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What Causes Pain In Left Outer Ear And Side Of Head?
Question: 60 yo female 5'7" 140#. psh acdf c5-6&6-7 2002 & c7-t1 2010. past 6 weeks now having pain in the left side of my next with numbness and burning up into my left outer ear and side of head, esp when I turn my head to the left. pain stays for a minute or 2 but the burning and pain & headache stays. I have C3-4 &4-5 disc bulging above the 1st fusion. Most recent mri in 2010 showed mod to severe stenosis at c5-6.als had recent epidural injection. should I be concerned enough about the to see my neurosurgeon about this new pain?
Brief Answer:
New MRI indicated first.
Detailed Answer:
I read your question carefully and i understand your concern.
Looking at your past history you are obviously someone with degenerative changes of the cervical spine which are rarely isolated but have changes also in other levels apart from those you had surgery for. Also fusion while stabilizing the corresponding level means movement limitation and the other neighboring regions are exposed to more stress, predisposing for acceleration of their degeneration.
So what I am trying to say is that it is common to have involvement of other cervical levels. Your symptoms look to be in this setting, with pain due to inflammation and compression of upper cervical nerve roots with pain radiating in the head.
Normally I would have suggested to try a cervical collar for a week, physical therapy and pain killers, usually the symptoms improve with inflammation subsiding. However since it's been already 6 weeks and your last MRI was 5 years ago, another cervical spine MRI exam is indicated. Of course you could see your neurosurgeon right away but it's probable that he'll require a MRI to evaluate you as well.
I remain at your disposal for further questions.
New MRI indicated first.
Detailed Answer:
I read your question carefully and i understand your concern.
Looking at your past history you are obviously someone with degenerative changes of the cervical spine which are rarely isolated but have changes also in other levels apart from those you had surgery for. Also fusion while stabilizing the corresponding level means movement limitation and the other neighboring regions are exposed to more stress, predisposing for acceleration of their degeneration.
So what I am trying to say is that it is common to have involvement of other cervical levels. Your symptoms look to be in this setting, with pain due to inflammation and compression of upper cervical nerve roots with pain radiating in the head.
Normally I would have suggested to try a cervical collar for a week, physical therapy and pain killers, usually the symptoms improve with inflammation subsiding. However since it's been already 6 weeks and your last MRI was 5 years ago, another cervical spine MRI exam is indicated. Of course you could see your neurosurgeon right away but it's probable that he'll require a MRI to evaluate you as well.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I know there are, most likely, significant degenerative changes. Once everything has been tried without success: Is this a surgical dilemma? If so, what type of surgery am I looking at and what is the success rate?
Brief Answer:
Read below.
Detailed Answer:
If there is a focal mechanical nerve root compression or compression of the spinal cord on MRI then surgery might be needed.
If on the other hand there is no marked compression and the symptoms are more in the setting of diffuse spinal changes with inflammation and muscle spasms then surgery is not indicated.
In over 90% of the cases surgery is not needed, but if no improvement after 6 weeks imaging is done.
The decision will depend very much on MRI. There are two main types of approaches anterior cervical discectomy like the one you have had and posterior cervical foraminotomy. Anterior approach is more common as easier technically, also if the disc herniation is central and not lateral, posterior approach is not possible. Posterior approach can avoid fusion and preserve mobility but there is a possibility of herniation recurrence since the disc is not completely removed.
In terms of improvement chances from surgery, it's around 80-85% for anterior approach and 90-96% for posterior approach.
As I said though both the decision on whether to intervene surgically or not and the chosen procedure depend a lot on MRI findings.
I hope to have been of help.
Read below.
Detailed Answer:
If there is a focal mechanical nerve root compression or compression of the spinal cord on MRI then surgery might be needed.
If on the other hand there is no marked compression and the symptoms are more in the setting of diffuse spinal changes with inflammation and muscle spasms then surgery is not indicated.
In over 90% of the cases surgery is not needed, but if no improvement after 6 weeks imaging is done.
The decision will depend very much on MRI. There are two main types of approaches anterior cervical discectomy like the one you have had and posterior cervical foraminotomy. Anterior approach is more common as easier technically, also if the disc herniation is central and not lateral, posterior approach is not possible. Posterior approach can avoid fusion and preserve mobility but there is a possibility of herniation recurrence since the disc is not completely removed.
In terms of improvement chances from surgery, it's around 80-85% for anterior approach and 90-96% for posterior approach.
As I said though both the decision on whether to intervene surgically or not and the chosen procedure depend a lot on MRI findings.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What about the anti-convulsants, like lyrica or gabapentin. what is your opinion of the efficacy of these drugs on radiculopathy
Brief Answer:
I use them often.
Detailed Answer:
I as many colleagues do use them often, generally as the second step when over the counter anti inflammatory drugs do not work or are contraindicated.
Most of my experience is with Gabapentin (simply for pricing reasons, several generics available) with which improvement is noted in around 50% of the patients. Sedation has been the most encountered side effect.
I have less personal experience with pregabalin (lyrica), but efficacy should be about the same according to studies and judging by mechanism of action.
Another option to be considered if you haven't already tried is also a course of muscle relaxants like cyclobenzaprine or tiocolchicoside.
All these drugs though shouldn't be considered substitute for physical therapy with exercises for stretching and strengthening neck muscles. Mechanical traction techniques are also often beneficial in cervical radiculopathy.
I hope you find these suggestions helpful.
I use them often.
Detailed Answer:
I as many colleagues do use them often, generally as the second step when over the counter anti inflammatory drugs do not work or are contraindicated.
Most of my experience is with Gabapentin (simply for pricing reasons, several generics available) with which improvement is noted in around 50% of the patients. Sedation has been the most encountered side effect.
I have less personal experience with pregabalin (lyrica), but efficacy should be about the same according to studies and judging by mechanism of action.
Another option to be considered if you haven't already tried is also a course of muscle relaxants like cyclobenzaprine or tiocolchicoside.
All these drugs though shouldn't be considered substitute for physical therapy with exercises for stretching and strengthening neck muscles. Mechanical traction techniques are also often beneficial in cervical radiculopathy.
I hope you find these suggestions helpful.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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