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  • Avatarwestie California
    Participant
    Post count: 108

    Good afternoon Dr. Corenman,

    I hope your well and healthy. My question is in regard to cervical laminectomy with fusion and hardware, in particular five levels (C3-C7) procedure. I’m still having a lot of pain, muscle spasms, tingling in fingers, dizziness, bicep pain and occipital headaches. My head at times feels like its too heavy for my neck, I’m told that I’ve developed post laminectomy kyphosis and the measurement is 3.1 cm. A recent consultation with a spine surgeon mentioned that part of my problem is that the “Nuchal Ligament” was removed and basically the muscles are fatiguing in order to hold my head. I’m also told there’s no fix for this.

    I’ve spoken to several surgeons and never heard of this. Have you heard of Laminectomies where Nuchal Ligament is removed and causing issues? I’m also wondering if the hardware should of been left in to strengthen the construct.

    Thanks in advance

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7956

    I assume that you are post-surgery from a “cervical laminectomy with fusion and hardware, in particular five levels (C3-C7) procedure”. How far out are you from this procedure?

    You note you have developed “post laminectomy kyphosis” and that the reason is “the ‘Nuchal Ligament’ was removed”. If you are undergoing a laminectomy, by definition the nuchal ligament is removed as this ligament is attached to the spinous processes which have to be removed for a decompression.

    If you did not have an instrumented fusion (“fusion and hardware”), then it is not uncommon to develop a kyphosis. You however report you did have this instrumented fusion which means that you have developed hardware failure.

    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.
    Avatarwestie California
    Participant
    Post count: 108

    Hello Dr. Corenmen,

    My first laminectomy was performed in 2013 (C3-C7), however it was determined that a revision procedure was required due to “defects”. So in 2017 a revision surgery cervical laminectomy with foraminotomies, medial facetectomies C5-C7 and segmental instrumentation C4-T2 was performed. In 2018 removal of hardware C4-T2, excision, debridement of upper back and neck wound, and reconstruction of right and left trapezius myocutaneous flaps was performed.

    In 2018, I also developed cervical thoracic kyphosis. I recently spoke to a surgeon who mentioned that close to 40% of patients who undergo cervical laminectomy develop post laminectomy kyphosis due to nuchal ligament removal. The head tilts downward and causes pain, neck muscle fatigue, etc. My question is, would adding back hardware alleviate neck muscle fatigue by avoiding head from tilting downward?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7956

    So, your original laminectomy was in 2013. Then, in “2017 a revision surgery cervical laminectomy with foraminotomies, medial facetectomies C5-C7 and segmental instrumentation C4-T2 was performed. In 2018 removal of hardware C4-T2, excision, debridement of upper back and neck wound, and reconstruction of right and left trapezius myocutaneous flaps was performed”.

    It sounds like you then had a fusion during the second surgery (the reason for the segmental instrumentation C4-T2). It then appears you had an infection requiring the removal of hardware and debridement/flaps to cure the infection and tissue loss.

    Most likely, you have a failed fusion that is falling into kyphosis which is normal for your condition. If this is all true, you probably will need an anterior fusion (ACDF) to stabilize your neck if you can’t live with it.

    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.
    Avatarwestie California
    Participant
    Post count: 108

    I’ve had the following ACDF’s also:

    1. 2012-ACDF with Plate C5 & C6

    2.2013-ACDF with Plate C3,C4,C7

    3.2015-ACDF C7/T1 Peek Cage

    4.2019- Re-exploration of ACDF with removal of cage & instrumentation & plate partial Corpectomy C7 and Diskecotmy C7- T1.Placement of cage biomechanical device into corpectomy defect, anterior instrumentation C7-T1.

    2020 CT Scan shows solid fusion. What can be done to stabilize my spine, since I’ve now developed cervical thoracic kyphosis? Would adding instrumentation back help? How can one develop kyphosis if one is fused anteriorly and posteriorly from C3 -T2? Thanks

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7956

    You are not a stranger to spine surgeons! You should have a solid fusion from C3 to T1 with both anterior and posterior fusion techniques. I will assume that you don’t have a kyphosis from C3 to T1 but are developing kyphosis below that T1 level. You would need a posterior fusion from T1 to T5 (assuming the apex of your thoracic curve is below T6-7) with instrumentation up into the C4 or C5 levels. If your kyphosis is very stiff, you might need preoperative traction first to “loosen” the curve.

    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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