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  • mnjody
    Participant
    Post count: 19

    Hi, last December I had c5-t2 ACDF. In the past month, pain has hit me so hard, my left side of my body is just not my friend. I have neck pain, into my shoulder, down my arm in numbness into my hand – all left sided. I recently had an MRI, and here are the results. Any insight?

    IMPRESSION:
    1. Postoperative findings of the cervical and upper thoracic spine from C5
    through T2 levels. Central bulging annulus at C5-6 and to a lesser extent at
    C6-7 contributing to moderate canal narrowing at C5-6 with mass effect along the
    ventral aspect of the cord at this level. Repeat CT may be helpful for further
    characterization if clinically indicated.
    2. Multilevel neural foraminal narrowing is also present, greatest on the left
    at C4-5 and C6-7.
    EXAM: MR CERVICAL SPINE WITHOUT IV CONTRAST
    COMPARISON: Radiographs 12/14/2020, previous MRI 12/31/2019, CT 12/29/2019.
    FINDINGS:
    Skull base-C2: No focal abnormality.
    C2-3: No canal or neural foraminal narrowing.
    C3-4: Left-sided uncovertebral hypertrophy contributing to mild to moderate
    left neural foraminal narrowing. No significant canal narrowing or right neural
    foraminal narrowing.
    C4-5: Regional hardware-related artifact limiting detailed evaluation. No
    significant canal narrowing identified on sagittal imaging. Bilateral facet and
    uncovertebral hypertrophy contributing to neural foraminal narrowing, moderate
    to severe on the left, mild to moderate on the right.
    C5-6: Operative level. Postoperative findings with central bulging annulus with
    flattening along the ventral aspect of the cord best demonstrated on image 23
    series 6/7, image 7 series 3/5. Overall moderate canal narrowing with retention
    of small amount of CSF posterior to the cord at this level.
    Uncovertebral hypertrophy contributing to mild left neural foraminal narrowing.
    No significant right neural foraminal narrowing.
    C6-7: Operative level. Postoperative findings with central bulging annulus
    without significant mass effect on the cord, partial effacement of the thecal
    sac compatible with mild to moderate canal narrowing. Bilateral uncovertebral
    hypertrophy, left greater than right contributing to moderate to severe left
    neural foraminal narrowing, mild right neural foraminal narrowing.
    C7-T1: Operative level: No significant canal or right neural foraminal
    narrowing. Mild left-sided uncovertebral hypertrophy contributing to mild left
    neural foraminal narrowing.
    Alignment: Within normal limits. Hardware-related artifact limiting detailed
    evaluation.
    Bone Marrow: No fracture or destructive marrow signal abnormality.
    Hardware-related artifact limiting detailed evaluation.
    Extra-spinal Findings: No significant incidental findings.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    First of all, having a 4 level ACDF fusion has a higher chance of pseudoarthrosis (lack of fusion) so immediately, my thoughts start with that possibility. Pseudoarthrosis is best diagnosed with CT scan followed closely by X-rays including flexion/extension.

    You have significant foraminal stenosis at C6-7 left (“moderate to severe left neural foraminal narrowing”) so you could have a Left C7 radiculopathy either from a residual compression or a developmental compression from a pseudoarthrosis. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

    The way I would consider a workup is to have the CT and X-rays, determine fusion status, then use a SNRB at C6-7 left (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/) to determine if the C7 root is involved. If the SNRB is positive (gives you temporary relief), then you have two choices.

    If the CT scan shows a solid fusion, you can have a posterior foraminotomy. If you don’t have solid fusion, you can have a revision ACDF and clean out the foramen from the front at the same time or have a posterior foraminotomy and a posterior fusion at the same time.

    Dr. Corenman

    mnjody
    Participant
    Post count: 19

    Thank you for this information. guess I didn’t realize the same issues that I had surgery for – could resurface again a year later. I feel defeated right now.

    I had xrays, but not including flexion/extension ones. Nothing abnormal was found on those, all looked good again.

    My best hope is for solid fusion, obviously – but if I do NOT have solid fusion, a revision ACDF would take care of it – or are you saying both an ACDF and Posterior surgery would then be the next step?

    Do you think if I am only 1 year out – that things could just spontaneously improve yet from the surgery? Or has that window pretty much passed?

    Thanks again for your help – it’s appreciated tremendously.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    If you have continuing symptoms and pain in the pathway of the C7 nerve root, you can elect to wait but after a year, your fusion should be solid. If it is not, then where is the pseudoarthrosis? A CT will reveal the non-union (along with flexion/extension X-rays). If a pseudo is present you could have revision ACDF, ACDF with posterior fusion or posterior decompression and fusion.

    Dr. Corenman

    mnjody
    Participant
    Post count: 19

    The CT revealed solid fusion. Impression from CT report: Large posterior bony spurs at c5 and c6.
    What could cause those bone spurs to return after surgery? Does having this put me at a higher risk of injury if in a car accident or something, or am I overthinking? Does this happen often, and if so – what is the outcome? More surgery? Could the bone spurs eventually get better/disappear?

    I am still in pain – but don’t know where to go from here.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    If the CT noted solid fusion, then these bone spurs were “left over” from the original pathology. Bone spurs do not increase in size in the presence of a solid fusion. If these spurs do not compress the cord or a nerve root, then they are stable and you don’t need to worry. If your symptoms did not improve after surgery, then you need to ask your surgeon why they did not improve or gain a second opinion.

    Dr. Corenman

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