Donald Corenman, MD, DCModeratorJune 10, 2014 at 8:40 pmPost count: 8508
Thanks for sharing your story. The more information that individuals can volunteer, the more that others can understand what can happen and hopefully be prepared to question their doctor regarding outcome.
Dr. CorenmanCowboysFanMemberJune 11, 2014 at 12:11 amPost count: 19
My goodness, Andybythesea, I am so sorry to hear that you have went through all of that. I hope that while you continue to look for answers that you consult with a pain management physician, if you have not done so. The level of pain that you are suffering can be very difficult to deal with emotionally and physically.
Just to be clear, my shoulder (clavicle, upper arm, etc.) pain was actually being caused by severe arthritis in the acromioclavicular (AC) joint in my left shoulder and was not related to the non-fusion in my neck. That shoulder pain has been completely resolved since I had the arthroscopic surgery done on the AC joint, where part of the back end of my clavicle was removed along with the bone spurs in the joint.
I shared the results of the MRI imaging on my shoulder (before I had the shoulder surgery) with Dr. Corenman and his comments were invaluable. He pointed out that I had severe arthritis in the joint and that I needed to see an orthopedic surgeon. I found an orthopedic shoulder surgeon to see, but that surgeon actually felt that I did not have much arthritis in the joint and had me try many different treatments and felt that my neck was causing the problem, even though the pain was only generated by moving my arm and shoulder in certain ways.
Keeping in mind Dr. Corenman’s comments about the severity of the arthritis, I decided to seek out another opinion from one of the best orthopedic surgeons in my area. Within 5 minutes of looking at my MRI images and performing a physical test on my arm and shoulder, this surgeon suggested that surgery was the only option and that my neck had nothing to do with it at all.
My issues since my C5-C7 ACDF surgery have been daily headaches and neck pain, stiff neck muscles and occasional muscle spasms in my neck. There is a direct relationship between my activity level and my pain level, the more active I am, the more pain I have.CowboysFanMemberJune 11, 2014 at 12:35 amPost count: 19
I have a couple of questions for you, if you do not mind:
(1) I have consulted with a neurosurgeon who believes that it is very possible that my neck pain and headaches are being caused by a “micro” instability at the C5-C7 levels. His suggestion is to have the have those 2 levels fused posteriorly, in order to stop that “micro” movement.
I have a non fusion at C5-C6 and a PEEK cage was used at both levels. The plate and screws look good in all my imaging. It has been a while since I looked at any of my MRI reports, but I recall having a lot of foraminal stenosis at those two levels.
Is it possible that I could have a “micro” instability at either or both levels, just enough that the C6 and C7 nerves could be getting bumped around and generate pain?
(2) What is the incidence rate of a patient being allergic to the materials that were used in an ACDF, like the titanium plate and screws, the PEEK cage and the bone material used in the cage? Could such an allergy be the cause of a non-fusion or possibly be causing a inflammatory response that could be the cause of my neck pain and headaches?
After the discectomy was performed, plastic disc spacers were inserted that contained putty-like bone material. I believe that those disc spacers are called PEEK cages, but please correct me if I am wrong about the terminology.
Thank you in advanceAndybytheSeaMemberJune 17, 2014 at 2:04 pmPost count: 3
Thank you for your reply post CowboysFan;)
. I appreciate the empathy…And understand the seriousness of your own journey through the Spine machine.
For me ,Yes it has been a saga , one that I would never have dreamed could happen. Bonefide Living Nightmare.
But i amnot a bitter person and I try to learn from every experience…improve myself…or pretend to for my attitudes sake…
Of course If only I knew more before going under the knife
The first time. Wish I had been able to receive a more forthright discussion about the risks
Of even an ACDF but as you know….yah can’t go back now;)….
(don’t you find it overwhelming going to different surgeons often
Receiving different opinions!?)
Of course Regrettably my outcome was pretty awful but that
Was largely due to incorrect placement/size of implant, then failure and then lack of follow up care to arrest the collapse and deal with complication… I still can not believe it happened the way it did… But Must move on.
How’s the song go “No regrets just lessons to be learned?”
I think I was a bit too trusting ..(.that’s changed(lol).
I also should have understood that spine surgery is a business FIRST.
Best that patients realize this possible motivation instead
Of trusting that a doctor is a God…and just because he/she says you will be able to run marathons again, be pain free, does not mean it will happen. ( In fact if he /she says such then run away quick!)
I wish I would have understood the life altering risks and also what would happen, heaven forbid, if any complication occurred?
