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  • MB007
    Participant
    Post count: 11

    Hello Dr. Corenman,

    I had C3-C6 laminoplasty for arm pain that provided only partial improvement. It was not significant reduction in pain. The surgeon did not do foraminotomy during surgery. I do have OPLL. It has been almost 3 years since surgery. I did have neck pain after surgery which subsided. However, when I started going back to the gym, the neck and arm pain increased.

    Questions
    1. What are the activity restrictions after C3-C6 Laminoplasty and why? I was told that this surgery does not change the biomechanics of the spine.
    2. Are roller coaster rides ok?
    3. Do the muscles attach back to the spinous processes or not? What is causing neck pain?
    4. How can I get rid of neck pain?

    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Typically, a cervical laminoplasty (an opening of the back of the bony spinal canal not unlike cracking open the roof of your house for ventilation) is performed for cervical stenosis or narrowing of the spinal canal causing cord compression. This operation is not designed for neck pain (it does nothing for neck pain and can induce some pain). A laminoplasty can be incorporated with a foraminotomy at one of more levels to try and also open the exiting nerve holes.

    Continued neck pain could be from degenerative discs or facets which are not addressed with a laminoplasty. You need a neck pain workup.

    The spine biomechanics are not severely changed with a laminoplasty. Roller coaster rides should not be dangerous if the canal is opened. Muscles attache to facets and spinous processes. The surgery does alter those connections somewhat.

    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.
    MB007
    Participant
    Post count: 11

    Hello Dr. Corenman,

    Thank you very much for your reply.

    The neck surgery was done for the arm pain, not neck pain. I had minimal neck pain prior to surgery. Neck pain increased to a severe level post-op and then subsided to minimal level after a couple of months. When I resumed gym activities, neck pain increased. Some surgeons advised not to do ACDF due to the risk of tearing the dura. I have ossification of posterior longitudinal ligament. Laminoplasty was done to fix spinal stenosis and remove pressure from the nerves. My surgeon did not do foraminotomies. The surgeon said that when he was operating, my foramens were clear. However, his statement is contradicting the MRI report.

    I later saw a neurologist because I was still having pain in my arm. According to the neurologist, my surgeon did the easy stuff (decompress the spine) but did not fix the cause of my pain. The neurologist thinks there could be multiple levels involved.

    1. Is there a way to post MRI report in this forum? I was not able to paste a picture. Do I need to type the whole report?
    2. What is meant by neck pain workup as stated in your response? What kind of doctor should I see?
    3. After surgery, do the muscles re-attach to the facets and spinous processes?

    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    The laminoplasty sounds like it fixed your central stenosis. If you had significant foraminal stenosis and did not have foraminotomies, it is highly unlikely you had decompressions of your foramen. However, foraminal stenosis does not generally cause central neck pain unless it is one sided neck pain that radiates into the shoulder/arm (depending on the nerve involved) made worse with bending the head backwards. Central neck pain is generally caused by degeneration of the disc and facet.

    You should post the entire MRI report here (without names) to allow the most information to be processed.

    A neck pain workup starts with a careful history and physical examination. Then motion X-rays and an MRI (and/or CT scan) are perused. After a suspected differential diagnosis is formulated, diagnostic testing (facet blocks, nerve root blocks or discograms) are used to determine the correct diagnosis.

    The muscles do reattach to the bony surfaces but the biomechanics can be “off” and scar of the muscle can occur which can cause pain

    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.
    MB007
    Participant
    Post count: 11

    Hello Dr. Corenman,

    Thank you very much for your reply. Here is the MRI that was done 9 months after surgery.

    In my last post I stated that foraminotomies were not performed. This was in reference to my right arm pain, not neck pain.

    Year 2009: Carpal tunnel surgery in right arm. Reason: right hand used to get numb while riding motorcycle. Pain in hand while using mouse. Neck MRI in 2009 was normal.

    Year 2010: In summer of 2010, I woke up in the morning and had severe neck pain. After a few days of ibuprofen, it subsided. Right arm pain and shoulder pinching started.

    Year 2011: Tenosynovitis surgery (Fibro osseus tunnel release) was done in the right wrist under the thumb. Reason: Mousing was painful. Not much relief from surgery. There was one episode of entire right arm getting numb after doing pull ups, but it quickly subsided in a few hours.

    Year 2012: Rotator cuff repair was done on the right shoulder. When I woke up from surgery, pain in right outer forearm was still there. I was disappointed. Shoulder pinching did improve. In the following months, I started having burning sensation in upper right back. Pain was still present in outer forearm, top of wrist and triceps. I did get recommendations for 2 to 3 level ACDF.

    My pain can be described as dull achy pain

    MRI was repeated in 2013 and early 2015. CT scan was done in 2014. OPLL was seen in all imaging studies.

    Injections: (1) Epidural injection (2) Diagnostic nerve blocks for C5, C6, C7 (3) Therapeutic nerve block for C7. Diagnostic nerve blocks provided some pain relief, but were not very clear in identifying the source. C7 block was the best based on my notes.

    I saw multiple surgeons and got varied surgical opinions – posterior and anterior. Anterior option had the risk of dural tear and CSF leak. Laminoplasty was also expected to preserve the biomechanics of the spine.

    Neck surgery was done in early 2015. After the surgery, the burning sensation in my right upper back improved. Few days prior to surgery, I developed mild pain and numbness in the tips of my right fingers (localized to the nails). It improved after surgery. I don’t remember the fingers involved.

