Excruciating chronic left side neck pain plus lumbar issues

Hi Everyone,

Today I had the CT guided left C7/T1 T1/T2 T2/3 facet joint steroid injections at a Melbourne Radiology Clinic.
The procedure was over in 15 minutes and had to wait 20 minutes after the procedure for observation.
The Doctor that performed the procedure was excellent. He told me that I was being injected with a mix of lidocaine and steroid.

Initially I felt that the pain abated by 50%, but when I went back home the pain increased again.
Currently it is more than 9 hours since the procedure and the pain is at 8 out of 10 consistently.
Maybe I should wait a few more days if it settles down.

I did notice the main pain is originating some 4 cm above the injection sites and spreading downwards in an aggressive way therefore I don't what is happening above is overwhelming the whole area below making it hard for me to judge if the injected area has improved or not.

I went back to re-read the MRI reports and worried about the following points:

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C4/5: Disc osteophyte complex and buckling of the ligamentum flavum causing mild to moderate canal
stenosis with severe right neural compressive foraminal stenosis. Moderate left foraminal stenosis.
C5/6: Disc osteophyte complex and buckling of the ligamentum flavum causing mild canal stenosis with
severe left neural compressive foraminal stenosis.
C6/7: Uncovertebral disc osteophyte complex is larger on the right with severe right neural compressive
foraminal stenosis. Moderate left foraminal narrowing.
C7/T1: Moderate left and mild right facet degeneration with 2mm anterolisthesis. No canal or foraminal
stenosis.

They above buckling of the ligamentum flavum was not present in the Aug 2022 MRI. Therefore what has happened for me to get worse?
I have been extremely careful with my movements and my activities.
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In particular:

1) buckling of the ligamentum flavum causing mild to moderate canal
stenosis with severe right neural compressive foraminal stenosis
2) C6/7: Uncovertebral disc osteophyte complex is larger
3) C7/T1: Moderate left and mild right facet degeneration with 2mm anterolisthesis

I read that:
1) The "buckling of the ligamentum flavum" may cause compression of the central canal
2) The C6/C7 large osteophyte complex could be pinching the nerves
3) The C7/T1 2mm anterolisthesis is a slight slipping of the upper vertebra in front of the one below

This is worrisome to me because it makes me think that I may have a serious problem.
Can this be fixed with surgery? Can they just grind down the bone spurs? Or will I need a fusion ultimately?

This can be food for thought for Jennifer @jenniferhunter 😊

Thanks again

Best regards

Alfred

I have not had facet joint steroid injections but I have had several lumbar epidural injections at Mayo Clinic in Rochester. It can take up to two weeks to feel some relief. Hopefully, you will experience some relief soon!

Hi Everyone,

I have been really active on my computer the last few days despite the immense pain in order to find some surgery which is not fusion. I am a bit worried about it even though many people are happy with it.
I found these two web sites about different and just as effective surgeries.

Cervical Stenosis: Traditional Technology vs. Newer Ultrasonic Technology for Spine Surgery

Alfred

Alfred, @ab6540183
For bone spurs inside the central canal, the surgeon needs to be able to get in there and I believe that they do grind them off with a special tool. The usual path is by removing a bad disc, then removing the bone spurs and damaged disc in the canal, and then grinding the end plates (surfaces) of the vertebrae to be flat to prepare them for the fusion. In my surgery, only a bone disc spacer was used made of donor bone that is milled to the right size and shape and had a space to seed the removed bone spurs. Sometimes cages are used made of plastic or titanium metal. I would think that your surgeon would likely offer you a fusion. In order to used artificial discs, there needs to be enough stability to the spine or you would not be a candidate.

I think you are now understanding the seriousness of your condition. I'm glad that you are now looking at educational videos to learn about various spine procedures. Write down your questions to ask your surgeon. Make sure to ask why a procedure is preferred over another as it pertains specifically to your case. In other words, what makes you a candidate for a procedure or what disqualifies you? I think they sometimes remove the Ligamentum Flavum, but you'll need to ask that question. When there is spine damage, you compensate with different movements. Perhaps possibly this is why the ligament is affected now? The statistics on ligament issues affects the Asian population at greater rates than people of other races.

The progression of spine disease is usually degenerative when you loose stability of maintaining vertebrae in the proper alignment, and with discs that collapse. There isn't a way to save a collapsed disc, and if it is left alone, the spine can start to fuse itself around it which may not be in a good alignment. That's why it is important to make a good decision as to what will give you the best outcome. The doctors may have done the facet injections to rule it out as the major problem because if that had fixed all your pain, they could claim that all the stenosis is not causing the pain.

The designations of "moderate" or "severe" when talking about stenosis have to do with an actual measurement from the imaging as compared to a normal measurement. They have a range they define as severe which you have. I do not think they can make excuses for not helping you with surgery when your report says severe compression on nerves. This can cause permanent damage, and the sooner it is decompressed with surgery, the sooner you can begin healing and recovery. Surgery is always a compromise, and you loose spine movement with fusions, but when you compare that with the symptoms you have now, it is an easier choice to make. I had surgery when my report said I had "mild" compression of the spinal cord. I feel that you are an urgent case, and you need to keep asking questions about this until the doctors agree to help you.

Jennifer

Hi @jenniferhunter,

how are you?

Thank you for your detailed reply.

On top of my nerves impingement issues a lot of pain is caused by some facet joints which were injected last week on 2023/01/05 namely C7/T1, T1/T2, T2/T3.

I got relief the day after the injections which makes me think that they could be causing additional pain. After that day of relief the pain started coming back.

