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Hi, I Have Been Dealing With Chronic Neck Pain For
Question: Hi, I have been dealing with chronic neck pain for about three years. I tried rest, physical therapy and ultimately had a fusion at c4/5 it did little to nothing to resolve the pain. About three months ago I had radio frequency ablation done from c4/7 right side, still no improvement. My drs have had a difficult time finding a solution to my pain because the mri shows damage to more than one level. I have a constant headache, and pain turning my head laterally as well as in flexion and extension. I have no referring into my elbows or hands, no weakness. The mri shows some minimal damage to the faccet joint at c2/3 is it possible this level could be responsible for the ongoing symptoms?
Here is a copy of the mri report:
Status post ACDF at C4-5.
Right posterolateral C6-7 disc protrusion with foraminal extension, right side and partial encroachment upon the right anterior subarachnoid space.
Punctate increased T2 signal, lateral right cervical cord at C5-6 possibly punctate myelomalacia. Demyelination is perhaps less likely.
No significant spinal canal stenosis.
Surgery at C4-5 with resection of the previously seen left posterolateral disc herniation is a new finding. No significant change in the above findings otherwise.
Narrative
CLINICAL INDICATION: Bilateral neck pain, shoulder radiculopathy x3 years. Prior cervical fusion
MRI OF THE CERVICAL SPINE WITHOUT IV CONTRAST:
TECHNIQUE: Multiplanar multisequence MR imaging of the cervical spine was performed without the administration of intravenous contrast.
COMPARISON: 9/18.
FINDINGS:
ALIGNMENT: No alignment abnormality.
VERTEBRAE: Vertebral height is maintained. Susceptibility artifact at C4-5. No marrow signal abnormality otherwise.
DISCS: Slight loss of disc height at C6-7. See individual disc levels.
CORD: Punctate increased T2 signal, lateral right cervical cord at C5-6. No definite cervical cord signal abnormality otherwise. No intradural abnormality. Normal craniocervical junction.
PARAVERTEBRAL SOFT TISSUES: No paraspinal abnormality
EVALUATION OF INDIVIDUAL LEVELS DEMONSTRATES:
C2-3: No spinal canal or neural foraminal stenosis. Question of minimal left C2-3 facet hypertrophy.
C3-4: No spinal canal or neural foraminal stenosis.
C4-5: Status post ACDF at C4-5 with susceptibility artifact. Intact C4-5 disc otherwise. No spinal canal or foraminal narrowing. Previously seen left C4-5 disc protrusion has present resected.
C5-6: Central C5-6 disc bulge. No spinal canal or foraminal narrowing.
C6-7: Right posterolateral C6-7 disc protrusion with foraminal extension. Partial encroachment upon the right anterior subarachnoid space.
C7-T1: No spinal canal or neural foraminal stenosis.
T1-2: No spinal canal or neural foraminal stenosis.
T2-3: No spinal canal or neural foraminal stenosis.
Here is a copy of the mri report:
Status post ACDF at C4-5.
Right posterolateral C6-7 disc protrusion with foraminal extension, right side and partial encroachment upon the right anterior subarachnoid space.
Punctate increased T2 signal, lateral right cervical cord at C5-6 possibly punctate myelomalacia. Demyelination is perhaps less likely.
No significant spinal canal stenosis.
Surgery at C4-5 with resection of the previously seen left posterolateral disc herniation is a new finding. No significant change in the above findings otherwise.
Narrative
CLINICAL INDICATION: Bilateral neck pain, shoulder radiculopathy x3 years. Prior cervical fusion
MRI OF THE CERVICAL SPINE WITHOUT IV CONTRAST:
TECHNIQUE: Multiplanar multisequence MR imaging of the cervical spine was performed without the administration of intravenous contrast.
COMPARISON: 9/18.
FINDINGS:
ALIGNMENT: No alignment abnormality.
VERTEBRAE: Vertebral height is maintained. Susceptibility artifact at C4-5. No marrow signal abnormality otherwise.
DISCS: Slight loss of disc height at C6-7. See individual disc levels.
CORD: Punctate increased T2 signal, lateral right cervical cord at C5-6. No definite cervical cord signal abnormality otherwise. No intradural abnormality. Normal craniocervical junction.
