[beth]

#19025

Hi – I’m a 57 year old female. I’ve had 5 c-spine surgeries from 2007-2010. Had a posterior laminectomy at C3-4, without much relief. C3-4-5 acdf followed. That gave me great relief for a month, then C5-6 went. Had another posterior laminectomy, again without relief. Followed by re-plating acdf C3-7. Had a false arthrosis, which required repositioning and cabling to get the fusion to fuse. Also used a bone stimulator. Since then, I’ve been consistently on methadone and vicodin for pain with valium for spasm issues. The meds really don’t handle it, but can keep it to a dull roar. The new federal narcotic regs make medication problematic at best.
I’ve had some new symptoms, specifically parathesias in both little fingers. I also have parasthesias in the entirety of both hands, especially whwn waking – current opinion on that is carpal tunnel. I’m scheduled for EMG testing next month. My pain and spasms are consistent. Moderate to severe L arm and shoulder pain. L side of head, up to cranial mid-line is painful, and neck is consistently in spasm. My L shoulder goes in to severe spasm at least a couple of times a day. i have L arm and hand weakness. I have had some gait issues, and had one vertigo episode a couple of days ago. Never had that before, and I wonder if it’s related to my neck. Had an MRI this last week as follows:

Cord and epidural space:

There is no abnormal cord signal. The cerebellar tonsils are in
their normal anatomic location.

Soft tissues:

There is no prevertebral or paravertebral soft tissue swelling.
There is a 1.2 cm nodule at the left lobe of the thyroid gland,
which was partially obscured on the prior exam.

Vertebral column:

There is anterior cervical discectomy and fusion from C4 through C7.

C2-C3: A small broad-based disc osteophyte complex narrows the
ventral subarachnoid space. Uncovertebral osteophytosis and moderate
to severe right facet joint arthropathy cause moderate to severe
right and minimal left neural foraminal narrowing.

C3-C4: A tiny central disc protrusion narrows the ventral
subarachnoid space. Ligamentum flavum redundancy narrows the dorsal
subarachnoid space. No significant central spinal stenosis.
Uncovertebral osteophytosis and moderate facet joint arthropathy
cause moderate bilateral neural foraminal narrowing.

C4-C5: Endplate osteophytic ridging narrows the ventral subarachnoid
space. A probable laminectomy prevents significant central spinal
stenosis.

C5-C6: Endplate osteophytic ridging minimally narrows the ventral
subarachnoid space. A probable laminectomy prevents significant
central spinal stenosis.

C6-C7: Endplate osteophytic ridging narrows the ventral subarachnoid
space. Ligamentum flavum redundancy effaces the dorsal subarachnoid
space. Minimal central spinal stenosis. Uncovertebral osteophytosis
and mild-to-moderate facet joint arthropathy cause moderate
bilateral neural foraminal narrowing.

C7-T1: 2.5 mm anterolisthesis and an uncovered broad-based disc
bulge narrow the ventral subarachnoid space. Ligamentum flavum
redundancy narrows the dorsal subarachnoid space. Mild central
spinal stenosis. Anterolisthesis, uncovertebral osteophytosis, and
severe facet joint arthropathy cause moderate right and moderate to
severe left neural foraminal narrowing.

T1-T2: Mild to moderate bilateral facet joint arthropathy.

T3-T4: Mild bilateral facet joint arthropathy.

T4-T5: Mild to moderate right facet joint arthropathy.

IMPRESSION:

1. 1.2 cm nodule at the left lobe of the thyroid gland, which was
partially obscured on the prior exam.

2. Unchanged anterior cervical discectomy and fusion from C4
through C7. Osseous fusion is likely present. Unchanged probable
laminectomies at C4 and C5.

3. Unchanged moderate to severe right neural foraminal narrowing at
C2-C3.

4. Unchanged moderate bilateral neural foraminal narrowing at C3-C4.

5. Unchanged minimal central spinal stenosis at C6-C7.

6. Unchanged 2.5 mm anterolisthesis, mild central spinal stenosis,
moderate right neural foraminal narrowing, moderate to severe left
neural foraminal narrowing, and severe facet joint arthropathy at
C7-T1. The left greater than right exiting C8 nerve roots are
potentially compressed. Consider correlation for bilateral C8
radiculopathy.

