Excruciating chronic left side neck pain plus lumbar issues

Good morning Alfred - I am also praying for you to get resolve soon for your issues. You are persistent for an answer and that’s what will provide you a solution.

Hang in there and follow the directions of your Pain Management and look forward to your upcoming tests. Looking toward a New Year that is filled with hope, and solutions for you.

Hi @willjean19
Thank you for your prayers 🙏 and advice.

I am due to have the cortisone injections in left of C7/T1 T1/T2 T2/3 facet joint injection on 5 Jan 2023. I hope that this will help me with the pain and help them diagnose what the hell is going with my cervical/thoracic spine.

The last few days have been horrible despite the fact I didn't push myself, just doing daily light short slow walks as suggested by the physio. All I know is that before the C6 nerve root injection on the 1 Dec 2022 my pain was bad, but not as bad as what it is now. After that injection I started to get more pain around C7/T1/T2/T3. Did the hospital stuff it up? They says they didn't.
Also I have had some physiotherapists and osteopaths that have treated my neck in a rough manner by pushing hard when I asked them to be gentle. I showed them my MRI reports and told them to be delicate, but they didn't. Can physios and osteopaths cause more damage to your spine by being rough? I.E. push a disc out of place, herniate it more, break something inside?

My current worse spine condition has occurred after these treatments and nerve root injection and I can only logically draw the conclusion that these events must have had something to do with it.

Currently I have constant pain spreading from C6 down to T3 mainly in the left side and recently I feel new pain as of 2 days ago in the right from C5 to T3. WTF!

I don't know whether it is due to nerve or facet joint issues. The neurosurgery group pain management specialist does not know yet and that is why he has recommended these facet joint injections.

10 hours ago Australia celebrated New Years day, but I had nothing to celebrate, because I was in extreme pain. I kept standing throughout the first few hours of Sunday morning here in Melbourne AUS, because it mitigated the pain then I had to go to bed. Despite I took 1 Endep 10mg (amitriptyline), 1 Lyrica 25mg (Pregabalin), 1 Diclofenac 50mg, Clonidine 50mcg and Targin 10/5mg (Oxycodone/naloxone) I could still feel on the left of my neck, around C7/T1, a massive penetrating stab which was almost unbearable. What is this stab caused by? Spasms, facet joints catching onto a nerve, nerve compression by disc bulge?
I asked my specialist, but he didn't have an answer for me.

I am not able to manage my pain completely, I.E. get a good night sleep. Throughout the day I act like a drunken blow fly moving around the house not knowing what to do or how to kill my time during the day? A minute feels like a hour, a hour feels like a day, a day feels like a week.

I sort of feel like a vegetable, because I have lost purpose in life due to the continuous pain.
I can't spend more than 20 minutes sitting down in front of my computer, sit down for dinner before I have to get up, move around and try to sit again. Driving my car has become an impossible task, not because I am not able to drive it, but because it is painful sitting down and obviously I can't drive if I am under the influence of strong drugs. I also miss seeing my 3 grandchildren. When I try to call friends and relatives to have chat, they never pickup. I have been forgotten.

I am feeling rather depressed and anxious, but still have the hope that a very good surgeon can fix my issues in a way that pain will be manageable. The other problems are financial ones, because I don't have a lot of money currently. I am unable to work despite 30 years of experience in the IT field . Maybe I should try those Gofundme websites to raise some money.
Since I have been at home I put on 5 kg due to the lack of physical activities. Until 6 months ago I was doing 60km bicycle rides.

Anyway enough of my whinging.

Best regards to everyone and Happy New Year! I hope that everyone will be able to get much better ❤️️🙏

I just got my latest MRI cervical/thoracic, Bone Scan cervical, thoracic and lumbar reports and I am shocked.
My spine looks like a mess to me. These are the old bike accidents from several years ago that have caused all this.

If there is an orthopaedic/neuro surgeon reading this discussion, could you please tell me what you think of it?

Thanks

Alfred

@ab6540183 Alfred, It's very unlikely that spine professionals wold be reading discussions here as they just don't have time with their workload, and wouldn't be able to offer medical advice without physical examination and imaging just based on patient comments. I think I can help you understand your reports. I'm sorry you are going through all of this.

The MRI is more descriptive of your condition. One question I have is which came first, this imaging or the spinal injections? You described having increasing pain around C7/T1/T2/T3. The report describes a mass at the T2/T3 foramen (space between vertebrae where the nerve roots exit the spinal cord) suggesting a nerve sheath tumor. Do you know where the spinal injection was placed? Was it in that location?

