[Angelcam]

#8817

Dear Dr. Corenman,

Here is the result of my most recent MRI to begin;

C1-C2: Intact articulation.
C2-C3: Mild disc degeneration and bulging.
C3-C4: Moderate disc degeneration and bulging. Large left foraminal disc osteophyte complex, resulting in severe left foraminal stenosis.
C4-C5: Severe spondylitic disc disease and bulging. Large bilateral disc osteophyte complexes, resulting in moderate right and severe left foraminal stenosis. Mild to moderate central stenosis and mild cervical cord effacement and compression.
C5-C6: Severe spondylitic disc disease and bulging. Large right greater than left foraminal disc osteophyte complexes result in severe foraminal stenosis. Moderate central stenosis with mild cervical cord compression.
C6-C7: Severe spondylitic disc disease and bulging. Small right central extrusion. Minimal bilateral foraminal disc osteophyte complexes. Moderate central stenosis with mild cervical cord compression.
C6-C7: Minimal central protrusion
Straightened lordotic curve.

I was attacked at work and thrown to the ground in early 2010, prior to this I have never experienced neck pain. All my life I have had low back pain from scoliosis, but not neck pain. I was treated for a “neck sprain” immediately following the attack by the Occupational Health Physician, which involved only muscle relaxers. The pain worsened and I finally got an MRI. I saw a 2 Orthopedic surgeons in 2010 and both said I was non-surgical. I went through months of physical therapy which seemed to help, and I was also told to have cervical epidural injections which workman’s comp refused to pay for.

After painful physical therapy I did improve, but it did not last long. I was forced to leave my job and and have been in moderate to severe pain ever since. Muscle spasms from the back of my neck down my entire back, shooting pain down my arms and into my hands fingers and toes has been ongoing, along with numbness and tingling in those places. I became non functional and now am on SSDI. I have been seeing a pain management doctor and am currently taking Opana ER 10 mg bid. Without pain medicine my pain is off the scale. Last week I saw a neurosurgeon who told me I need a three level spinal fusion. I am terrified. I have to wait 6 more months before I receive Medicare and I am out of money to get more opinions. I am writing to ask for your opinion based on the MRI findings (if possible). I have been all over the internet hearing different stories about how levels above and below the fusions become stressed and need repair down the line. Am I going to spend my entire life with this pain and weakness? Any insights would be appreciated greatly. I liked your the video of the surgery, it gave me more insight. I am 45 female.

Thank you

[Donald Corenman, MD, DC]

#8827

You have substantial degenerative changes at multiple levels in your cervical spine. Neck pain generally develops from degenerative disc and facet disease. Shoulder and arm pain is typically generated by nerve root compression. You have both finding on your MRI.

Surgery most likely can help you but will not return you back to when you were 16 years old. If your expectations are within range (reduction but not elimination of neck pain) and you have no desires to compete in the Olympics (you could be satisfied with only a modest increase in activity), the surgery could be quite helpful.

A three level fusion at C4-7 might not affect your range of motion much at all. Many people think that a three level fusion will significantly stiffen the neck. If your MRI reading is accurate, look at your flexion/extension X-rays. Have an expert measure the motion of these segments. Motion of these segments should normally be greater than 50 degrees but I bet your motion would be less than 10 degrees now with these degenerative segments.

This means that you would only lose ten total degrees of motion with a three level fusion. One bonus is that with pain reduction, you might even gain motion from a fusion as without pain, you might be more likely to move your neck further as the painful segments will not trigger a muscle spasm pain response.

The caveat here is the C3-4 level where it is noted “moderate disc degeneration and bulging. Large left foraminal disc osteophyte complex, resulting in severe left foraminal stenosis”. This could be a pain generator now or in the future and you would need a work-up to determine how symptomatic this level is. That might consist of discograms, selective nerve root blocks (SNRB) or facet blocks.

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.

[Angelcam]

#8828

Thank you very much for the information. I would simply like to return to work and get back to the gym, walking, hiking and swimming, none of these on an olympic level.

Again, my thanks to you for taking the time to answer. I have several months to prepare and search for a surgeon that has done this procedure a trillion times.

[Donald Corenman, MD, DC]

#8829

The surgery is not hard to perform but a better result will come from a meticulous surgeon with long experience.

Please keep the forum up to date on your progress.

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.

[Angelcam]

#10434

Hello again Dr. Corenman.

On November 28th, 2013 I had an ACDF with cadaver bone (c4-c5, c5-c6 and c6-c7)surgery that took 7 hours. I no longer have pain or weakness in my hands and arms for which I am grateful. I was released from the Aspen collar yesterday and have had some physical therapy. My surgeon was not happy to hear that my therapists were having me turn my neck during sessions and said that it will take a 100% fusion down to 90%. The problem I am having now is the return of neck, shoulder and upper back muscle spasm with severe pain I am sometimes in tears. My surgeon told me that my pain cannot be that bad as the x-rays look perfect and should not have any pain at 4 months post op. Desperately I found a pain management doctor who did a Medial Branch Nerve Block who stated it may break the cycle of pain I have had for nearly 4 years. So far it has helped greatly, I hope it lasts while I work on strengthening muscles. I hope this was the right surgeon, he is known for working “miracles” Any thoughts on this pain would be once again appreciated.

P.S. I asked my surgeon about the c3-c4 level you mentioned and he said it is simply arthritis, everyone has some.

[Donald Corenman, MD, DC]

#10438

You have been in the collar for three months. That is quite a long peroid of time. I normally have patients out of the collar in one week and allow careful range of motion for the beginning.

I would disagree with your surgeon that surgery normally has a 100% fusion rate as that is not accurate. The fusion rate for a three level surgery with your own bone is between 90-94%. The fusion rate with cadaver bone is at least 10% less than that.

With signficant pain four months after your ACDF surgery, I would consider a pseudoarthrosis of the surgical levels, pain generation from the level above (C3-4) which was already degenerative or possibly from the level below.

It is unusual for a facet block (medial branch block) to give you relief of the operated levels as there should be no motion of these levels with a solid fusion. Motion is normally what causes facet 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.

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