PARAVERTEBRAL SOFT TISSUES: No paraspinal abnormality
EVALUATION OF INDIVIDUAL LEVELS DEMONSTRATES:
C2-3: No spinal canal or neural foraminal stenosis. Question of minimal left C2-3 facet hypertrophy.
C3-4: No spinal canal or neural foraminal stenosis.
C4-5: Status post ACDF at C4-5 with susceptibility artifact. Intact C4-5 disc otherwise. No spinal canal or foraminal narrowing. Previously seen left C4-5 disc protrusion has present resected.
C5-6: Central C5-6 disc bulge. No spinal canal or foraminal narrowing.
C6-7: Right posterolateral C6-7 disc protrusion with foraminal extension. Partial encroachment upon the right anterior subarachnoid space.
C7-T1: No spinal canal or neural foraminal stenosis.
T1-2: No spinal canal or neural foraminal stenosis.
T2-3: No spinal canal or neural foraminal stenosis.
Hi, I have been dealing with chronic neck pain for about three years. I tried rest, physical therapy and ultimately had a fusion at c4/5 it did little to nothing to resolve the pain. About three months ago I had radio frequency ablation done from c4/7 right side, still no improvement. My drs have had a difficult time finding a solution to my pain because the mri shows damage to more than one level. I have a constant headache, and pain turning my head laterally as well as in flexion and extension. I have no referring into my elbows or hands, no weakness. The mri shows some minimal damage to the faccet joint at c2/3 is it possible this level could be responsible for the ongoing symptoms?
Here is a copy of the mri report:
Status post ACDF at C4-5.
Right posterolateral C6-7 disc protrusion with foraminal extension, right side and partial encroachment upon the right anterior subarachnoid space.
Punctate increased T2 signal, lateral right cervical cord at C5-6 possibly punctate myelomalacia. Demyelination is perhaps less likely.
No significant spinal canal stenosis.
Surgery at C4-5 with resection of the previously seen left posterolateral disc herniation is a new finding. No significant change in the above findings otherwise.
Narrative
CLINICAL INDICATION: Bilateral neck pain, shoulder radiculopathy x3 years. Prior cervical fusion
MRI OF THE CERVICAL SPINE WITHOUT IV CONTRAST:
TECHNIQUE: Multiplanar multisequence MR imaging of the cervical spine was performed without the administration of intravenous contrast.
COMPARISON: 9/18.
FINDINGS:
ALIGNMENT: No alignment abnormality.
VERTEBRAE: Vertebral height is maintained. Susceptibility artifact at C4-5. No marrow signal abnormality otherwise.
DISCS: Slight loss of disc height at C6-7. See individual disc levels.
CORD: Punctate increased T2 signal, lateral right cervical cord at C5-6. No definite cervical cord signal abnormality otherwise. No intradural abnormality. Normal craniocervical junction.
PARAVERTEBRAL SOFT TISSUES: No paraspinal abnormality
EVALUATION OF INDIVIDUAL LEVELS DEMONSTRATES:
C2-3: No spinal canal or neural foraminal stenosis. Question of minimal left C2-3 facet hypertrophy.
C3-4: No spinal canal or neural foraminal stenosis.
C4-5: Status post ACDF at C4-5 with susceptibility artifact. Intact C4-5 disc otherwise. No spinal canal or foraminal narrowing. Previously seen left C4-5 disc protrusion has present resected.
C5-6: Central C5-6 disc bulge. No spinal canal or foraminal narrowing.
C6-7: Right posterolateral C6-7 disc protrusion with foraminal extension. Partial encroachment upon the right anterior subarachnoid space.
C7-T1: No spinal canal or neural foraminal stenosis.
T1-2: No spinal canal or neural foraminal stenosis.
T2-3: No spinal canal or neural foraminal stenosis.
Here is a copy of the mri report:
Status post ACDF at C4-5.
Right posterolateral C6-7 disc protrusion with foraminal extension, right side and partial encroachment upon the right anterior subarachnoid space.
Punctate increased T2 signal, lateral right cervical cord at C5-6 possibly punctate myelomalacia. Demyelination is perhaps less likely.
No significant spinal canal stenosis.
