Viewing 6 posts - 7 through 12 (of 13 total)
  • Author
    Posts
  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    You do have some stenosis at C6-7 but it is considered “mild” by this radiologist. He or she does not comment on the canal opening at C5-6 where the ADR and that might be from the metal of the disc obscuring the canal.You “neck being on fire” still after the ADR might indicate that the ADR could be causing pain or the level below could be a pain generator.

    You have had multiple injections but I am not clear if you had diagnostic injections around the C5-6 or C6-7 levels. This might shed some light on your pain generators. See https://www.neckandback.com/treatments/diagnostic-therapeutic-neck/.

    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.
    Avatarlakegirlmn
    Participant
    Post count: 7

    Hello Dr. Corenman,

    After months of feeling significantly better (minimal to none) in terms of neck pain, I suffered a major setback.

    A week ago today, I decided to replace the drawer pulls on my dresser using a screwdriver instead of a drill. Bad decision. I didn’t feel any neck discomfort right away, but two days later I woke up with a stiff neck and sharp, stabbing pain along my shoulder blade. I was in so much pain I had to call into work. The stiff neck symptoms significantly improved and the stabbing shoulder blade pain nearly subsided later that same day of Tuesday. I went to work on Wednesday with only minimal discomfort. Thursday I had zero pain. Friday I woke up with awful right posterior neck pain, which traveled down my right arm and down my right shoulder. A combination of constant, dull pain, with sharp stabbing pain centered at the medial edge of my right shoulder blade. I felt pain and numbness down my right arm, and complete numbness of my right anterior neck.

    Awful timing to be in pain, as I had planned to spent the entire day cleaning my house for a houseful of guests arriving in town for a 40th birthday party. I somehow was able to suck it up and did spend the entire day cleaning, yet felt worse with each passing moment.

    Fast forward to yesterday. I woke up in excruciating pain (7/10). The pain worsens when sitting or lying down. The pain is only tolerable when standing still. At this point I could not function any longer. I ended up missing the birthday party and went to Orthopaedic Urgent Care where I had an MRI. I was advised to follow up with my neurosurgeon and start PT. She also recommended use of heat/ice and NSAIDs.

    Today my pain is 9/10 at rest. I did not sleep well last night. I have a high tolerance to pain, but this is maddening pain. I guess I am wishfully hoping that there is a chance I can recover from this without surgery or steroid injections. As I mentioned earlier in the thread, my life was flipped upside down after the trigger point injections. I am not willing to trade relief from pain for worsening of my erythromelalgia symptoms (visibly red, hot feet, hands and face) as I am certain steroid injections clearly triggered the development of it, as well as temporary 50% loss of scalp hair, eyelashes, eyebrows, temporary development of facial hair, and having my period for 7 weeks straight.

    In your opinion, is there a chance I can avoid surgery with physical therapy alone? I am a single mother of an active son. Another surgery will create significant hardship. However I can’t physically function with this level of pain. I am terrified. I can’t lay down comfortably , sit or sleep right now . The only slight relief I get while lying down, is to lie down on the floor completely flat on my back without moving.

    Below I have attached my MRI results.
    Thank you doctor

    Exam: MR Cervical Spine WO IV Cont
    Completed: 08/03/2019 4:10 PM
    Signs & Symptoms: right cervical radiculopathy hx prior cervical disc replacement

    IMPRESSION
    INDICATION: right cervical radiculopathy hx prior cervical disc replacement
    TECHNIQUE: MRI of the cervical spine without contrast.
    COMPARISON: MRI of the cervical spine from 4/2/18
    FINDINGS: The visualized midline posterior fossa structures are unremarkable. No definite
    abnormal spinal cord signal, however artifact from artificial disc prosthesis at C5-C6
    limits evaluation at C5-C6. No suspicious marrow edema, however hardware artifact limits
    evaluation at C5-C6. Stable postsurgical changes of artificial disc placement at C5-C6.
    Disc desiccation again seen throughout the cervical spine. Straightening and mild reversal
    of the cervical lordosis is again seen. Normal enhancement. Mildly prominent multilevel
    cervical nodes are again seen, and do not appear significantly changed.
    Level by level:
    C2-3: Spinal canal and neural foramina are patent.
    C3-4: Spinal canal and neural foramina are patent.
    C4-5: Small central disc protrusion effaces the ventral thecal sac and mildly flattens the
    ventral spinal cord, similar to prior MRI. Neural foramina are patent.
    C5-6: Surgical changes of artificial disc replacement. Artifact from surgical hardware
    limits evaluation. The dorsal thecal sac appears patent. There may be moderate left neural
    foraminal narrowing secondary to uncinate spurring. Possible mild right neural foraminal
    narrowing secondary to uncinate spurring. Findings are unchanged.
    C6-7: Right central disc protrusion which effaces the ventral thecal sac has increased
    with now probable severe proximal right neural foraminal narrowing. Left neural foramen is
    patent.
    C7-T1: Spinal canal is patent. Unchanged mild right neural foraminal narrowing secondary
    to uncinate spurring. Left neural foramen is patent.

