Tagged: cervical degenerative spondylolisthesis, failed cervical surgery syndrome, Multilevel cervical fusion
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If you had both left and right arm pain before surgery and there was no change after surgery with the previously mentioned lack of nerve compression based upon the MRI findings, it seems your arm pain is not from nerve root compression in the neck. You might have other potential areas of compression in the neck (see nerve entrapment/compression on this website). You also might have had also developed chronic radiculopathy (see website). Shoulder disorders (rotator cuff syndrome and others) can mimic nerve pain from the neck.
It seems that nothing can be surgically done to the neck to relieve your arm pain. Do not expect relief from any future surgical attempts.
Is the C7-T1 level unstable? That is, does it move on flexion/extension X-ray films? Also, you have to understand what a slip or a cervical degenerative spondylolisthesis (see website) will cause as far as symptoms go. You would have base of the neck pain (where your neck meets your shoulders) and some mild radiation of pain into the tops of your shoulders. You might have cracking and popping noises from the base of your neck.
A goos way to determine if this level is causing pain is to undergo a small volume epidural steroid injection at this level (see ESI on the website). If you gained great temporary pain relief (see pain diary to understand this), you might be a candidate for this fusion.
A fusion here with previous fusion from C3-C7 above probably should be performed both front and back (an ACDF with a posterior instrumented fusion probably down to T2. The stress on this segment from the previous fusions makes fusing this segment more difficult.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.If you had both left and right arm pain before surgery and there was no change after surgery with the previously mentioned lack of nerve compression based upon the MRI findings, it seems your arm pain is not from nerve root compression in the neck. You might have other potential areas of compression in the shoulder and arm (see nerve entrapment/compression on this website). You also might have had also developed chronic radiculopathy (see website). Shoulder disorders (rotator cuff syndrome and others) can also mimic nerve pain from the neck.
It seems that nothing can be surgically done to the neck to relieve your arm pain. Do not expect arm pain relief from any future surgical attempts.
Is the C7-T1 level unstable? That is, does it move on flexion/extension X-ray films? Also, you have to understand what a slip or a cervical degenerative spondylolisthesis (see website) will cause as far as symptoms go. You would have base of the neck pain (where your neck meets your shoulders) and some mild radiation of pain into the tops of your shoulders. You might have cracking and popping noises from the base of your neck.
A good way to determine if this level is causing pain is to undergo a small volume epidural steroid injection at this level (see ESI on the website). If you gained great temporary pain relief (see pain diary to understand this), you might be a candidate for this fusion.
A fusion here with previous fusion from C3-C7 above probably should be performed both front and back (an ACDF with a posterior instrumented fusion probably down to T2. The stress on this segment from the previous fusions makes fusing this segment more difficult.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Dr. Corenman,
I can’t thank you enough!My decision is to put off surgery and get more diagnostic testing. My surgeon is on vacation for two weeks and I left him a message.
My medical records were sent to a Minimally Invasive Spine Surgery Center and they would like to see images also before they send a formal report. They mentioned that my thoracic spine also has five levels of herniations, not sure if this can cause some of my symptoms?
Per our conversation, they were a bit surprised that after four open spine surgeries with fusion (posterior & anterior) that :
1) C3 Cord impingment
2)Mild Neural Foraminal narrowing @ C3-4, C6-7, C7-T1
3)Facet Joints degenerative changes @ C3-4, C4-5, C6-7, C7-T1
4)C7/T1 subluxation
They would like to perform the following:
Foraminotomy – used to relieve the symptoms associated with nerve root compression in cases where the foramen is being compressed by bone, disc, scar tissue, or excessive ligament development and results in a pinched nerve. (click this link to learn more about this procedure)
Laminotomy – used to relieve pressure off the spinal canal for the exiting nerve root and spinal cord; a common spinal condition known as spinal stenosis. This procedure is designed to increase the amount of space available for the neural tissue and thus releasing the pinched nerve(s). (click this link to learn more about this procedure)
Percutaneous Discectomy – removes portion of a herniated or bulging disc that is pressing on a nerve root or the spinal cord. Surgeons utilize X-ray monitoring and fiber-optics devices in order to see precisely what is compressing the nerve and remove it without causing any destabilization of the spine. (click this link to learn more about this procedure)
Facet Thermal Ablation – a laser is used to debride the facet joint and deadens the nerve within the joint that causes painful symptoms. (click this link to learn more about this procedure)
They will get back to me within a few days, however an interesting point was raised on my thoracic spine. Can these herniations cause a problem from neck pain, arm pain, headaches etc?
You have unfortunately been given misinformation by this “center”. I would advise against using these individuals for many reasons. First-your pain generator or generators have not been identified so suggesting “surgeries” to cure your condition is ridiculous.
Second, you have no evidence of myelopathy which is dysfunction of the spinal cord. Your “stenosis” at C3 does not impinge the cord so you do not need a laminectomy at that level.
You do not need a percutaneous discectomy as none of your previous surgeries worked to relieve nerve pain and your arm pain does not appear to be from nerve compression from the neck.
You already had two foraminotomies that gave you no relief. Do you think that another foraminotomy will do anything more?
You have had facet blocks without relief. This is a good indicator for poor relief from ablation of the facet nerves. This “laser” “Facet Thermal Ablation” will not be effective.
As far as I can tell, you need to run far away from this company that gave you this poor advice.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Dr. Corenman,
A big thank you! I did see my neurologist today and she stated surgery should be a last resort, I’ve been through too much. After a review of my scans, and my symptoms, she noted that my C7/T1 subluxation is mild and highly doubts, neck pain, muscle spams, headaches, bilateral arm pain, forearms, fingers numbness (tingling) etc is from this subluxation.
Her thoughts are most of my symptoms are in line with post-laminectomy syndrome. She also heard the cracking and popping with flexion/extensions and did not know why. After sitting with her for approx 30 minutes things tightened up further, which she stated was in the area of C5 to T1 (both left and right side). She wants to think about my issues and look at the information further, and she will call me in a few days on what my next steps should be.
You mentioned flexion/extension studies. Are you referring to X-rays or MRI and would contrast be required if MRI? Also if an ACDF is performed due to instability, what range of motion can be expected to be lost at this level? I thought, I read somewhere that C7/T1 has the lowest movement in cervical spine? Thanks always for your response.
Flexion/extension studies are from X-rays.
If you do have a cervical degenerative spondylolisthesis at C7-T1, this means the facets are degenerative at that level. Clicking and popping can commonly issue from these degenerative facets.
“Post-laminectomy syndrome” is a “waste basket” type of term meaning that poor results from previous surgery commonly are all grouped and ascribed to this category. This is not a diagnostic term like chronic radiculopathy or instability. You still might have pain generators that have not been identified (the aforementioned C7-T1 degenerative spondylolisthesis) or something else.
If you are still having symptoms that impair you, a full workup would be in order. You might not be a surgical candidate but at least you will know.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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