geno71

So I’m still dealing with this chronic neck pain issue. Just to recap, the symptom appears to be sore achy muscles on both sides midway to lower part of the neck on both sides but most pronounced on the right. Pain is lowest in the morning and worst at night. In general pain is lower when lying down than sitting/standing. Muscle relaxants/NSAIDS/Oral Steroids do not relieve the pain. Palpating of the neck muscles as well as the tops of shoulders feel tender.

I went to another PM doc last summer and he sent me for a SPECT-CT which the results are below. His view was that if the issue was facet or even disc related, something would show on this test. The test did not show any abnormal uptake in the cervical spine. Based on the test, the PM doc was thinking the issue is purely muscular in nature and wanted to start with trigger point injections into the neck. I decided to hold off on that treatment because I had previously had TPI in the tops of my shoulders from another doc and they did nothing to help. Does the SPECT-CT shed any additional insight into a possible cause of my pain? The only other thing I noted in the scan was the additional uptake in the AC joints.

TECHNIQUE
A total body bone scan was obtained in standard projections with additional views obtained of the
cervical, ribcage and skull. SPECT CT images of the cervical in the standard projection were
performed. A low dose attenuated CT scan was obtained for localization purposes.
CT was performed with one or more of the following dose reduction techniques: automated exposure
control, adjustment of the mA and/or kV according to patient size, or use of iterative
reconstruction technique. Total DLP (mGycm)= 109

COMPARISON
No comparisons

TOTAL BONE SCAN FINDINGS
The total body bone scan shows multiple patchy areas of increased activity seen throughout both
sides the ribcage, both sides the mandible left greater than right as well as the right
supraorbital region. Rest of bone scan shows some activity involving the AC joints. Both kidneys are identified.

TOTAL BONE SCAN IMPRESSION
1. Abnormal bone scan showing multiple areas of osteoblastic activity seen throughout both sides
the ribcage. The patient gives no history of trauma. This are indeterminate could related to
old remote trauma and or if the patient had no trauma than pathological etiology would have to be
consideration. This may need further clinical evaluation
2. There is increased activity involving both sides of the mandible left greater than right
consistent with periodontal disease
3. Focus of increased activity involving the right supraorbital region of the skull.
This indeterminate. May need further clinical evaluation.

SPECT CT SCAN FINDINGS
The SPECT scan shows no abnormal areas of increased activity seen involving the cervical spine
particular the articulating facets or posterior elements

There is intense activity seen involving the left side of the mandible posteriorly as well as the
right side of the mandible also posteriorly.

The rest of the SPECT scan localizing images show no bony lesions identified. Upper lung zones
that are imaged appear normal. There is no adenopathy identified.

SPECT CT SCAN IMPRESSION
1. Coronal SPECT CT of cervical spine
2. There is significant activity involving both sides the mandible posteriorly compatible with
periodontal disease. Oral dental evaluations advise
3. No addition pathology otherwise

Hi Dr. Corenman,

I’m still having the same constant low grade neck pain that I reported on here over a year ago. It’s still primarily on the right side mid to lower neck, but I’ve also noticed tenderness if I press on the spinous process around the c5-c6 area. The pain is better but not completely gone in the morning when I first wake up. The pain gets worse as the day goes on. At times, the pain seems to radiate into the tops of my shoulders on both sides. Bending my head backward seems to produce pain more so than bending forward.

I’ve been to a few different pain doctors in the past year, but really haven’t been given a diagnosis if it’s facet or disc related. Since I last posted, I’ve been prescribed Meloxicam which I took for a month as well as Skelaxin and Flexeril which offered no relief.

I’ve been to three different pain doctors and none of them felt like the facet joints were the issue. The most recent doctor prescribed a Medrol pack for a week which made no difference. He now would like to proceed with a cervical epidural instead of facet block based on the fact that it’s highly unlikely for me to have facet arthritis at age 37 without any prior trauma and that my original issue in 2014 involved left sided shoulder and arm pain/tingling which is more indicative of a disc problem. I wanted to get your thoughts on this approach.

Here is my most recent mri and extension/flexion X-rays performed on 9-23-17.

Comparison:
Previous MR cervical spine from 02/15/2016.

Technique:
MRI of the Cervical Spine without contrast:
T2/STIR fat saturation sagittal, T1 sagittal, T2 FSE axial, and 3D gradient echo axial imaging sequences were performed through the cervical spine.

Findings:
Craniocervical junction: No significant abnormalities are detected of the clivus or cervicomedullary junction. The cerebellar tonsils are normal in position. The foramen magnum is patent. The atlantoaxial articulations are unremarkable.
C2-3: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebra) joint or facet arthrosis. Neural foramina patent. The central canal is normal.
C3-4; Mild right-sided annular disc bulging. No focal disc herniation. The neural foramina are patent. The central canal is normal.
C4-5: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebral joint or facet arthrosis. Neural foramina patent. The central canal is normal.
C5-6; There is mild circumferential annular disc bulging. There is normal disc height. There is no focal disc herniation demonstrated. The neural foramina are patent. There is no central canal stenosis.
C6-7: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebral joint or facet arthrosis. Neural foramina patent. The central canal is normal.
C7-T1: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebral joint or facet arthrosis. Neural foramina patent. The central canal is normal.

Alignment: There are no significant alignment changes from the prior examination.
Osseous structures: There are no acute osseous abnormalities or bone marrow abnormalities demonstrated in the cervical spine.

Cervical cord: There are no cervical cord abnormalities.

Paraspinous soft tissues: There are no significant parasplnous soft tissue abnormalities demonstrated.

IMPRESSION:
There are no significant MR abnormalities in the cervical spine for age. There are no significant interval changes detected in comparison to the previous February 2016 cervical spine MRI examination.

EXAM: XRAY SPINE CERVICAL 6 OR MORE VIEWS

No relevant prior examinations.
Technique:
7 radiographic views of the cervical spine were performed, to include flexion and extension.

Findings

Osseous structures: There are no acute fractures or acute osseous abnormalities demonstrated in the cervical spine.
Alignment; The alignment of the vertebral bodies of the cervical spine is normal, including in flexion and extension.
Bone mineralization: The bone density of the cervical spine is normal.
Intervertebral discs and facet joints: The interveriebral disc spaces are preserved. The facet joints demonstrate no significant abnormalities.
Soft tissues: The prevertebral soft tissues are unremarkable.

IMPRESSION:
There are no acute fractures or acute osseous abnormalities demonstrated in the cervical spine. There are no significant, abnormal degenerative findings demonstrated for age.