension X-rays would be a better tool for evidence of fusion.

    If solid fusion is noted, and you have “moderate to severe right foraminal stenosis, and moderate left foraminal stenosis”, a selective nerve root block at C3-4 with good temporary relief would give evidence of the pain generating capacity of C3-4 where you could do something about this surgically (or the injection calms down the area and can be used for treatment).

    See:
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

    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.
Viewing 6 results - 73 through 78 (of 2,193 total)