The spinal cord floats inside the central canal in spinal fluid so it can glide as you move and change your spine position. Think of it like a rope inside a garden hose and when you curl it up, the rope will move back and forth to accommodate the change in curvature. Stenosis means narrowing which happens when the canal is narrowed by damaged discs, bone spurs or an enlarged ligament. When it is advanced enough, it presses into the spinal cord and there is no fluid space left at those levels.

Spinal discs have an outer fibrous layer and the inside is like jelly to act as a shock absorber. With age, discs dry out and become stiffer and can shrink a bit. During an injury, the outer layer can develop minute cracks that over time with drying of the disc can open fissures and weaken the outer layer. If that ruptures, the jelly (nucleus) spills out of the disc as a herniation. This can happen many years after the initial injury.

Each vertebrae has facet joints that meet the facet joints of the adjacent vertebrae that allow it to slide when the spine twists and limit bending movements so the discs would not bear all the strain of bending. When a disc starts to narrow or collapse, more pressure is put on facet joints that then can become damaged with wear and tear and develop arthritis. Pain from facet joints is felt to the side of the spine. Facet joints sometimes catch and click and there can be pain with that if there are degenerative changes.

The ligamentum flavum is the ligament on the back of the spine that holds some tension. When it buckles as indicated in your report, it presses on the spinal cord from behind causing canal stenosis.

Foraminal stenosis happens when a ruptured disc spills into the space between vertebrae and also causes arthritic bone growth that compresses the nerve roots that are exiting the spine.

A disc osteophyte complex happens when a disc ruptures into the central canal and the inflammation causes bone spurs (osteophytes) to grow alongside it in an attempt to stabilize the spine. This starts to press into the spinal cord when it replaces the fluid space. Uneven pressure on end plates ( the top and bottom surface of the vertebrae adjacent to the discs ) also causes bone growth. When discs bulge or rupture, it creates this uneven pressure. If you think about pressing on a balloon and it is tilted toward one direction, the disc bulges away from the increased pressure.

Listhesis means one vertebrae is slipping past another. "Antero" means forward. Your C7 is slipping forward past your T1 by 2mm indicating that the disc is not strong enough to prevent that movement from happening. When that happens, effectively, the spinal canal become smaller. If there are also other things pressing into that space at that level, listhesis can cause symptoms to come or go depending on if the pressure on the spinal cord is changing.

You will need a very qualified surgeon for this. Many spine surgeons don't work on thoracic levels because of the lungs that are kind of in the way of being able to access a surgical path to the problem. You have both central canal stenosis and foraminal stenosis which is significant. Both of those will cause nerve compression leading to pain. The access to the central canal is through the disc space after the bad discs are removed, and they can clean out the foramen while they are in there. I don't know how great demand is for expert spine surgeons in Australia or how long the wait would be, but I might expect that this would be a priority case. Spine injections will not fix this, and may not help much. When they do them as a diagnostic procedure, the injection can reduce some inflammation and buy a little bit of space which might ease the pain, so it gives an indication of what surgery may be able to fix. The effect is usually temporary, and the pain comes back. When I had a spine injection, I got only 5 days of pain relief before symptoms gradually re-occurred. Also spine surgery is very expensive. If you need to fund raise for that, why not get started? Then there is the question of doing facet joint injections? That won't help the the moderate and severe foraminal stenosis that is crushing the nerves or the spinal cord compression caused by moderate canal stenosis. There may be pain from facet joints too, but the stenosis looks like the bigger problem and the only way to fix that is surgery.

You will need to advocate with your doctors and question them about everything and why they suggest what they want to do. It may not be necessary and may be just to validate the doctor's position. It makes more sense to discuss how surgery can help and how critical the situation is. Does it make sense to keep putting off surgery with other tests and injections when clearly you have spine issues screaming for attention? They do need to determine where your pain is coming from if possible, but they also need to address the functional problems that are evident in imaging. Obviously, they want to know that surgery would help the situation, but at some point, a decision must be made. I don't know if your financial situation is causing them to hesitate for fear of not being paid. I hope that is not delaying your care. Often surgeons don't promise to improve the pain; they promise to address the functional problems so that the condition doesn't deteriorate further.

Do you have a referral to a spine surgeon and a scheduled appointment?

Jennifer

Hi Jennifer @jenniferhunter

Thanks for the very in depth explanation. I am amazed by your knowledge.
Not even my pain management specialist has given me that much information.

