[Neck98]

#31394

I’m almost 10 months post single-level ACDF on C4-C5. The surgery and recovery were uneventful, in that there were no surprises, post-procedure complications or anything outside the norm to indicate that the surgery was no successful. I’ve had two rounds of X-rays since the surgery (the last one in late June or early July), and by all indications everything was fusing as expected and there were no herniations, disc height concerns, stenosis, etc. on any adjacent levels [though the most recent report indicated a very mild case of kyphosis still – it was pretty severe before]. All this said, there are a few things that have me wondering if I am experiencing symptoms associated with the surgery, the conditions that led me to surgery in the first place, or if I am dealing with something else altogether.

1) Lately I’ve experienced muscle spams in my legs. I do work out (walking, elliptical, stationery bike), so I initially thought that my first bout with this was due to exercise, as I had done some lunges, wall sits and other lower body work around the time the leg (quad) spams and soreness occurred last time. However, my quads have been spasming again for about the past week, and I have not done anything exceptional to precipitate it.

2) Muscle spams in my arms (deltoids and triceps) – Before the surgery, I didn’t have soreness or muscle spasms in my deltoids and triceps (or any other parts of my arms), but since the procedure, they’ve been relatively consistent, on-again and off-again.

3) Foot numbness – I occasionally feel numbness on a certain spot of one foot; it’s generally on the top of the foot, doesn’t hurt or impede my ability to ambulate or move — just something I feel.

The last time I saw my neurosurgeon (August), he said that sometimes it takes TWO YEARS for nerves to heal, so any symptoms related to muscle pains and spams could be associated with nerve recovery. Additionally, he told me that since I had myelopathy (herniation bending my spinal cord at that level), I could experience a range of symptoms associated with the impingement that may never completely resolve. My surgeon said the goals are to preserve function, address structural issues and HOPE your pain or discomfort goes from a 8-10 level to something more manageable, like a 2-5, on a daily basis.

Otherwise, I’ve had no problems (or suspected problems) I can associate with my surgery. I just need to know if this spasming is common or to be expected; if it ever resolves and goes away; how, if at all, it was caused by the surgery or my prior condition; and anything else that can assist.

I’ve even looked up other conditions, like MS, and I don’t have any other symptoms that would lead me to think it could be something like that.

[Donald Corenman, MD, DC]

#31416

Let’s break this down into its components. You had an ACDF at C4-5. I would assume this was for radiculopathy (nerve compression) and not for central stenosis causing spinal cord compression (myelopathy). The C5 nerve is affected by a C4-5 level of nerve compression.

This nerve does not go down the arm below the elbow and symptoms really don’t radiate below the upper arm. Your complaint “Muscle spams in my arms (deltoids and triceps) – Before the surgery, I didn’t have soreness or muscle spasms in my deltoids and triceps (or any other parts of my arms), but since the procedure, they’ve been relatively consistent, on-again and off-again” do not fit with that C4-5 level. If you have nerve compression at C5-6 or C6-7 below the level of your prior surgery, that would fit.

Your complaint “Lately I’ve experienced muscle spams in my legs…my quads have been spasming again for about the past week” would not stem from the cervical spine unless you had significant spinal cord compression in your neck (myelopathy) which I will assume you don’t have. Leg symptoms can commonly be generated by the lower back or even metabolic problems (imbalance in blood electrolytes, etc..) or hormonal issues.

Finally, “Foot numbness – I occasionally feel numbness on a certain spot of one foot; it’s generally on the top of the foot”. This can be causes by various issues such as a foot nerve problem (Morton’s neuroma, Tarsal Tunnel Syndrome). peroneal neuropathy or even lumbar herniated disc.

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.

[Neck98]

#31440

Thank you so much for responding, Dr. Corenman! Actually, I did have myelopathy at the C4-C5 level. Before surgery and after years of neck pain, shoulder spasms and worsening symptoms (such as urinary urgency) – all originating from a rear-end car wreck 20 years before – I had the ACDF surgery in January 2019. So, yes, myelopathy was present.

My June 2019 X-ray report reads:

Findings: 3 views demonstrate no acute fractures or dislocations. Vertebral bodies are well-maintained in height and alignment. Mild focal kyphosis apexed at C5. Stable. Anterior plate and screw fixation at C4-5 with intervening disc spacing device. Intervertebral disc spaces well-preserved. The odontoid process is intact. Soft tissues
unremarkable.

During my August 2019 post-op appointment with my neurosurgeon, he told me that nerve-related pain and issues stemming from the prior cord compression could take up to two years to resolve. He also emphasized that the goals of surgery were to prevent additional decline, maintain and restore as much function as possible, and to reduce pain as an added, but not certain, benefit. I rarely have any neck pain or shoulder spasms anymore, but I never had intermittent deltoid pain before the procedure. Before the ACDF, I did experience some strange sensations in my legs, but they were not of the muscular soreness variety I’m feeling now.

I otherwise have no known health problems. I have always been a very active individual and take great care in my wellness and fitness, from diet and nutrition to exercise. I am only 40 with two children, so I am concerned about my future, and want to be proactive in exploring possible issues I could be facing.

[Donald Corenman, MD, DC]

#31486

Your symptoms in your legs “Lately I’ve experienced muscle spams in my legs…my quads have been spasming again for about the past week” when you seem not to have these symptoms to a great degree after your C4-5 ACDF (“Before the ACDF, I did experience some strange sensations in my legs, but they were not of the muscular soreness variety I’m feeling now”). New leg symptoms could be from other levels in the neck that have caused spinal cord compression or can originate from the lumbar spine.

Your note “I never had intermittent deltoid pain before the procedure” could be an indication of advancing degenerative changes of the surrounding levels or from a possible pseudoarthrosis of the C4-5 level. Possibly a CT scan could be useful if flexion/extension X-rays don’t indicate solid fusion.

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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