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  • SushiCami
    Participant
    Post count: 6

    Hello, Dr Corenman,

    In your post regarding how to describe pain, you mentioned patients recovering from surgery who do well for months and then have sudden pain for a week or so (and repeat). In your experience, do these type of patients usually have fibromyalgia?

    I’ve had fibromyalgia most of my life, and I am having the same issue after 4-level ACDF surgery. However, the flair-up I’m having now (9 months post-surgery) is much worse and longer than those before. The muscles are cramping in the right side of my neck. The pain is so severe that I can stand or sit for only about 15 minutes before I have to rest my head back. Also, a few times a day, I feel tingling at my suboccipital migraine trigger point. Likely inflammation causing pressure on a nerve, correct? What helps this? It can’t be time.

    Only a couple weeks ago, I had been so pleased with my progress. I was finally at a point where I could do almost all essential activities again, including light exercise. If I could go to my Physical Therapist every other day for the rest of my life for manual muscle therapy, I would feel great. Since that isn’t an option, do you have any thoughts on next steps? Pain specialist? Continue PT? Accept this level of functionality?

    In your patients, did the flair-ups ever stop long enough so they could fully recover from surgery?

    —————
    BACKGROUND: I had ACDF surgery, C2-C6, in mid-March 2022. 10-week xray looked perfect. If you’d like, you can read more details in my previous question, #35018 . I have gone to physical therapy for 6 months, which has helped immensely. I have a wonderfully knowledgeable Physical Therapist, who is one of the few who knows how to treat acute pain when it’s all wrapped in chronic pain. It’s been a very long recovery, with flair-ups every month or two causing my progress to backtrack. During these times, only manual manipulation by my PT gets me through (neck, top of shoulders, around shoulder blade).
    —————

    Thank you for your help,
    LeAnn

    SushiCami
    Participant
    Post count: 6

    DR. CORENMAN,

    When I wrote this latest question, you hadn’t been active in the forum for a time, and I never received a response. I am still struggling with severe neck and upper back pain. Would love to hear your thoughts.

    NEW INFO
    My last MRI showed heavy marbling of FAT INFILTRATION in the cervical muscles.
    (My Physical Therapist had to show me this, since imaging and surgeons don’t check for this important recovery factor (for some reason).

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Sorry, but I was out of the country.

    Fatty infiltration of the muscles (“My last MRI showed heavy marbling of FAT INFILTRATION in the cervical muscles”) is normally a sign of disuse or even neurological disconnection (nerve loss). It would be the opposite of recovery.

    I suspect your current symptoms are possibly from a lack of fusion of a 4-level ACDF. 4 levels is a lot to have to expect that all levels would fuse. Also, the long lever arm on the lowest level (the open C6-7) could wear this level out prematurely.

    Your symptoms are more focal and significant that what I would expect from Fibromyalgia (“The muscles are cramping in the right side of my neck. The pain is so severe that I can stand or sit for only about 15 minutes before I have to rest my head back”).

    I would say that a new set of x-rays including flexion/extension are necessary and if any questions, a CT scan of your neck could be in order.

    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.
    SushiCami
    Participant
    Post count: 6

    Dr Corenman,
    THANK YOU for your response! Your kindness in starting this forum and continuing to be active on it is overwhelming and touches us all. You allow us to feel that, at least, one person in the world understands. The encouragement we gain here is powerful. I pray that God will give you and your family the same powerful encouragement and that you will not be weighed down by all our constant questioning.
    —————

    ALREADY HAD XRAYS/MRI
    Between the first message (Dec 2022) and the second reminder (Mar 2023), I did have cervical x-rays (including flexion/extension) and an MRI (that’s how we found the fat infiltration). I have not had a CT scan. Results were compared to imaging taken pre- and post- surgery.

    XRAY/MRI RESULTS SUMMARIZED
    + According to my neurosurgeon and the reports, fusion at all 4 levels and alignment of cage is still perfect and intact.
    + Lordosis is good, considering.
    + There is no longer impingement of the nerve compared with before surgery.
    + Degeneration at all cervical levels has not changed significantly since surgery.