    Prior to surgery, I had minimal neck pain. After the surgery, the neck pain worsened due to surgical intervention, but it subsided to a minimal level in 1 or 2 months. Since early last year, it worsened again. I have had about 3 rounds of Medrol dose pack since fall 2015 several months apart. It does provide some relief of pain. However, my pain never went back to the minimal level as it was after surgery. Resuming gym activities have worsened the neck pain.

    Prior to surgery my significant issue was right arm pain. I had only 1 problem. At this point I have 2 problems: Arm pain and Neck pain. Arm pain did not improve significantly after surgery. It is very depressing when I look back at my life. I feel that I was better off without the surgery. This surgeon also did not do foraminotomies. According to him, my foramens were clear during surgery. This is contradicting the MRI report. According to the surgeon, it is just muscle spasms that is bothering me. He is only offering muscle relaxants, PT, and second opinion. I last saw him in early 2017.

    MOST RECENT ISSUE
    A few days ago I lifted my kid who is about 100 pounds. While lifting, I did not feel any pain. Pain started a few minutes later. My upper back is burning. Neck is hurting, snapping, cracking, and grinding. Right arm pain has also gotten worse. What do you recommend?

    Here is the MRI that was done at the end of 2015. It was compared to the pre-surgical MRI done in early 2015.

    TECHNIQUE: MRI of the cervical spine was obtained before and after the administration of 20 ml of OptiMARK intravenous gadolinium contrast according to standard protocol.

    There has been interval postoperative changes of “open door” laminoplasty, C3-C6, with resulting decompression of the central canal at these levels. However, there is persistent abutment of and slight deformity exerted upon the ventral aspect of the thecal sac at the C5 and C6 levels by underlying ossification of the posterior longitudinal ligament.
    Susceptibility artifact from underlying hardware seen along the right lamina as these levels, which, on the axial images, limits evaluation of the right-sided facet joints , C3-C7.

    No postoperative fluid collections. No epidural collections/hematomas .

    Alignment is anatomic. No spondylolisthesis . Vertebral body heights are maintained. No compression fractures. Mild endplate edema is seen anteriorly along the right aspect of the C6-C7 level, compatible with Modic type I endplate changes. Marrow signal intensity is otherwise normal.

    The visualized portions of the posterior fossa and craniocervical junction are normal. Normal flow-voids are seen within the vertebral arteries. The cervical cord demonstrates normal signal intensity and morphology on all pulse sequences.

    There is mild multilevel degenerative disc disease of the cervical spine, C4-C7, unchanged in appearance compared to the previous study.

    No abnormal enhancement after contrast administration. Mild expected enhancement within the soft tissues posterior to surgical intervention represents postoperative scar tissue. Scattered foci of susceptibility artifact is also seen within the posterior soft tissues, related to surgery.

    Again seen is ossification of the posterior longitudinal ligament, extending from the C3-C4 level down to C6-C7.

    C2-3: The disc is normal without central canal stenosis. The facets are normal. The uncovertebral joints are normal without foraminal stenosis.

    C3-4: There are changes of laminoplasty . No spinal canal stenosis. The left facet appears normal. There is no uncovertebral joint osteoarthritis or foraminal stenosis.

    C4-5: There are changes of laminoplasty. There is a posterior disc osteophyte complex without spinal canal stenosis. There is mild left facet osteoarthritis. There is mild right and severe left uncovertebral joint osteoarthritis resulting in the same degree of foraminal stenosis.

    C5-6: There are changes of laminoplasty. There is a posterior disc osteophyte complex that abuts and slightly deforms the ventral aspect of thecal sac. No spinal canal stenosis. The facets are normal. No significant uncovertebral joint osteoarthritis or foraminal stenosis.

    C6-7 : There is a posterior disc osteophyte complex with mild persistent canal stenosis at this level. There is mild left facet osteoarthrit is. There is moderate right and mild left uncovertebral joint osteoarthritis resulting in the same degree of foraminal stenosis.

    C7-T1 : The disc is normal without central canal stenosis. The facets are normal. The uncovertebral joints are normal without foraminal stenosis. ยท

    There is a small right paracentral disc protrusion at the T1-T2 level.

    IMPRESSION:
    1. Interval postoperative changes of “open door” laminoplasties , C3-C6, with resulting decompression of the central canal at these levels. No postoperative fluid collections or epidural hematoma/abscess.

    2. Ossification of the posterior longitudinal ligament, extending from C3-C4 down to the C6-C7 level. There is mild persistent spinal canal stenosis is seen at C6-C7 .

    3. Normal MR appearance of the cervical cord without evidence of edema or myelomalacia.

    4. Multilevel degenerative uncovertebral joint osteoarthritis, with severe foraminal stenosis on the left at C4-C5 and moderate stenosis on the right at C6-C7.

    5. Mild multilevel cervical degenerative disc disease, C4-C7, with mild active Modic type I endplate changes along the right anterior aspect of the C6-C7 level.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You have both significant degenerative disc disease at C6-7 (“Modic type I endplate changes along the right anterior aspect of the C6-C7 level”) which can by itself cause neck pain as well as degenerative facet disease (“Multilevel degenerative uncovertebral joint osteoarthritis”). By trying to interpret your report, you might have a degenerative kyphosis (See”https://neckandback.com/conditions/cervical-degenerative-kyphosis/”). This would be picked up on your lateral cervical X-ray.

    You also have continued foraminal stenosis (“severe foraminal stenosis on the left at C4-C5 and moderate stenosis on the right at C6-C7”) which could explain your arm symptoms.

    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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