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  • wbwalsh
    Participant
    Post count: 3

    Hi everyone. My name is Brian I am 50 years old and had my third fusion surgery in February 17 which included installing a cage at C2-C3. In 2007 I had my first fusion at C5-C6 and in 2010 that hardware was removed and a single plate installed from C4-C7. Wasn’t able to “bounce back” after Feb17 surgery. My pain management doc ordered MRI and strongly suggested a second opinion from a neurosurgeon as all my surgeries were done by the same orthopedic surgeon who is advising every “looks good”. My second opinion included nerve tests and a CT scan. I will post those results in separate post immediately following this post. The second opinion doc spent less than 5 minutes on our first appointment when ordering test then had his secretary call me this morning saying doc thinks only issue could be Feb17 surgery not fusing and wants to wait 6 months for another CT scan to see if any issues.

    I have constant pain in the base of my skull, pain/pressure in neck, right shoulder, numbness/pain right arm/outer fingers. Pain move to left side, down back and legs as my activity increases.

    Anyway I hope to get some insight from this forum on other people’s experience with continued pain/issues after fusion.

    wbwalsh
    Participant
    Post count: 3

    Below is a copy/paste of my latest CT Scan. I have removed my identifying information and the physician’s information.

    Patient Copy

    Generated on: 25-Aug-2017 13:05

    Page: 1

    Creation Date : 08/17/2017
    Performed At : Mayo Building Jacksonville
    Indications : Cervicalgia;neck pain

    17-Aug-2017 13:31 *** Final ***
    Exam: CT Cervical Spine WO/CST

    Copy

    Impression: Complex anterior cervical fusion is present from C3 through C7,
    with stand-alone cervical cage fusion at C3-4 without loosening of hardware
    but without evidence of bony bridging across the disc space, and ACDF/anterior
    plating from C4 through C7 with solid fusion across the disc spaces at C4-C5
    and C5-C6, questionable very minimal anterior bridging at C6-C7, but there is
    no evidence of solid bony fusion across the disc space at C6-C7 otherwise.
    Please see the discussion below.
    Findings: Complex postsurgical changes are present of the cervical spine. At
    C3-C4, there is a stand -alone anterior cervical cage fusion at C3-C4 without
    evidence of loosening or displacement of this hardware. I do not see evidence
    to suggest bony bridging across the disc space at this level. At C4-C5, C5-C6,
    and C6-C7, there are further ACDF’s with intervertebral disc spacers, with
    anterior plating from C4 through C7. There is solid fusion across the disc
    spaces at C4-C5 and C5-C6. There is question of minimal amount of a bony
    bridging across the anterior margin of C6-C7 disc space, but I do not see
    evidence of a solid bony fusion across the disc space at this level. I do not
    This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

    Copy

    Comparisons: Outside MRI of the cervical spine dated June 7, 2017 and outside
    cervical spine series on May 25, 2017.

    Patient Copy

    Generated on: 25-Aug-2017 13:05

    Page: 2

    see evidence to suggest loosening of the hardware or abnormal displacement of
    the same.
    Adjacent segment degenerative change is present at C2-C3 with slightly
    diminished intervertebral disc space and a 2 mm grade 1 degenerative
    spondylolisthesis. Minimal anterior subluxation is present at C3-C4.
    Additional intervertebral disc space loss is present from C7-T1 through T2-T3
    levels. There is expected straightening of the cervical spine from the
    surgical findings.
    C1-C2: Minimal hypertrophic degenerative changes are present at the
    atlantoodontoid junction, otherwise unremarkable.

    Copy

    C3-C4: Mild facet arthropathy is present. There is minimal endplate spur.

    C4-C5: Expected postsurgical changes are present with solid interbody fusion.
    Mild facet arthropathy is present. Suspect minimal partial ankylosis of the
    facets.
    C5-C6: Expected surgical changes from solid interbody fusion. There is mild
    facet arthropathy. There is minimal partial ankylosis of the facets.
    C6-C7: Mild facet arthropathy is present. There is a minimal endplate spur
    formation. Uncovertebral hypertrophy is present with mild left-sided neural
    foraminal encroachment.
    C7-T1: Moderate right and mild left facet arthropathy are present. There is
    minimal disc bulge.
    T1-T2: Minimal disc bulge is present, otherwise unremarkable.
    This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

    Copy

    C2-C3: Mild facet arthropathy is present. There is mild degenerative anterior
    subluxation as described above.

