SuzjarParticipantAugust 1, 2020 at 9:38 pmPost count: 2
Hi De Coreman
I broke my wrist so can’t upload all of my documents but had a c4/c5 ACDF surgery in October 2019. I had previously had a c5-c7 TDR in Dec 2017. I did not experience relief from the ACDF surgery despite significant stenosis/disc herniation. Finally my surgeon did an X-ray showing lesions then a CT Scan but other than uncinate spurring referred me to pain management. Because of artifact nothing could be seen on an MRI w and w/out contrast. I asked about a meylogram and my surgeon thought that involved something akin to spinal tap. He’s a top surgeon in SF but maybe past his prime. Would a meylogram help at this juncture? Thank you- sent via iPhoneDonald Corenman, MD, DCModeratorAugust 2, 2020 at 6:30 amPost count: 8459
I assume the new symptoms presumably generated from C4-5 developed after your total disc replacements (TDR aka ADR-artificial disc replacement) from C5-7 (which again presumably yielded good relief in 2017). If that is in error, please let me know.
Pain generation can develop from TDRs as motion allowed by the TDR can develop bone spurs which in turn can compress the nerve roots or pain can develop from loosening or settling of the metal/bone interface too. Did you have any workup (diagnostic pain injections) or did you have findings on your examination that pointed to the C5 nerve root?
MRIs are not helpful to determine anatomy at the TDR levels due to the large amount of artifact generated by the TDRs but generally, the adjacent levels can commonly be analyzed on an MRI. A CT scan is the best tool to use for determining the anatomy of the TDR levels. Adding a myelogram can be helpful as this “lights up” the nerve roots and spinal canal. Your specific symptoms would be helpful to know to determine if a myelogram should be added to the CT scan. See: https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/
Dr. CorenmanSuzjarParticipantAugust 10, 2020 at 1:41 amPost count: 2
Hi Dr Coremam:
I had a C5-C7 TDR in Dec 2017 but did not experience relief and did the maximum PT. In Oct 2019 another surgeon said I had significant stenosis at c4/c5. I have his notes and he’s known to be conservative. He said for a 3rd level we would need to go with ACDF. I am 10 months out and he punted me to a pain Management specialist who did a contrast MRI but it yielded artifact. He wants me to see a neurologist thinking I might have a movement disorder like cervical dystonia. I asked about a Myelogram but his only use for an MRI was to see if I could have a spinal cord stimulator so dismissed the idea. Thoughts? Thank you ???? SusanDonald Corenman, MD, DCModeratorAugust 10, 2020 at 7:12 amPost count: 8459
If you continue to have symptoms and you have known stenosis at C4-5, that level should be suspicious for the pain generator. A diagnostic block of that level would be the next step.
See https://neckandback.com/treatments/diagnostic-therapeutic-neck/ and
The ADRs will obscure an MRI image due to the significant mass of metal these items are made of. If you really want to image the spine well, a CT myelogram would be the next step.
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