Surgery at C4-5 with resection of the previously seen left posterolateral disc herniation is a new finding. No significant change in the above findings otherwise.
Narrative
CLINICAL INDICATION: Bilateral neck pain, shoulder radiculopathy x3 years. Prior cervical fusion
MRI OF THE CERVICAL SPINE WITHOUT IV CONTRAST:
TECHNIQUE: Multiplanar multisequence MR imaging of the cervical spine was performed without the administration of intravenous contrast.
COMPARISON: 9/18.
FINDINGS:
ALIGNMENT: No alignment abnormality.
VERTEBRAE: Vertebral height is maintained. Susceptibility artifact at C4-5. No marrow signal abnormality otherwise.
DISCS: Slight loss of disc height at C6-7. See individual disc levels.
CORD: Punctate increased T2 signal, lateral right cervical cord at C5-6. No definite cervical cord signal abnormality otherwise. No intradural abnormality. Normal craniocervical junction.
PARAVERTEBRAL SOFT TISSUES: No paraspinal abnormality
EVALUATION OF INDIVIDUAL LEVELS DEMONSTRATES:
C2-3: No spinal canal or neural foraminal stenosis. Question of minimal left C2-3 facet hypertrophy.
C3-4: No spinal canal or neural foraminal stenosis.
C4-5: Status post ACDF at C4-5 with susceptibility artifact. Intact C4-5 disc otherwise. No spinal canal or foraminal narrowing. Previously seen left C4-5 disc protrusion has present resected.
C5-6: Central C5-6 disc bulge. No spinal canal or foraminal narrowing.
C6-7: Right posterolateral C6-7 disc protrusion with foraminal extension. Partial encroachment upon the right anterior subarachnoid space.
C7-T1: No spinal canal or neural foraminal stenosis.
T1-2: No spinal canal or neural foraminal stenosis.
T2-3: No spinal canal or neural foraminal stenosis.
Brief Answer:
MRI findings can explain your symptoms.
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your clinical details. Based on this, your symptoms can be explained on the basis of your MRI findings.
C2-3 facet hypertrophy can lead to neck pain, as well as occipital headache (involving back of head).
C5-C6, C6-C7 disc bulges can lead to neck pain and shoulder pain.
As of now, there is no need for another surgery. Previous surgery has worked well at C4-C5 level.
Focus should be on following measures: 1. Medications such as pregabalin, amitriptyline, etc, 2. Physiotherapy
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
MRI findings can explain your symptoms.
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your clinical details. Based on this, your symptoms can be explained on the basis of your MRI findings.
C2-3 facet hypertrophy can lead to neck pain, as well as occipital headache (involving back of head).
C5-C6, C6-C7 disc bulges can lead to neck pain and shoulder pain.
As of now, there is no need for another surgery. Previous surgery has worked well at C4-C5 level.
Focus should be on following measures: 1. Medications such as pregabalin, amitriptyline, etc, 2. Physiotherapy
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
MRI findings can explain your symptoms.
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your clinical details. Based on this, your symptoms can be explained on the basis of your MRI findings.
C2-3 facet hypertrophy can lead to neck pain, as well as occipital headache (involving back of head).
C5-C6, C6-C7 disc bulges can lead to neck pain and shoulder pain.
As of now, there is no need for another surgery. Previous surgery has worked well at C4-C5 level.
Focus should be on following measures: 1. Medications such as pregabalin, amitriptyline, etc, 2. Physiotherapy
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
MRI findings can explain your symptoms.
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your clinical details. Based on this, your symptoms can be explained on the basis of your MRI findings.
C2-3 facet hypertrophy can lead to neck pain, as well as occipital headache (involving back of head).
C5-C6, C6-C7 disc bulges can lead to neck pain and shoulder pain.
As of now, there is no need for another surgery. Previous surgery has worked well at C4-C5 level.
Focus should be on following measures: 1. Medications such as pregabalin, amitriptyline, etc, 2. Physiotherapy
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the informative reply. I have been going to therapy for 4 months with no real change in symptoms. I am trying to avoid another surgery at all costs. I recently have began to look into regenitive medicine for orthopedic pain. I know there is no long term empirical data on these interventions but perhaps a treatment like regenokine could help alleviate some of the constant pain. I would be interested to hear your thoughts on this kind of treatment. Thank you for your time.