7. No abnormal cord signal.

I’be been referred back to neurosurgery for consult. Per my understanding of previous posts, I may be looking at needing another fusion at C7-T1

So – with all that lengthy information (sorry!), can I ask your general impression of what direction I go next? I really don’t want to live with this pain anymore, but they can’t seem to resolve it. I’m worried that if I have yet another surgery, I’ll just go from bad to worse. So – any thoughts or advice would be greatly appreciated. Thanks so much.

[beth]

#19215

A more specific question than the one I posed above: With the MRI results shown at C-7, T-1,(specifically the anteriolisthesis and mild central canal stenosis), and my clinical symptoms – do you think that surgery would be an option for me? Thanks.

[Donald Corenman, MD, DC]

#19222

You have had a C4-7 anterior fusion that I assume is solid along with a posterior laminectomy at C4-5 and C5-6. I also assume you were mistaken in that you did not have an operation at C3-4 (“Had a posterior laminectomy at C3-4, without much relief. C3-4-5 acdf followed”).

Assuming a solid fusion at C4-7, you have multiple potential pain generators. C7-T1 has a degenerative spondylolisthesis (see website). The report also notes “left greater than right exiting C8 nerve roots are potentially compressed”. This means the C8 nerves can be compressed causing “little finger” numbness (see website under “symptoms of cervical nerve injuries”).

You have C3-4 “Uncovertebral osteophytosis and moderate facet joint arthropathy cause moderate bilateral neural foraminal narrowing” or compression of the C4 nerves (again see website) and local degeneration of the disc and facets which is also mirrored at the C2-3 level. These levels can cause upper neck pain and headaches.

Unfortunately you have what I call CNS or “crappy neck syndrome”. All levels are degenerative and probably cause pain. Treatment can be a combination of surgery and more conservative measures (facet blocks/rhizotomies, epidurals and medications along with electrical stimulation).

Diagnosis is related to the appropriate use of nerve blocks, facet blocks and possibly discograms. Without this information, I would not be able to give you the correct direction to go to.

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.

[beth]

#19231

Thank you so much for your reply, Dr. Corenman. This
helps a great deal. I can go back to my doctors and seek treatment in a more confident and knowledgeable fashion. I have Kaiser insurance, which can be great with less complex issues. When you have issues like mine, it’s best to go in knowing what to ask for, as it probably won’t be offered without some prompting. This really has helped. Thank you.

[Donald Corenman, MD, DC]

#19233

Please keep in contact and let us know what your continuing care is like.

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.

[beth]

#19613

Hi Dr. Corenman: wanted to briefly follow up with you. I have seen the neurologist. She confirms that I have a very mild carpal tunnel issue, but my entire L arm and hand are at least moderately denervated. She did not see any new areas – the damage looked old. She didn’t examine the right arm as my symptoms are mostly on the left. I am due to see my neurologist in a couple of weeks. My plan was to talk with him about basically doing some “tune-up” surgeries like foraminotomies to improve the quality of my life. I know I’m not going to get much better, but it seems like some interventions can take place that would help me be more comfortable.

In the meantime, I have had an episode which has caused me some concern. I’ve had 2 episodes of dysphagia in the last month. A large pill lodged in my throat the first time, and I had to vomit to dislodge it. This is really unusual for me as I take a LOT of pills without issue, but I passed it off.
A couple of days ago, the same thing happened. I coughed violently to dislodge the pill. The pill came up, but I went through a 5-10 minute episode of intense radicular pain. The pain stated at the base of my skull and radiated bilaterally down the tops of my shoulders, arms to my middle fingers and thumbs (mostly – the rest of my hands were affected, but not as strongly). The pain was very intense, made me gasp and freeze. It faded, thank god! – and left me with more pain and weakness in my L shoulder, arm and hand. That has not subsided. Today, both arms feel heavy, weaker, and mildly painful.
I am wondering what I might have done with the coughing episode. Am I looking at failure or movement of the plate, screws or cabling? Did I herniate yet another disc? I realize you can’t really answer this question with any certainty at all, but I guess I’m just looking for your thoughts on what might have happened, and if I should take action sooner, rather than later in seeing the neurosurgeon. Thanks again for your help! Beth

[Author]

Posts