Case of the Month #20: Neck Pain and Headache by Dr Kerry Bosworth
Further Relevant Information
He was offered a trial of anti-neuropathic medication and an occipital nerve block. After considering the potential drug side effects, he decided against the anti-neuropathic drug.
His occipital nerve block gave him significant but not complete relief. This was repeated after six months which gave him further benefit. Six months later, he had pulsed radiofrequency to his occipital nerve but this gave him minimal benefit.
He was now experiencing a reduced range of movement of his neck, especially on rotation and lateral flexion. He had physiotherapy sessions but did not find these helped.
He was referred for a CT guided C2 nerve root block. His CT showed a partial fusion on the left hand side within the C2/3 intervertebral disc space and throughout the articulating facets of C2/3. This did not appear to have been present when his initial MRI was performed. The C2/3 facet joint was not accessible but he had a local anaesthetic and steroid injection around the C2 nerve root. This gave him a small improvement that lasted a few days.
As his symptoms continued to worsen, he decided to start duloxetine and a referral was made to the spinal surgery team.