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Ask Dr Uzair Your Own Question
Dr Uzair
Dr Uzair, Doctor
Category: Neurology
Satisfied Customers: 6190
Experience:  MBBS, FCPS (R) General Surgery, 5 years experience in Emergency Medicine.
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Had cervical spinal surgery four years ago. Have a lot of

Customer Question

Had cervical spinal surgery four years ago. Have a lot of instrumentation in my neck. I was under the care of a pain physician for two years. He diagnosed me with "Myalgia". No treatment helped. Recently read about Botox helping neck spasms. Saw a neurologist who, after asking me if anyone ever told me my head wasn't on straight, diagnosed me with Cervical Dystonia. Her evaluation took all of about three minutes. She set me up with Botox injections. I was elated. The first set of injections did nothing. No side effects, no relief,nothing. The second set, she told me she was increasing the Botox amount by 50%. After several days I was much worse. Extreme pressure and pulling - I was a "7" and now I'm a "9". The doctor assistant explained to me that they had given me "too much" (meaning Botox). She also said that there is nothing they could do - just wait 90 days for it to wear off. She also told me that it was "rare" (1%) to experience more pain and have no relief after injections. Have you heard of such a reaction? How do I know to have any further injections? Are there just certain categories of people who are not helped by Botox? How do I know her diagnosis of Cervical Dystonia is correct?
JA: How long have you been dealing with this issue? Are you experiencing any numbness or tingling?
Customer: No. No numbness or tingling. Dealing with it for four years.
JA: Anything else in your medical history you think the doctor should know?
Customer: Yes. I have multiple myeloma, but am currently in remission. I am otherwise in good health, no other medical issues. I am on no medication. Rarely take any pain meds. Muscle relaxants don't work, nor did physical therapy.
Submitted: 24 days ago.
Category: Neurology
Expert:  Dr Uzair replied 24 days ago.

Hi. Welcome to JustAnswer. My name is Uzair.
I am reviewing your post and will get back to your reply momentarily.

Expert:  Dr Uzair replied 24 days ago.

Well, the cervical spine surgery is possibly the cause of the cervical dystonia. Spasmodic torticollis is another name for cervical dystonia and it simply means that the neck muscle namely, sternocleidomastoid muscle is having spasms, while there are other treatments, Botox has shown to provide temporary relief in most patients, but what needs to be understood is that botox only alleviates the spasms by paralyzing selective muscle fibers, it does not do anything to treat the cause.

The spasms are being caused by an impinged nerve or a set of nerves around the cervical spine that are supplying the overlying skin in the area. The accessory nerve that supplies the Sternocleidomastoid muscle does not originate from the C spine and is a cranial nerve, it is however, possible, that this nerve can get damaged during cervical spine surgery especially in the anterior approach. So, the best thing will be to visit a Neurosurgeon, get an MRI done and a Nerve conduction study and Electromyogram done to see what is actually causing your spasms and what can be done to get rid of them permanently.

I have not heard Botox causing pain, it does not. However, paralysis of the Sternoclidomastoid muscle where the botox was injected could have caused further load on the C spine causing impingement of the nerves further and aggravating the pain. Botox is temporary, affects last for 4 to 5 months, so waiting is the best solution and mean while, the doctor should top you up with pain killers - opiate and NSAIDs and a soft neck collar.

Hope this helps.

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Best wishes.