I will quickly summarize the situation:
1) 16 August 2022 I started feeling a nasty sting in the left of my neck around C6 I believe. This wasn't preventing my from doing sports activities, but it was annoying

2) On the 27 August 2022 the situation degenerated. I was lying on the loungeroom floor, sort of relaxing, and when I got up I felt part of my spine making popping noises, but didn't hurt.
I went to sleep and 30 minutes later I woke up in excruciating pain 10 out of 10 starting around C6 level and spreading down the left of the first 5 vertebrae of the thoracic spine. It felt as if I was twisted inside. I got some MRIs of the cervical/thoracic spine on 29 August 2022. I attached these reports when first started this conversation on Mayo Clinic Connect . In the first few weeks I saw an orthopaedic surgeon for an opinion who told that it was a mechanical injury. He recommended no surgery, perhaps a fusion if things didn't improve. In September 2022 I received a CT Guided Injection at L5/S1 to ease the lumbar pain, but it didn't help at all. I wondered why the specialist aimed for that area first rather than my neck.

3) I paid for some physiotherapy and osteopathy out of my own pocket. I feel that some physiotherapist/osteopaths made things worse by pushing to hard on the neck when I specifically told them that I was inflamed, but they ignored my requests. I was very angry. I wondered if these people made things worse inside.

4) On 1 Dec 2022 I went to the Alfred Hospital Radiology department to have a left C6 nerve root steroid injection based on the recommendation of the orthopaedic clinic's orthopaedic surgeons. Once I came out and the local anesthesia wore off, I started to feel a new horrible pain a couple of centimetres down from C6 that was really excruciating. They told me that it could be a cortisone flareup. I waited 1, 2, 3 weeks, but nothing improved. I wonder if they accidentally disturbed some nerves.
The latest MRIs/Bone Scans that you read were taken on 21 Dec 2022. My pain management specialist has recommended left C7/T1 T1/T2 T2/3 facet joint injections. I am going get these injections tomorrow 5 Jan 2023. This is the first time that I will be taking these facet joint injections in order to diagnose the cause of the pain.

In the last 2 weeks my specialist changed my pain management medication from:

Diclofenac 50mg bd.
Endep 10mg nocte
Pregabalin 25mg nocte prn.

To:
Targin 10/5mg nocte for 6 weeks
Endep 25mg nocte.
Diclofenac 50mg
Clonidine 50mcg
Pregabalin 25mg

This helped a lot in killing the pain so that I could sleep.
Personally I don't not taking medications for the rest of my life. It is ok for a short period.

My Pain

When I stand I have the least pain in the left of my neck and I can manage even without medication.
Then when I sit, the pain increases in intensity and also get some numbness in the part of my groin, legs and feet.

Lying down, I.E. going to sleep is the worst position, because it causes an incredible, unbearable amount of pain unless I take the meds. My legs/feet go numb.

Recently the right side of my neck started to hurt from C6 to T3 but not as bad. I never had pain in the hand right side of my neck before. I can't understand why this is happening now considering that I have been very careful, I haven't exerted my self and avoided physios and osteos in the last 3 weeks due to the inflammation.

I get referred pain in my traps, shoulders, arms and fingers, mainly the index fingers and the middle fingers. Sometimes I can feel the pain in the little, ring fingers and thumbs. These radiated pains are not always there, they come on and off, go from left to right, but most prevalent in the left side.

I asked my pain management specialist why this is happening and was told that it is very difficult to determine where the pain is coming from and that MRI equipment mostly detect between 60-70% of the details, 30-40% is not detected. Hopefully they are going to design newer machines that will get the full picture one day. He also told me that there could be people with the MRI results similar to mine and they get no symptoms.

All these treatments and doctors' visits have been paid by the Transport Accident Commission insurance in the state of Victoria, because I was a victim of a transport accidents (2015,2019). Every driver in the state of Victoria pays this compulsory third party insurance as part of their car registration fee. Unfortunately they have set scheduled fees to pay for visits and surgeries, which means that if a neurosurgeon charges a lot more than the TAC scheduled fee, I would have to pay the difference. This really sucks considering that your body has been badly mangled by the actions of a negligent, you nearly lost your life and even though you are alive, you live your daily life putting up with a lot of pain and are restricted from performing your work, sporting activities and social activities.

One thing that I haven't understood is this:

Are my cervical nerves causing this pain and referred pain? Or is pain/ referred pain being caused by facet joints? I read online that the cervical facet joint's sensory nerves can cause referred pain that mimic the pain of neck functional nerves.

Is the above true?

How do I tell whether the pain/referred pain is caused by the facet joint sensory nerves or by the cervical functional nerves?

When I turn my neck left/right I feel lots of clicks and cracking noises inside. Is there a possibility that a bone spur may break and may float inside causing pain?
Can MRIs detect this?

I asked my pain specialist, but he couldn't give me an answer.

Thank you

Best regards

Alfred

@ab6540183 Alfred, It's very unlikely that spine professionals wold be reading discussions here as they just don't have time with their workload, and wouldn't be able to offer medical advice without physical examination and imaging just based on patient comments. I think I can help you understand your reports. I'm sorry you are going through all of this.

