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Dr. Corenman:

I am pretty sure this is at C2-C3 (vs. C3-C4). I now have some pins and needles in the C2-C3 distribution after my PT sessions and at other times.

This problem started about 6 weeks ago. After about 2 weeks, I couldn’t turn my head enough to drive safely. After trying the other usual stuff, I had a few days of prednisone (from an emergency stash) — 20mg/day (BW~50kg). The result was marked — even after just a day. I continued 20mg for 5 days and then 10mg for another 5 days. After a couple days, my range of motion and my pain had dramatically improved. I completed this trial of steroids about 2.5 weeks ago.

This seems to be a bit of synovitis if you ask me. But no signs of inflammation on MRI — not even a little bit of edema? Is the C2-C3 facet joint adequately imaged in the typical C-spine MRI views? Would one expect MRI findings if there was synovitis of 6 week duration? (I do vaguely remember seeing a physio back in Australia maybe 5 years ago for an annoying problem — probably soreness/stiffness on rotation — which she told me was at C2-C3. I went to physio a couple times a week for a few weeks and it got better. I didn’t need any tablets for pain. This time around is a different story!)

While no one really LIKES to use prednisone (including the person taking it), what type of doses do you prescribe for these sorts of things? I read of high doses (60-80 mg) with taper being used. I get the feeling, the practice I have been going to passes out dose packs in the physiologic dose range. That is quite a variation in prescribing habits!

Do you have anything to say about injections for this problem? Risk vs. benefit.

BTW, I go to physio 4 times a week. I think the “manipulation” might be stirring things up a bit. I have been laying off that and doing pilates sessions with a different physio in the office instead this last week. My physio (the same guy who helped me with T spine for months) is brilliant but I just feel like the current treatments are fueling the inflammation.

Cheers

Dear Dr. Corenman:

“To determine a recurrent herniation without a previous MRI is generally speculation except in certain specific circumstances.” You mean like autopsy or some other way :) In the US, can patients get consultations with radiologists? At my assigned hospital in Sydney and on rotation in Dunedin, I could just poke my head into radiology with questions about anything — patients, personal. In fact, radiologists liked the fact that students and trainees might actually be interested in what they are doing. They’d even bring out some of there prized films just for fun — I wonder if all radiologists have a collection of films revealing miscellaneous objects that just happened to end up in the rectum. Enough silliness!

OK, no healing. Does the annulus tend to scar such as to complete the annular ring and thereby contain what is left of the nasty “jelly”?

I had no “event” to cause this. I didn’t pick something up and have my “back go out”. Presumably there is a mechanism of action for this injury. Broadly, I read simultaneous forward flexion and torsion.

I am about 5’5″ and 50 kg and pretty sturdy for someone with these dimensions. Ever since I was a young child my torso has been riddled with muscle. I was like this ripped baby! (This injury has taken care of that. For 2 months, I imagined myself in a brace from shoulders to hips — it was the only way I could carry on ADLs.) Of course this apparent muscle-iness is likely genetic and doesn’t necessarily mean that I am strong! I like all sort of sport and outdoor activity. I am not a couch potato. In respect to the general population, I don’t think I would have been considered weak last December when this presented.

I am hitting physio HARD. I hate the gym. But I am doing it ’cause I need those smooth rotational movements to ski, etc!

This surgeon didn’t seem familiar with a non-kyphotic variant of Scheuermann’s disease. He said everyone has Schmorl’s nodes. I do read they are relatively common in back pain sufferers and can be present in those with no complaints. I suppose it’s an academic matter without much bearing on mgt. However, I’m curious. Looking for reasons this happened and hoping to avoid it in the future. If re-herniation is likely to be a recurrent problem, it changes my view of surgery. From what I have read, I would probably opt for the definitive approach — which I assume is thoracotomy with fusion or some variation thereof — should surgery become indicated. I do consider this a BIG operation and want to avoid at all costs! Less invasive procedures are not always less destructive. Of course it would depend on the surgeon and his expertise in one approach over another. This may be a case where you pick a surgeon based on his approach to the problem, IMO.

This is a great forum. I have told lots of people with back trouble to come here.

Thank you

Trying message in 2 parts. Encountering spam control :(

Dear Dr. Corenman:

I ventured into the office of a local spine surgeon today. It wasn’t all that bad, I guess.

I was motivated to see a physician at this time as in addition to persistent soreness of my thoracic spine (note: this was not part of the initial disc herniation presentation which was simply radicular pain at the costal margin), I am having a great deal of pain and soreness in the neck — pain with lateral flexion and rotation and bad (and different) headache. Forward flexion and extension with head supported is only minimally sore. Yes, it definitely could be just “stress”. Basically, I figured I had enough spine stuff going on to finally consult a spine surgeon. I reasoned then I will know where to go if in the event of future spinal woes.

The staff obtained a C-spine plain film on scene prior to my visit with the surgeon. BTW, this film showed degeneration at C5-C6 (wouldn’t think this with jive with my current neck pain and headache) according to the surgeon; and evidence of a 20+ year old C7 fracture that I was well aware of. I have requested a copy of the study and report. I do not have them yet.