I have been doing some research and I would like to know what you think in regards to the following therapies for facet joint such as:

PRP injections
Stem Cell Therapy
Prolotherapy

Could the above help?

Many thanks and regards

Alfred

Alfred, @ab6540183

I don't have any experience with those therapies. I know stem cell injections are limited in how much they can help. I have talked to a podiatrist about that for my ankle (after healing from a fracture) and he said it isn't a miracle cure, but can help clean up a bit of stuff related to tendons and ligaments. Prolotherapy is about injecting a sugar solution to cause inflammation.

Sometimes it does take a day or 2 for a steroid injection to have an effect and it has a temporary effect. Facet arthritis can certainly add to the problems and that happens because the discs are shrinking putting more pressure on facet joints, or perhaps because of the stresses during your injuries. None of this is going to cure stenosis. I was hoping stem cells could prevent surgery too, but that wasn't the case. Discs don't have a blood supply and cannot regrow themselves at this stage of medical research. I know there has been some success at Mayo with stems cells and a spinal cord injury patient.

Read about it here:
https://newsnetwork.mayoclinic.org/discussion/case-report-stem-cells-a-step-toward-improving-motor-sensory-function-after-spinal-cord-injury/
I expect that your doctors will offer spine surgery, and I would agree that they should. Your spine issues are significant and your quality of life is suffering.

You can find a lot of videos with surgeons presenting spine cases at the Seattle Science Foundation on You Tube. They are age restricted, so you'll need to have and sign in to a Google account that indicates your birth date to be able to watch these. Some may be courses that you can't access. They do show imaging and surgery photos, video, etc. Once you are on their Your Tube account, you can search "cervical spine" and bring up a lot of them. If you can watch these (as not everyone will be comfortable), you can learn a lot about spine surgery. I have watched some of these to learn about my own condition prior to spine surgery. This video gives an overview of cervical stenosis.
https://www.youtube.com/watch?v=8cW6ANDJah8
Did you find this helpful?

Hi Alfred -
I have had mesenchymal cell injections to my facet joints followed by 3 PRP injections all spaced 3 months apart for my cervical issues and an ongoing lumbar issue.
I did get relief followed by a 3-4 week painful period of inflammation to the area as the cells proliferate to heal the areas. Unfortunately, relief was short lived (3-4 weeks) between injections. My last injection was not successful at all. This treatment was not covered by insurance and the out of pocket cost was very high. In my pursuit to try everything before considering surgery, at the time I felt it was worth it. In addition the clinic I visited was available at a time when other treatments had a wait list of 3-4 months because of COVID. I also believe the treatments restored me and alleviated pain long enough for me to get back to a modified program at the gym to get my strength back.
My issue is derived from degenerative disc disease with little to no cartilage in my C4-C7 resulting in painful bone spurs & pinched nerves. My understanding now is the possibility of success potentially lies in the injection to intervertebral unhealthy discs to regenerate cell growth in an effort to create space that has been lost in the degenerative disease. I don’t believe these treatments are legally available or approved in the United States. In addition there are few statistical medical studies to substantiate the success of these treatments here in the USA.
Please do your research and I sincerely hope there is a non invasive procedure that can regenerate and restore your impacted areas to provide healing and a pain free option.

Best Regards

Hi willjean19

How are you?

Thank you very much for sharing your experience.

Today I feel very disappointed.

I had an appointment with my pain management doctor this morning. I asked him to explain the MRI and the results of the C7/T1. T1/T2, T2/T3 facet joints cortisone injections.

I also asked him the meaning of "severe right neural compressive foraminal stenosis" but he told me that people may have this and have no symptoms and should not worry about it.

I am trying to understand what is meant by right and left on the MRI report. Is it my rear left/right or my front left/right? @jenniferhunter

I was told by him that my anxiety is increasing the pain. I told him that when the pain increases to astronomical levels, I get anxiety, not the other way around.
When my pain is low I don't complain.

He doesn't think that the facet joints are causing the pain.

According to him, he doesn't know where the pain is coming from yet.

I thought the proper diagnostics would be to test all suspect facets and nerves one by one until the correct source is found.

I can tell you with some certainty that my main pain is between C7-T1. The pain is a burning type causing tingling and numbness going downwards. I also get referred pain in my left trap, shoulder, arm, index/middle fingers from time to time.

Then I asked the doctor what is his plan for me. He told me to keep taking the pain medication (endep, lyrica, diclofenac, clonidine and targin) .

I questioned him: For life?
He answered: Why not?

I am not prepared to take this drugs to mask my pain for ever. I want the problem fixed.

I think that I should be looking for another specialist.

Best regards

Alfred

Hi Alfred:

Yes, disappointing is a perfect description. Unfortunately it can take visiting multiple physicians and medical experts to try to understand the source of your pain. It sounds very much like nerve compression to me, although I have not read your results. Does your MRI mention nerve compression in the foraminal space due to the stenosis? It is true there are those of us that show results on diagnostic tests that do not equate pain in those individuals. My father was heavily burdened with osteoarthritis in his later years of life. It deeply affected his mobility but he had no pain.

It is frustrating but I would continue to seek another opinion as to a solution.

Best of luck to you

Hi willjean19,

I am attaching the latest cervical/thoracic MRI (21/12/2022) and bone scan to this reply.

I find it hard to understand which right are they referring to? From the front or from the rear of the body?

For example:
C6/7: Uncovertebral disc osteophyte complex is larger on the right with severe right neural compressive foraminal stenosis. Moderate left foraminal narrowing.

Thank you.

Alfred