Thank you for the informative reply. I have been going to therapy for 4 months with no real change in symptoms. I am trying to avoid another surgery at all costs. I recently have began to look into regenitive medicine for orthopedic pain. I know there is no long term empirical data on these interventions but perhaps a treatment like regenokine could help alleviate some of the constant pain. I would be interested to hear your thoughts on this kind of treatment. Thank you for your time.
Brief Answer:
Regenokine can be tried as an experimental treatment.
Detailed Answer:
Thank you for getting back.
I should let you know that I have not personal experience with regenokine treatment, and also it is not available in our hospital.
I reviewed the published articles on Regenokine and my observations are as follows:
1. It can be tried as an experimental treatment, as there is no hard data regarding its efficacy, as you mentioned.
2. It is not widely available, so, you may need to search for a centre specialised in doing this treatment.
3. Seems to be costly, so, that could be an issue in some cases.
As in your case, since standard treatments have failed, you could try it as an experimental basis, if you are assured about its safety.
Dr Sudhir Kumar MD DM
Regenokine can be tried as an experimental treatment.
Detailed Answer:
Thank you for getting back.
I should let you know that I have not personal experience with regenokine treatment, and also it is not available in our hospital.
I reviewed the published articles on Regenokine and my observations are as follows:
1. It can be tried as an experimental treatment, as there is no hard data regarding its efficacy, as you mentioned.
2. It is not widely available, so, you may need to search for a centre specialised in doing this treatment.
3. Seems to be costly, so, that could be an issue in some cases.
As in your case, since standard treatments have failed, you could try it as an experimental basis, if you are assured about its safety.
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Regenokine can be tried as an experimental treatment.
Detailed Answer:
Thank you for getting back.
I should let you know that I have not personal experience with regenokine treatment, and also it is not available in our hospital.
I reviewed the published articles on Regenokine and my observations are as follows:
1. It can be tried as an experimental treatment, as there is no hard data regarding its efficacy, as you mentioned.
2. It is not widely available, so, you may need to search for a centre specialised in doing this treatment.
3. Seems to be costly, so, that could be an issue in some cases.
As in your case, since standard treatments have failed, you could try it as an experimental basis, if you are assured about its safety.
Dr Sudhir Kumar MD DM
Regenokine can be tried as an experimental treatment.
Detailed Answer:
Thank you for getting back.
I should let you know that I have not personal experience with regenokine treatment, and also it is not available in our hospital.
I reviewed the published articles on Regenokine and my observations are as follows:
1. It can be tried as an experimental treatment, as there is no hard data regarding its efficacy, as you mentioned.
2. It is not widely available, so, you may need to search for a centre specialised in doing this treatment.
3. Seems to be costly, so, that could be an issue in some cases.
As in your case, since standard treatments have failed, you could try it as an experimental basis, if you are assured about its safety.
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, thank for another great answer? I just have one last question. I have been having shoulder pain (right side) that has not responded to any therapy. I truly believe the pain is coming from my neck. My mri revealed I have a herniated disc at c6 c7. When I discussed this with my surgeon he said he has never seen c6 c7 cause shoulder pain exclusively and the pain would radiate into my hand if c6 c7 is causing issues. Do you know this to be the case? Can c6 c7 exclusively cause shoulder pain?
Hi, thank for another great answer? I just have one last question. I have been having shoulder pain (right side) that has not responded to any therapy. I truly believe the pain is coming from my neck. My mri revealed I have a herniated disc at c6 c7. When I discussed this with my surgeon he said he has never seen c6 c7 cause shoulder pain exclusively and the pain would radiate into my hand if c6 c7 is causing issues. Do you know this to be the case? Can c6 c7 exclusively cause shoulder pain?
Brief Answer:
Shoulder pain is not due to C6-C7 disc
Detailed Answer:
Thank you for getting back.
I agree with your surgeon that a problem at C6-C7 level would affect the C7 nerve root, which would cause pain in neck, forearm and middle finger, and not just shoulder.
Shoulder pain could be related to neck pain, however, in that case, it would be related to C3-C4, or C4-C5 levels. I know MRI does not show much at those levels, however, MRI is not 100% sensitive, and it can be falsely normal in about 5-10% of cases.