    [FYI – I typed my levels incorrectly before – my fusion is C3-C7. Tried to edit but no option.]

    My surgeon did tell me that the levels above and below would eventually degenerate, but I don’t think that would happen within 7 months, especially since I’m not able to do many of the activities I did before (including work).

    FOLLOW-UP QUESTIONS
    Q1. I am a small-framed 5’1” 110 lb female. Do you think that maybe my muscles were just not strong enough to handle the change in biomechanics of a 4-level fusion?

    Q2. My physical therapist said that my cervical muscles were very marbled with fat, so much so that it would be difficult to believe it occurred recently. He also mentioned that fat infiltration is often seen in Chronic Pain patients (of which I am one – Chronic Migraine, Myofascial Pain Syndrome, Fibromyalgia, Bruxism, Major Depressive Disorder, DDD, etc). In your experience, have you seen a significant difference in % Recovery from ACDF between chronic pain patients and non-chronic pain patients?

    Thanks again,

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    ‘My surgeon did tell me that the levels above and below would eventually degenerate, but I don’t think that would happen within 7 months”. Very unlikely.

    Do you think that maybe my muscles were just not strong enough to handle the change in biomechanics of a 4-level fusion. Probably your muscles were OK. Is your alignment OK (lordosis) or was there a big change?

    “Have you seen a significant difference in % Recovery from ACDF between chronic pain patients and non-chronic pain patients”? The difference would be residual pain. If the surgery was performed for the right reasons, the pain created by deformity and nerve compression should be relieved but the chronic residual pain should remain.

    What did the radiologist who reviewed the CT scan dictate? You can cut and paste here (without identifying marks).

    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.
    SushiCami
    Participant
    Post count: 6

    I didn’t have a CT scan, but here is my MRI report. Current imaging (Feb 2023) is compared with imaging prior to ACDF surgery (Dec 2021). Even though the radiologist said C2-C3 was “severe” (in several ways), he also said it was the same as the imagining prior to surgery. I had different pain prior to surgery but not the problems I’m having now. See what you think. Thank you for your help.
    ______________________________
    ______________________________

    RADIOLOGY REPORT

    Spine cervical wo contrast MRI

    CLINICAL – M47.812 Spondylosis without myelopathy or radiculopathy, cervical region

    TECHNIQUE: Multiplanar multisequence imaging of the cervical spine was performed.
    IV CONTRAST: No gadolinium.
    COMPARISON: 02/15/2023 radiograph, 12/28/2021 MRI exam

    FINDINGS:
    C3-C7 ACDF changes are present. No vertebral marrow or paraspinal edema identified.
    Spinal cord: Appears unremarkable.

    C1-C2: No spinal stenosis or neural foraminal stenosis.
    C2-C3: Severe left facet arthrosis with left foraminal osteophytes and severe left foraminal stenosis, similar to prior exam. Ligamenta flava thickening is present without spinal canal stenosis present.
    C3-C4: Resolved spinal canal stenosis since prior exam. Severe left facet arthrosis with mild left foraminal stenosis.
    C4-C5: Resolved spinal canal stenosis since prior exam. Right facet arthrosis is present with mild right
    foraminal stenosis.
    C5-C6: No spinal canal stenosis. Bilateral facet arthrosis is present. Moderate left foraminal stenosis due to left foraminal osteophytes.
    C6-C7: 3 mm posterior osteophytes with mild spinal canal stenosis and contact with anterior cord margin. Moderate bilateral foraminal stenosis due to left foraminal osteophytes.
    C7-T1: Bilateral facet arthrosis with foraminal osteophytes, with moderate left foraminal stenosis. No spinal canal stenosis.

    IMPRESSION

    1. C3-C7 ACDF with resolved or significantly improved multilevel spinal canal stenosis described previously. C6-C7 mild spinal canal stenosis present.
    2. C2-C3 severe left foraminal stenosis. C5-C6 moderate left foraminal stenosis. C6-C7 moderate bilateral foraminal stenosis. C7-T1 moderate left foraminal stenosis.

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