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  • sfontana
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    Post count: 1

    Dear Dr Corenman,
    I am a 33 years old male who underwent a C6/C7 ACDF 10 months ago.
    Before the surgery, symptoms were a loss of strength in the left tricep and burning pain in the left tricep and forearm. Pain improved a little bit after 2 months of conservative therapy (oral steroids and physical therapy), but the loss of strength did not, so the spine surgeon suggested an ACDF surgery.
    After the surgery, the tricep’s strength improved very quickly and, according to the surgeon and my own feeling, is now back to normal. However, I had only a slight improvement in arm pain.
    The last x-ray shows that the fusion is solid and there is no sign of non-union or pseudoarthrosis.
    Since the pain did not improve substantially, after 6 months the surgeon prescribed me an MRI and a CT scan. Both show that there is no residual compression on the nerve. However, there are small C5/C6 and T1/T2 herniations, without nerve or spinal cord compression. These herniations were already there before the surgery. The surgeon said that they were nothing serious but that I have arthrosis at the C5/C6 left facet joint. Therefore, he prescribed a 3 months therapy of NSAIDs (Etoricoxib).
    During the first week of therapy, the pain improved a little bit, but then it remained stationary.
    I also saw a pain specialist, who prescribed me Lyrica (75mg 3 times a day) and a low dose of Amitriptyline. With this therapy, in conjunction with NSAIDs, the pain almost completely disappeared and I could finally go back to my normal life! Nevertheless, when I stopped taking NSAIDs, the pain, although not as intense as before, went back.
    A neurological examination shows that my reflexes are normal, my arm strength is normal and my sensations are normal (although sometimes I feel the left arm much colder than the right, without any apparent reason).
    Now I feel pain almost only at the left forearm. Arm pain is sometimes associated with neck pain, but mostly not. The pain improves or even disappear if I do some kind of physical activity, however, it usually comes back when I stop.
    Based on your experience, is having pain 10 months after an ACDF normal? Could it be that the nerve is still recovering from axonotmesis caused by the herniated disc? Shouldn’t I have some sort of neurological deficit if the nerve is still healing?

    Thanks a lot,
    Simone

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    “C6/C7 ACDF 10 months ago.After the surgery, the tricep’s strength improved very quickly and, according to the surgeon and my own feeling, is now back to normal. However, I had only a slight improvement in arm pain”. “The last x-ray shows that the fusion is solid and there is no sign of non-union or pseudoarthrosis”. “there is no residual compression on the nerve”.

    “A neurological examination shows that my reflexes are normal, my arm strength is normal and my sensations are normal. Now I feel pain almost only at the left forearm”.

    There are conditions like cubital or carpel tunnel syndrome that can cause similar pain. A simple examination can help to rule those out. It is not inconceivable that you have a slight chronic radiculopathy.

    https://neckandback.com/conditions/carpal-tunnel-syndrome/
    https://neckandback.com/conditions/cubital-tunnel-syndrome/
    https://neckandback.com/conditions/chronic-radiculopathy-neck/

    Dr. Corenman

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