Best wishes,
Dr Sudhir Kumar MD DM
Shoulder pain is not due to C6-C7 disc
Detailed Answer:
Thank you for getting back.
I agree with your surgeon that a problem at C6-C7 level would affect the C7 nerve root, which would cause pain in neck, forearm and middle finger, and not just shoulder.
Shoulder pain could be related to neck pain, however, in that case, it would be related to C3-C4, or C4-C5 levels. I know MRI does not show much at those levels, however, MRI is not 100% sensitive, and it can be falsely normal in about 5-10% of cases.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Shoulder pain is not due to C6-C7 disc
Detailed Answer:
Thank you for getting back.
I agree with your surgeon that a problem at C6-C7 level would affect the C7 nerve root, which would cause pain in neck, forearm and middle finger, and not just shoulder.
Shoulder pain could be related to neck pain, however, in that case, it would be related to C3-C4, or C4-C5 levels. I know MRI does not show much at those levels, however, MRI is not 100% sensitive, and it can be falsely normal in about 5-10% of cases.
Best wishes,
Dr Sudhir Kumar MD DM
Shoulder pain is not due to C6-C7 disc
Detailed Answer:
Thank you for getting back.
I agree with your surgeon that a problem at C6-C7 level would affect the C7 nerve root, which would cause pain in neck, forearm and middle finger, and not just shoulder.
Shoulder pain could be related to neck pain, however, in that case, it would be related to C3-C4, or C4-C5 levels. I know MRI does not show much at those levels, however, MRI is not 100% sensitive, and it can be falsely normal in about 5-10% of cases.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, I really appreciate all the great information! As I stated before I had a fusion at c4/5. Recently I was doing some exercises to try to strengthen the neck. I bought a device called the iron neck.https://www.youtube.com/watch?v=1-yJLmus0xw. Here is a link if you watch the video you could see the type of exercises I was doing. After doing this excelsis I developed a bad headache but no other symptoms. Is it possible these exercises jeopardized the fusion. I had the fusion surgery 11 months ago? Thank you again for the great answers.
Hi, I really appreciate all the great information! As I stated before I had a fusion at c4/5. Recently I was doing some exercises to try to strengthen the neck. I bought a device called the iron neck.https://www.youtube.com/watch?v=1-yJLmus0xw. Here is a link if you watch the video you could see the type of exercises I was doing. After doing this excelsis I developed a bad headache but no other symptoms. Is it possible these exercises jeopardized the fusion. I had the fusion surgery 11 months ago? Thank you again for the great answers.
Brief Answer:
Exercises could result in pain and headache.
Detailed Answer:
Thank you for getting back.
I went through the you tube video that you sent. I agree that exercises could result in pain and headache, however, any damage to fusion is unlikely with those exercises.
A word of caution though, you should do exercises under the guidance of a personal physiotherapist, as the exercises need to be individualized. One set of exercises do not fit everyone.
Wishing you the best,
Dr Sudhir Kumar MD DM
Exercises could result in pain and headache.
Detailed Answer:
Thank you for getting back.
I went through the you tube video that you sent. I agree that exercises could result in pain and headache, however, any damage to fusion is unlikely with those exercises.
A word of caution though, you should do exercises under the guidance of a personal physiotherapist, as the exercises need to be individualized. One set of exercises do not fit everyone.
Wishing you the best,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Exercises could result in pain and headache.
Detailed Answer:
Thank you for getting back.
I went through the you tube video that you sent. I agree that exercises could result in pain and headache, however, any damage to fusion is unlikely with those exercises.
A word of caution though, you should do exercises under the guidance of a personal physiotherapist, as the exercises need to be individualized. One set of exercises do not fit everyone.
Wishing you the best,
Dr Sudhir Kumar MD DM
Exercises could result in pain and headache.
Detailed Answer:
Thank you for getting back.
I went through the you tube video that you sent. I agree that exercises could result in pain and headache, however, any damage to fusion is unlikely with those exercises.
A word of caution though, you should do exercises under the guidance of a personal physiotherapist, as the exercises need to be individualized. One set of exercises do not fit everyone.
Wishing you the best,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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