[westie California]

#33687

Good morning Dr. Corenman,

Thanks for information. I do have fixed kyphosis at C7-T1 (cervical-thoracic). I was operated on back in December to address pseudarthrosis at this level, however when they went in a solid fusion was noted at this segment. The surgeon noted what they found was T2-T3 facet joint was significantly unstable and spondylotic, so they instrumented and fused T1-T3. Pedicle screws were placed at T1, T2 and T3 bilaterally.

My question is, in your opinion, would adding back hardware up to C5 alleviate neck muscle fatigue caused by fixed kyphosis and instability? My understanding is after the nuchal ligament is removed the spine can weaken causing neck muscles to fatigue due to increased instability. Thanks in advance

[Donald Corenman, MD, DC]

#33688

It is not wrong to fuse T1-T1 due to the kyphosis but there are times that the instrumentation does not have enough purchase to correct the kyphotic curve. If however, you developed a solid fusion of T1-3 (assuming a solid previous fusion of C3-T1), then there is nothing to gain from adding hardware above.

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.

[westie California]

#33689

Thank you a million Dr. Corenman!

Wishing you a great day, stay safe and healthy. Thanks so much for all that you do

[westie California]

#33696

Dr. Corenman,

I also attached my CT Scan report performed before my December 2020 surgery. Still not sure if anything here explains why after so many surgeries, I’m still having so much neck pain, severe muscle spasms, headaches, shoulder, bicep pain, dizziness, base of skull and base of neck pain. I’ve also noticed a lot of swelling from mid point of neck on both sides down to where shoulders meets neck. The muscle spasms continue into upper back traps. My surgeon prescribed Methocarbamol 2 months ago and I still don’t see any significant change. Any help with be appreciated.

****CT Scan****

FINDINGS:

Postsurgical Changes: Postsurgical fusion changes, appears to reflect a revision/addition since 5/19/2018, now appears to involve C3-T1 with multilevel postoperative hardware and decompressive laminectomies. Hardware appears intact, appropriately positioned without evidence of failure or loosening. Bony fusion appears solid at C3-4 through C7-T1.

Alignment: Lordotic straightening.

Vertebrae: Normal in height.

Soft Tissues: Expected postoperative changes.

Disc Spaces:

C2-3: Tiny central disc herniation. There is associated minimal mass effect on the anterior thecal sac without significant central canal stenosis No significant change.

C3-4: No significant disc disease. Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

C4-5, C5-6, C6-7, C7-T1: Postsurgical changes. No significant disc disease. Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, mild on the right at C4-5 and C5-6, mild on the left at C6-7. No significant foraminal narrowing at C7-T1. No significant central canal stenosis at any of these levels.

Spinal Canal Contents: Limited by CT technique, grossly unremarkable

[Donald Corenman, MD, DC]

#33755

First it should be noted that you have a reported solid fusion at C2-T1 (“Bony fusion appears solid at C3-4 through C7-T1”).

This CT was performed before the T1-3 instrumented fusion (“T2-T3 facet joint was significantly unstable and spondylotic, so they instrumented and fused T1-T3. Pedicle screws were placed at T1, T2 and T3 bilaterally” so no comment can be made on that surgery.

What makes no sense is that you have “Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018”. Why you would have progressive bone spur formation is quite unusual if you had a solid fusion as fusion prevents motion and motion should not be present with a solid fusion.

I assume the current T1-3 fusion did not help your base of shoulders 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.

[westie California]

#33761

Good morning Dr. Corenman,

I appreciate your response. Your 100% correct, I’m 3 months post op with no improvement! My current surgeon said the “bone spurs grew inside my previous fusions” and there’s no way to address. I’ve had other surgeons state that my symptoms are classic pseudarthrosis, since some of my symptoms are aggravated by motion.

So right now I’m totally confused, it sounds like “Spondylitic ridging and uncovertebral spurring” only happens when you have motion after a fusion, but yet the CT Scan states I have a solid fusion? Those levels had ACDF’s performed back in 2012 & 2013. Can CT scan be overlooking pseudarthrosis?

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