Whatever surgeon you /we go to they need to be experienced in your exact surgery, and revision of if need be. My first guy was so confident he could fix me, but not so. Then he panicked not wanting to deal with a problem.
Rude awakening but I did not know the hardware could break so did not think to ask about before surgery.
And Thank you CowboysFan for your suggestion about pain management.
Been through that strange but neccesary process and probably will be a chronic pain patient for foreseeable future( oh joy)
But again, so far seems like the same business model… Everyone wants to stick a needle in you, try injections steroids, spinal stimulator…
All temporary ( but billable )treatments with very limited result for me… Definitely have tried it all despite the often painful procedures.
PerhapsThe most positive thing I have gained through a very negative saga…
Is that much unbiased information can be gleaned if you can learn from other like patients …
Patients are not coming from a vested position where as when a surgeon profits from the surgery /costly implants or the pain management place makes more money performing billable procedures ( ie steroid injections etc)
Certainly Hard to feel informed enough with any major surgery but with spine surgeries we all need to be aware of being swept into the process, just because MRI report reads one way doesnt always indicate surgery…of course when we are in pain or discomfort we want FIX IT answers and resolution…
And just because a surgery is considered ” successful” by the surgeon, it may not mean your pain will be resolved. In fact, the result could be quite the contrary.
I remember when I thought I knew what level 10 pain was…..the worse your pain is the more you realize how relative perception is.(.a 10 before is like a 5 now.)
So unless you are losing the use of your hands or have a spastic gait (say severe myleopathy)
Be cautious…and seriously consider all the possible risks…even the ones the surgeon may not tell you about..regrettably .
be informed read about other patient, learn from their
Experiences , hopefully not also endure the same pitfalls.
And CowboyFan I will tell you …The posterior fix it sugery Is brutal…for most.
If you are still considering…One thing my revision
Surgeon told me that was beyond true, (actually an understatement) was that
Posterior revision for a two level failed AcDF C5-C7
Is TEN times more painful then the index (anterior) surgery.
You may also have complications from supra spinal muscle atrophy
Leading some deformity and more muscle spasms …neck stiffness, headaches etc
They have to cut thru ligaments that provide stability
So if you have any micro motion ( the term often used) or hint of kyphosis …posterior surgery
Could worsen your problems.
Sure The posterior revision may address the original lack of anterior fusion and assist with de ompression but the posterior surgery may add NEW problems.
(I did not have a choice in my revision surgeries as index hardware had fractured and metal parts were sawing away and loose migrating into dangerous territory…)
To all who have the choice…may you be in the best of hands and understand the excruciating operation /recovery and risks.
If you have any kyphosis, posterior stuff can be opening a can of worms as
” kyphosis begets kyphosis”…then the cord drapes over any posterior osteophytes especially at higher vertebrae level, say C3/4 .l.
(not sure if that was your case CowBoysFan but that’s what’s happened to me.)
Not sure how on track this post was hope someone related and to have been of some possible insight.
Wishing you and all fellow spiney patients the best of care and health.
I will continue to follow your progress and shout out a thank to Dr Coreman for his constant concern.
Been reading his posts for some time and appreciate the generous and insightful unbiased knowledge.
Here’s to your health!
AndybytheSeaDonald Corenman, MD, DCModeratorJune 17, 2014 at 10:49 pmPost count: 8508
Thanks for the frank discussion of your outcome. I want to emphasize that picking the right surgeon is important. Do some research and ask critical questions of the surgeon and his or her staff. See the section on asking the right questions to know what to ask and look for.
Yes, posterior surgery is more uncomforable than the anterior surgery (ACDF) generally but again, the technique of the surgeon will vary the outcome. Generally, a posterior fusion for a failed anterior fusion will allow solid fusion in 95% of all cases.
Dr. CorenmanAndybytheSeaMemberJune 18, 2014 at 7:16 pmPost count: 3
And Thank you again Dr Corenman.
You really do an amazing job of sharing your insight and knowledge.
I read the section you referred to and Those are great questions to ask!
As a patient it is easy to feel intimidated but we need to communicate
And do the research as you advise;)
I keep my questions on a list maker cell phone AP and bring with me to my follow ups
Helps get my concerns addressed.
I also find it supportive to have someone with me at my Appointments,
I am blessed to have a wonderful husband who is such a support.
Think patients should try and take someone with them to appointments,
Whether spouse, friend, family member.
Really Makes a big difference.
Keep up the good work Doctor Corenman.
Wellness to all.
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