cybermarcParticipantNovember 30, 2019 at 9:45 amPost count: 7
Hi Doctor Corenman, my name is Marcus and I’m a 36 year old male. 9 Weeks ago I had an ACDF performed on my C5-6 disc (with plate + cadaver bone.) And I’m looking for advice on how to go forward since my pain seems to still be much worse than before surgery (perhaps that’s normal at 9 weeks, I’m not sure.)
As background, I have had progressive pain and weakness from hands to biceps/triceps in both arms for 2+ years. I also had tingling and numbness when waking up. It is not nearly as bad as some people report, and mainly shows up when I exert myself physically (I live a very active lifestyle, homesteading on an off-grid cabin and farming sometime during the season.) I chose to get the surgery to try to get back some of my strength level to continue in these activities. Unfortunately, so far it’s had the opposite effect.
MRI revealed I had stenosis of spinal cord at C5-6 and also foraminal narrowing at same level. Attempted ~5 months of PT to little effect before opting for surgery.
Post surgery I had what I believe is the normal pain moving around to different places on different days. I regret to report I was not very strict with my restrictions (was not prescribed neck brace, first 6 weeks 10 pounds lifting, 2nd 6 weeks 25 pounds as tolerated.) Because of my lifestyle I had continual temptations to carry/push heavier things, which I did fairly regularly, although I definitely took it much easier than usual. This brings up worry about whether I may have aggravated my body’s attempt to fuse, and maybe that is why I still have pain?
For past two weeks my pain has been seemed to settle into a dull stabbing pain between my shoulder blades, but more on the right side, and also that travels up the back of my neck and around it’s right side when it gets worse. This shoulder blade pain comes very often, like when I am walking around or any impact really on my body, or even just turning. This was not really a pain I had before, at least not with any regularity.
My surgeon’s personality seems to be excessively relaxed, and his main input has been to congratulate himself on his surgery/experience so far. He says he does not do Xrays except in the most dire of pain circumstances (which I know I don’t have), but I feel like his lax attitude might be letting something slide. I’ve also read you saying that Xrays might not even show a failed fusion, but that CT scans are the way to go.
Another factor to add into the mix is that ten years ago I fell 85 feet out of a tree, compression fracturing T7 and T9 and facet fracturing T7. I healed up in a torso brace over 3 months with no PT and only suffered occasional back spasms over the ensuring years. Then, over the past three years I had a lot of life changes that first resulted in me being on the computer more (when the pain started in my hand, wrist, and forearm) and then progressed up to my medial epicondyle and bicep/tricep as I started a farming job and was regularly lifting heavy loads and also bending over for hours on end. I assume my tree fall had some cumulative effect over the years in combination with the normal wear and tear of aging and work on my body.
Thanks for your time in reading this. I’m specifically wondering how to direct my surgeon on my upcoming 12 week visit. Should I ask for xrays/CT, or some other approach? Of note also is that no imaging was ever done on my thoracic spine, which surprised me considering the level of trauma I’ve experienced there; might it be somehow linked to my cervical issues? I’m also wondering if my worry about failed fusion is unfounded because it’s so early after my surgery and pain right now is normal. To that end, I’ve been starting to do gradual warm ups with my body and light weightlifting to experiment with strengthening, but then if non-union is a danger then that could be the totally wrong thing to do.
MarcuscybermarcParticipantNovember 30, 2019 at 4:12 pmPost count: 7
I suppose I should also note that the surgery is on my right side, and so is the shoulderblade pain I’m having.Donald Corenman, MD, DCModeratorDecember 5, 2019 at 6:16 amPost count: 8460
I’ve summarized your history here; “9 Weeks ago I had an ACDF performed on my C5-6 disc…MRI revealed I had stenosis of spinal cord at C5-6 and also foraminal narrowing
“My pain seems to still be much worse than before surgery”. “As background, I have had progressive pain and weakness from hands to biceps/triceps in both arms for 2+ year”
After surgery, you report; “I was not very strict with my restrictions (was not prescribed neck brace, first 6 weeks 10 pounds lifting, 2nd 6 weeks 25 pounds as tolerated.) Because of my lifestyle I had continual temptations to carry/push heavier things”,
The first thing to consider is new X-rays with flexion/extension components. My thought is similar to yours, a possible pseudoarthrosis. I assume that it is neck and posterior shoulder (trapezius) pain you are concerned with and that your arm pain and weakness has abated.
Dr. CorenmancybermarcParticipantDecember 5, 2019 at 8:11 amPost count: 7
Thanks for your reply. I will ask for X-rays at my next appointment. What will the surgeon/radiologist be looking for? Movement? Might they justify that there “should” be movement because the fusion isn’t complete?
I don’t think it’s safe to say the arm pain/weakness is gone. Prior to surgery, it mostly manifested when I was exerting myself, which I’ve been doing less since surgery, but the threshold for the arm pain is now much less too it seems. The weakness is still there too, just less noticeable because I don’t carry heavy loads very much and have been “babying” myself more.
Regarding being 9-10 weeks out, I’ve heard conflicting reports from people that I should still expect to have a lot of pain, and no fusion anytime soon, and then from other people I hear it “should” be fused by 8-12 weeks. Any thoughts on this? Might I just be freaking out over the normal course of healing? It just seems odd that the pain has become so localized to one specific area.Donald Corenman, MD, DCModeratorDecember 5, 2019 at 12:32 pmPost count: 8460
You should not have more pain in your neck after surgery so various problems need to be ruled out. Did the graft migrate?, Did the graft collapse? Did the plate screws go where they should? Is there loosening. Most of the answers should be provided with simple X-rays including flexion/extension views.
Dr. CorenmancybermarcParticipantDecember 20, 2019 at 9:33 amPost count: 7
Ext/Flex Xrays showed fusion progressing and no problems with the graft.
I am now again experiencing the full pain and tingling/numbness of my worst symptoms from before surgery, extending from neck down both arms and into hands. My doctor has suggested the possibility of carpal tunnel and double crush syndrome. This would make sense, as my symptoms started 3 years ago in the wrist from computer use, before progressing up forearm, bicep, and then to neck last.
I have an EMG scheduled for both wrists in a couple weeks, but I am wondering if that may, again, be trying to isolate the problem at one location and then miss the bigger picture. Just watched a video on double crush that pointed out it can come from a combination of a number of locations, including ulnar nerve entrapment sites, thoracic outlet, etc. My surgeon has already told me he doesn’t believe thoracic outlet syndrome is a real thing…which scares me that diagnostic testing might be just paying attention to the most popular sites like the median nerve at carpal tunnel.
He also suggested the possibility that it’s my C6-C7. My previous MRIs showed some disc degeneration there, but nothing like the C5-6 that I had removed/fused. We will look into diagnostic steroid or nerve block to investigate if that level is causing the pain/weakness. Would you recommend nerve block over the steroids for that?
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