The MRI is more descriptive of your condition. One question I have is which came first, this imaging or the spinal injections? You described having increasing pain around C7/T1/T2/T3. The report describes a mass at the T2/T3 foramen (space between vertebrae where the nerve roots exit the spinal cord) suggesting a nerve sheath tumor. Do you know where the spinal injection was placed? Was it in that location?

The spinal cord floats inside the central canal in spinal fluid so it can glide as you move and change your spine position. Think of it like a rope inside a garden hose and when you curl it up, the rope will move back and forth to accommodate the change in curvature. Stenosis means narrowing which happens when the canal is narrowed by damaged discs, bone spurs or an enlarged ligament. When it is advanced enough, it presses into the spinal cord and there is no fluid space left at those levels.

Spinal discs have an outer fibrous layer and the inside is like jelly to act as a shock absorber. With age, discs dry out and become stiffer and can shrink a bit. During an injury, the outer layer can develop minute cracks that over time with drying of the disc can open fissures and weaken the outer layer. If that ruptures, the jelly (nucleus) spills out of the disc as a herniation. This can happen many years after the initial injury.

Each vertebrae has facet joints that meet the facet joints of the adjacent vertebrae that allow it to slide when the spine twists and limit bending movements so the discs would not bear all the strain of bending. When a disc starts to narrow or collapse, more pressure is put on facet joints that then can become damaged with wear and tear and develop arthritis. Pain from facet joints is felt to the side of the spine. Facet joints sometimes catch and click and there can be pain with that if there are degenerative changes.

The ligamentum flavum is the ligament on the back of the spine that holds some tension. When it buckles as indicated in your report, it presses on the spinal cord from behind causing canal stenosis.

Foraminal stenosis happens when a ruptured disc spills into the space between vertebrae and also causes arthritic bone growth that compresses the nerve roots that are exiting the spine.

A disc osteophyte complex happens when a disc ruptures into the central canal and the inflammation causes bone spurs (osteophytes) to grow alongside it in an attempt to stabilize the spine. This starts to press into the spinal cord when it replaces the fluid space. Uneven pressure on end plates ( the top and bottom surface of the vertebrae adjacent to the discs ) also causes bone growth. When discs bulge or rupture, it creates this uneven pressure. If you think about pressing on a balloon and it is tilted toward one direction, the disc bulges away from the increased pressure.

Listhesis means one vertebrae is slipping past another. "Antero" means forward. Your C7 is slipping forward past your T1 by 2mm indicating that the disc is not strong enough to prevent that movement from happening. When that happens, effectively, the spinal canal become smaller. If there are also other things pressing into that space at that level, listhesis can cause symptoms to come or go depending on if the pressure on the spinal cord is changing.

You will need a very qualified surgeon for this. Many spine surgeons don't work on thoracic levels because of the lungs that are kind of in the way of being able to access a surgical path to the problem. You have both central canal stenosis and foraminal stenosis which is significant. Both of those will cause nerve compression leading to pain. The access to the central canal is through the disc space after the bad discs are removed, and they can clean out the foramen while they are in there. I don't know how great demand is for expert spine surgeons in Australia or how long the wait would be, but I might expect that this would be a priority case. Spine injections will not fix this, and may not help much. When they do them as a diagnostic procedure, the injection can reduce some inflammation and buy a little bit of space which might ease the pain, so it gives an indication of what surgery may be able to fix. The effect is usually temporary, and the pain comes back. When I had a spine injection, I got only 5 days of pain relief before symptoms gradually re-occurred. Also spine surgery is very expensive. If you need to fund raise for that, why not get started? Then there is the question of doing facet joint injections? That won't help the the moderate and severe foraminal stenosis that is crushing the nerves or the spinal cord compression caused by moderate canal stenosis. There may be pain from facet joints too, but the stenosis looks like the bigger problem and the only way to fix that is surgery.

You will need to advocate with your doctors and question them about everything and why they suggest what they want to do. It may not be necessary and may be just to validate the doctor's position. It makes more sense to discuss how surgery can help and how critical the situation is. Does it make sense to keep putting off surgery with other tests and injections when clearly you have spine issues screaming for attention? They do need to determine where your pain is coming from if possible, but they also need to address the functional problems that are evident in imaging. Obviously, they want to know that surgery would help the situation, but at some point, a decision must be made. I don't know if your financial situation is causing them to hesitate for fear of not being paid. I hope that is not delaying your care. Often surgeons don't promise to improve the pain; they promise to address the functional problems so that the condition doesn't deteriorate further.

Do you have a referral to a spine surgeon and a scheduled appointment?

Jennifer