    Patient Copy

    Generated on: 25-Aug-2017 13:05

    Page: 3

    T2-T3: Mild facet arthropathy is present.
    Electronically signed by:
    17-Aug-2017 13:31

    Copy

    Copy
    This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

    wbwalsh
    Participant
    Post count: 3

    EMG Test pasted below:
    Patient Copy

    Generated on: 24-Aug-2017 09:13

    17-Aug-2017
    Study Number: 1

    Page: 1

    Electromyography

    Final Report

    Referred for: Neck pain
    Referral Code:
    011 019
    314

    Copy

    Nerve conduction studies of both upper limbs were
    normal. Concentric needle examination of selected right upper limb and right cervical paraspinal
    muscles demonstrated long duration, high amplitude motor unit potentials in the pronator teres
    muscle only.
    CLINICAL INTERPRETATION: Abnormal study. The findings are most compatible with an old, inactive
    right C7 radiculopathy. There is no evidence of an active right cervical radiculopathy or right
    upper limb mononeuropathy or left median mononeuropathy on the current study.
    E. Dimberg (127 or (78)3-9741)
    NERVE CONDUCTIONS

    Temperature: 34.5 ?C

    Record
    Rep
    Normal
    Normal Distal Normal F-Wave F-Wave
    Nerve
    Type Site
    Stim Side Amp Amp
    CV CV Lat Lat Lat Est
    ————————————————————————————————–abductor
    pollicis
    Median
    motor brevis
    L 10.8 (> 4.0) 55 (> 48) 3.3 (< 4.5)
    This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

    Copy

    SUMMARY: Prior to starting the procedure, the patient’s identity was verified, pertinent available
    records were reviewed, the nature of the procedure was explained, the appropriate sites of the
    exam were confirmed directly with the patient, and a pre-procedure pause was performed for final
    verification of all of the above.

    Patient Copy

    Generated on: 24-Aug-2017 09:13

    Median
    Ulnar
    Median
    Median
    Ulnar
    Ulnar

    Page: 2

    abductor
    pollicis
    motor brevis
    abductor
    motor digiti minimi
    sensory wrist
    sensory wrist
    sensory wrist
    sensory wrist

    R

    8.0 (> 4.0) 56 (> 48) 3.5

    (< 4.5)

    R 11.0 (> 6.0) 63 (> 51) 2.3 (< 3.6)
    L 148 (> 50.0) (> 55) 1.7 (< 2.3)
    R 109 (> 50.0) 63 (> 55) 1.8 (< 2.3)
    L 37 (> 15.0) (> 54) 1.6 (< 2.3)
    R 38 (> 15.0) 61 (> 54) 1.7 (< 2.3)

    NEEDLE EMG

    This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

    Turns

    Copy

    Copy

    Ins Spont MUP
    Recruitment Duration Amplitude Phases
    Muscle
    Side Act Fib Fasc Normal Activ Reduced Rapid Long Short High Low %
    ————————————————————————————————–First Dorsal
    Interosseous R NL 0 0 NL
    Extensor
    digitorum
    communis
    R NL 0 0 NL
    Pronator
    teres
    R NL 0 0
    1+
    1+
    Biceps
    brachii
    R NL 0 0 NL
    Deltoid
    R NL 0 0 NL
    Triceps
    brachii
    R NL 0 0 NL
    C7 paraspinal R NL 0 0 NL
    Patient Copy

    Generated on: 24-Aug-2017 09:13

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    To reiterate your symptoms: “I have constant pain in the base of my skull, pain/pressure in neck, right shoulder, numbness/pain right arm/outer fingers. Pain move to left side, down back and legs as my activity increases”.

    To dissect out symptoms, pain at the base of the skull can typically originate from degenerate facets, normally at C2-3 and C3-4 but occasionally at C1-2 (rare). There is noted degenerative facets at C2-3 (“Adjacent segment degenerative change is present at C2-C3 with slightly diminished intervertebral disc space and a 2 mm grade 1 degenerative spondylolisthesis”). This could be causing your base of neck pain.

    Since you have had a fusion at C2-3, please explain the rationale why that level was operated on and how the results went both initially and now. However, there is a discrepancy in your reporting. You note a fusion at C2-3 (“February 17 which included installing a cage at C2-C3” but your CT report notes “anterior cervical fusion is present from C3 through C7, with stand-alone cervical cage fusion at C3-4 without loosening of hardware but without evidence of bony bridging across the disc space”. Did you mean you had a fusion at C3-4?

    You have a fusion at C4-7 after an initial fusion at C5-6. What were the reasons and the results after those two surgeries?

    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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