    IMPRESSION:
    1. Stable changes of surgical disc replacement at C5-C6 are again seen. Again, this
    somewhat limits evaluation at this level. Previously described right paracentral
    protrusion at the C6-7 level has increased from prior with probable severe proximal right
    neural foraminal narrowing. Consider correlation for right C7 radicular symptoms. Other
    degenerative changes appear unchanged.
    2. Mildly prominent cervical lymph nodes are again seen but do not appear significantly
    changed from the prior MRI.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    You now have a disc herniation at right C6-7: “Right central disc protrusion which effaces the ventral thecal sac has increased with now probable severe proximal right neural foraminal narrowing. Left neural foramen is patent”. This can occur regardless of an ADR (artificial disc replacement) or an ACDF at C5-6. You could ask your neurosurgeon if he would give you an oral steroid. If that is not helpful, you could try a selective nerve root block af C6-7 which may help. Finally, if those are not effective, then another surgery would be in order. If that ADR at C5-6 is one of the types that can have another ADR at C6-7, you could consider that. If the ADR was not designed to have a juxtapositional ADR, you could have an ACDF.

    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.
    Avatarlakegirlmn
    Participant
    Post count: 7

    Thank you for your insight Dr Corenman. I called my neurosurgeon’s office and was offered a work-in appt for September 5th. Crossing my fingers I can tough it out until then! This is an absolute nightmare.

    I have two final questions for you.
    Is it possible that my C6-7 disc could magically heal on its own?
    Is it usually a herniation that causes the neural foraminal narrowing, a bone spur, or simply arthritic causes?

    Thank you again,
    Nicole

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Yes the C6-7 disc herniation can over time become less symptomatic but that is less certain.

    Normally the ratio of nerve compression symptom causes is 80% bone spur and 20% herniation. Bone spurs result from “arthritic causes”.

    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.
    Avatarlakegirlmn
    Participant
    Post count: 7

    I thought I would provide an update. I ended up seeing my neurosurgeon on 8/22. My arm and shoulder blade pain was unbearable at this point. She recommended selective C7 cervical nerve root block which I had the folllowing day. The procedure was painful, but provided immediate relief which slowly faded over the weekend. My pain increased in severity over the following days. I couldn’t take it anymore and went to the ER early Thursday morning. Another MRI was ordered which showed worsening since the MRI earlier in the month. I was admitted to the hospital and had emergency C6-7 disc replacement the following day. I feel like a new person now! My arm and shoulder blade pain is gone. Only normal swelling and slight tenderness from surgery. My surgeon said one of the disc fragments was one of of the largest she had ever seen. I am grateful to finally be pain free.
    Here is my MRI report if you’re interested. Thank you again for the insight you provided me.

    Impression:
    Study compromised due to underlying metallic susceptibility artifact
    from C5-C6 disc prosthesis.
    1. Worsened right central/subarticular/foraminal disc extrusion at
    C6-C7 since the comparison MRI from August 3, 2019. This finding may
    impinge right C7 nerve root.
    2. Postsurgical change of C5-C6 disc arthroplasty with associated
    regional cervical kyphosis with at least moderate to severe spinal
    canal stenosis. Degree of kyphosis appear similar to comparison.
    Underlying cord signal cannot be assessed due to artifact.

Viewing 6 posts - 7 through 12 (of 13 total)
  • You must be logged in to reply to this topic.