Osteophytes remaining after ACDF and a new complication of a frozen shoulder

Dr. Corenman,

I have a mess of a neck, but I will try to be succinct. My basic questions are (1) whether you have ever seen a shoulder freeze post-ACDF and (2) why I would still have osteophytes at the operative level.

I had ACDF at C6-C7 almost five months ago. I had a 6 mm partially calcified disc extrusion at C6-C7 resulting in severe central stenosis, as well as severe bilateral foraminal stenosis at C6-C7.

My situation was complicated by the fact that I have severe bilateral foraminal stenosis at every level of my cervical spine other than at C2-C3, where the foraminal stenosis is only left sided. I also have facet arthropathy noted at every level, except oddly the operative level. I also have 2 mm disc bulges at C3-C4 and C4-C5 and a 2-3 mm bulge at C5-C6.

Pre-surgery my symptoms were all left-sided, despite the fact that my foraminal stenosis is bilateral at all levels other than C2-C3 where it is only left-sided.

I had five pre-surgery consults — three from orthopedic surgeons and two from neurosurgeons. Two of the orthopedic surgeons and one of the neurosurgeons said to only fuse C6-C7 — that the other levels did not merit fusion. One orthopedic surgeon said fuse C5-C7 and the remaining doctor, a neurosurgeon, said fuse C5-C7 and put an artificial disc at C4-C5. My surgery was performed by a neurosurgeon who said we would fuse C6-C7 and we would later address the other levels with a foraminotomy. One of the orthopedic surgeons agreed with him. The other three consults told me there was nothing to be gained from a posterior approach. Anyway, that is all just by way of background.

I had my one level ACDF in January 2016 and did beautifully. I was back at work in 6 days and completely pain free for the first time in years.

However, about three months post-surgery, my left shoulder froze. I had no shoulder problems pre-surgery and, in fact, have done yoga for years and had great shoulder mobility where I could do very advanced yoga poses that required shoulder mobility.

After my left shoulder froze, my surgeon sent me for a consult with shoulder specialist orthopedic surgeon and he did a cortisone injection without fluoroscopy (which surprised me that there was no image guidance). The idea of the injection was to try to free up the shoulder so I could get back to my yoga practice and continue on my ACDF recovery. The injection was disastrous and I’m a little concerned the injection itself may have damaged the shoulder joint or torn something because immediately after the injection I began to feel pain in the joint, as well as burning on the inside of the upper arm and the shoulder became not just frozen, but very weak. This has continued in the six weeks since I had the injection. In other words, the injection left me worse off.

Following the disastrous injection, I was then sent for both a shoulder and a cervical MRI.

At the non-operative levels, the cervical MRI was consistent with the pre-surgery one. At the operative level, the report said (1) there was no evidence that I wasn’t fusing, but that a CT would be better to assess the situation; and (2) “Both foramina are markedly stenotic. There is mild effacement of the cord by a broad-based osteophyte.” I was shocked by the latter comment because I thought that osteophytes had been removed during the ACDF, and in fact, my operative report indicates “The neural foramen were opened bilaterally with a #1 Microsect shaver and the disk space distracted.”

The left shoulder MRI indicated “a mild degree of capsulitis” (sure doesn’t feel mild to me), “a delaminating tear of the distal supraspinatus with fluid tracking along the musculotendinous junction of the supraspinatus with no evidence of retraction” and “Tear of the posterior labrum at the 7 o’clock – 8 o’clock position.”

Following the MRI, I went back to the shoulder orthopedic surgeon who said he thinks it is really my neck that is the problem, not my shoulder, and he doesn’t want to do rotator cuff surgery because if the shoulder symptoms are from my neck, rotator cuff surgery won’t help me. I’m planning to get a second opinion from another orthopedic surgeon specializing in shoulders.

So, as I said, my two questions are (1) why in the world do I have osteophytes at the operative level following surgery when they were supposedly removed during surgery (MRI done almost 4 months post-op) and (2) have you ever seen a shoulder freeze up post-ACDF?

My symptoms are pain in the left scapula, frozen left shoulder, pain in the outside upper left shoulder — feels like someone punched me there — and occasional shooting pains between the thumb and index finger (which I assume is from C5-C6 pathology and which I had pre-surgery). I do have some left-side neck pain although it is better than before my ACDF.

Sorry to be so long-winded, but my neck is a mess and I’m just mystified why I felt so good initially after my surgery and now feel awful and have developed shoulder pathology to boot.