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MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Safe to have thoracic facet joint injection?

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Neurologist, Surgical
Practicing since : 1997
Answered : 65 Questions
Dear Doctor,
On the bases of MRI cervical spine done two years of now ,report attached, doctor advised me for -
Please clarify for this injection-
a)Does this is safe to have ? does this carry any side effects? For how much
time this is good?
b)In case no betterment in pain seen than what will be further treatments?
Present symptoms-
Pinning,tingling,vibrations and pain around shoulders both,arms. Weakness in arms and legs.
Heavyness in legs,while walking getting weakness, swelling on elbows, ankles, pain is travelling towards head specially to centre of head and front sides both.
Neck is stiff from both sides, feeling difficulty in movements. Always feeling tired and dizzy. Pain is experiencing on lower back also. Stairs climbing and standing from chair is like hard.Bowl movements are also changed like always feeling bowl movements- but happened every time.
Neurologist about one year advised Physiotherapy –which was started about 10 days= 3 seatings were done- physiotherapist given Neck attaraction with hot get treatment and 3-4 exercises for 25-20 times, during first day he used three needles on back side with BIOFREEZE and have given light manipulation only.
He has mentioned that this is a C6-7 Radiculopathy --does this is correct?
He also mentioned distal parasthesia , he has started isometric exercises and range of motion,he asked for to start GEBAPENTIN , this was tried last year,gets some side effects,now doctor is not advising this. He refused to favour SOFT COLLAR. What do you suggest for Soft Collar.
On the same time he asked for home neck traction- does this is safe to use every time on daily bases. I don’t think that home based traction of neck is advisable, does this is correct?
In Canada ,these injections are being given by Radiographer , does this is a appropriate method?
Advise that does these injections are safe to have?
You can please guide with details. What do you suggest that after injections does there is only surgery option for this.

Posted Sat, 11 May 2013 in Brain Tumor
Answered by Dr. Shivakumar S. Kupanur 1 hour later

Thanks for posting your query.

I could not open your MRI report, as it was not supporting my system. However, from your detailed history, I have understood that you have cervical spondylosis with Facet disease.

Facet injection are safe in experienced hand. These injection can be given by spine surgeon or clinical radiologist who are trained in this. These injection can make you pain free for few weeks. You can repeat these injection few times if necessary.

Side effects are usually less if performed by trained clinician, unless the injection is given in some other area causing nerve irritation.

I think the conservative management is sufficient in your case. If your symptoms does not resolve with this treatment, the other option to be considered is surgery. But, to comment precisely I need to see the fresh MRI report. Surgery decision can be taken depending on the report and severity of the disease.

Based on your described symptoms, I feel this just not radiculopathy, but also Facet arthropathy.

Soft collar will just avoid the muscular movement. Hard collar will help you more than a soft collar. Hard collar restricts the movement and reduce the joint pain. Avoid traction. It is not safe, especially home based traction.

The bottom line is, continue medication as advised. Continue physiotherapy, and repeat MRI. Facet injection can be tried now. If it doesn't work, we can decision about the surgery based on MRI.

I hope, I have answered your query. I will be available for follow up queries if any.

Above answer was peer-reviewed by
Follow-up: MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Safe to have thoracic facet joint injection? 8 hours later
Thanks Dr.Shivakumar,
You can please mention your e,mail id I can send MRI there.
Does CT scan can find actual position of cervical spine and lumber? Because CT is easy to have here like in 20-25 days, MRI will take months.
What do you think for XRAYS which are mose easy and early option to evaluate.
Does Capsules CAPSULES- 100MG TRAMADOL HYDROCHLORIDE DIN- 0000 is safe under present conditions?,
As you said that I have both radiculopathy also Facet arthropathy. does this carry more complications at later stage.
I understand that I may need repeat injections does this is correct? how often I should go for this.please clarify that does cervical/thoraric injections of C4-5. C6-7 have steroids or like BUDIVACAINE AND DEPRONE,
under this link they are explaining effects of BUDIVACAINE AND DEPRONE WWW.WWWW.WW , mentioning this injection.
Answered by Dr. Shivakumar S. Kupanur 14 hours later
Hello again.

You can send your MRI report at YYYY@YYYY with the subject as Attn to Dr. Shivakumar. They will forward it to me.

CT scan can be performed. It gives bony details. But, MRI is ideal as it provides soft tissue details as well. X-rays are not so useful.

Cap. Tramadol can be safely taken as a painkiller with your doctor's prescription.

Facet arthropathy is part of disease. It is a chronic process and progresses slowly. Usually, it settles with proper medication, rest and physiotherapy.

Repeat injections can be given based on need. If the pain is intolerable again after first injection, your doctor can suggest you to repeat after few weeks. It is not compulsory to repeat.

Yes, these injections do contain steroids and carries it's own side effects if not given properly like any other medical procedure. But, definitely it is a safe and routinely performed procedure in trained hands. Incidence of complication is always less than benefits. So, discuss with your treating doctor before you go ahead.

I hope, this answers your query. I wish you speedy recovery.


Above answer was peer-reviewed by
Follow-up: MRI showed cervical spondylosis, facet disease, foraminal stenosis at C5-6 and C-7. Safe to have thoracic facet joint injection? 2 days later
Dear Dr.Shivakumar,
Please mention expected side effects-
Yes, these injections do contain steroids and carries it's own side effects ,
Can I discontinue injections after first injection at say right side? in case it is increasing signs?
Decided to stop physiotherapy as per your advise.
MRI waiting is like 2 years. Radiologist decided to give injections during total 4 seatings ,giving one each at right and left of C4-5, C6-7,does this is correct procedure. Latest blood work 18 April shows- Free T4 8.8 pmol/L (LOW- RANGE IS 10.0-25.0),, TSH - 6.14 (High- Range is 0.20 -6.00 mIU/L, Thyroid Peroxidase antibody is 5.8 (Range 0.0- 34.0 KIU/L, Thyroid ultra sound is also enclosed, please guide.
Answered by Dr. Shivakumar S. Kupanur 26 hours later
Hello again.

Side effects are negligible could be procedure related. It can cause nerve irritation if not given properly.

Injection can be discontinued after first dose if pain subsides. Repeat injections can be given based on need, which your doctor can better suggest after assessing you physically if pain again increases.

I never advised you to stop physiotherapy. Check my first answer. In bottom line, I have mentioned to continue physiotherapy. It will help you to have more painful period.

Procedure explained by your radiologist is correct.

Your thyroid profile is also mildly deranged. You need to follow up with Endocrinologist.

I hope, this answers your query. I will be available for follow up queries if any.

Above answer was peer-reviewed by
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