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  • Sdc1213
    Participant
    Post count: 8

    Good Evening Doctor,

    I had an MRI done of my Cervical spine and I’m having some issues understanding the area under C6-C7. I understand the stenosis part, but when it gets to the part about flattening the “Ventral Cord”. I’m not sure if this was a typo on the doctors part? Mind you, this is post ACDF surgery at that level. I thought the Ventral Cord was essentially the Spinal Cord? I guess do these findings cause a big concern?

    Thank You in advance!

    “Cervical vertebral alignment is maintained. Vertebral body heights are preserved. Remainder of intervertebral disc space heights are preserved. No acute fracture or subluxation. The bone marrow signal shows no significant abnormality. The craniocervical junction is normal for age. The cervical spinal cord is normal in size and signal intensity without syringohydromyelia. Partially visualized posterior fossa structures are within normal limits. Prevertebral and paraspinal soft tissues are unremarkable.

    C2-3: Unremarkable.

    C3-4: Small central disc bulge. No spinal canal stenosis or neuroforaminal stenosis.

    C4-5: Small annular disc bulge indents the ventral thecal sac. Mild uncovertebral joint hypertrophy. No spinal canal stenosis or neuroforaminal stenosis.

    C5-6: Small annular disc bulge with bilateral foraminal extension indents the ventral thecal sac. Mild uncovertebral joint hypertrophy contributes to moderate left and mild right neuroforaminal stenosis.

    C6-7: Broad-based disc osteophyte complex flattens the ventral cord and results in moderate spinal canal stenosis. Uncovertebral joint hypertrophy contributes to severe left greater than right neuroforaminal stenosis.

    C7-T1: Small central disc protrusion indents the ventral thecal sac. No spinal canal stenosis or neuroforaminal stenosis.

    IMPRESSION:
    Status post anterior interbody fusion at the C6-C7 level, no acute complication.

    Multilevel cervical spondylosis most prominent at the C6-C7 level.

    Moderate spinal canal stenosis, severe left greater than right neuroforaminal stenosis at the C6-C7 level.

    Moderate left and mild right neuroforaminal stenosis at the C5-C6 level.

    No severe spinal canal stenosis at any level, no cord compression or myelomalacia.”

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    The C6-7 level I assume has a solid ACDF type of fusion. There is still continuing central canal narrowing and foraminal stenosis, left greater than right.However, there is the statement “No severe spinal canal stenosis at any level, no cord compression or myelomalacia”.

    If there is no “severe” spinal stenosis and no cord signal change, this is a good sign. Once the level is successfully fused with no “severe” findings and no sign of cord injury (“no cord compression or myelomalacia”), this level is much less likely to be injured with a fall or impact.

    What are your current symptoms? Do you have any symptoms of myelopathy or radiculopathy? See https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

    Dr. Corenman

    Sdc1213
    Participant
    Post count: 8

    Good Evening Doctor, Yes I had an ACDF on C6-C7 a year ago. As of recent, I have been having complications. Severe pain at the base of the neck and severe cervicogenic headaches that have come back. We recently found through Xray, a possible (99.9% likely as it’s apparent) fracture in the screw in the C6 endplate. I just went in today for an epidural steroid shot in my C5/C6/C7 as the pain has been excruciating. I will have a CT scan, but it’s a week way to find out if the bone fused successfully and if this was a late notice on the broken screw (coincidence to the pain and pain may come from the stenosis) There has been a gap of 7 months (March to October) between X-Rays because I had my second epidural steroid shot and that helped a good bit. I’m thinking possible Pseudarthrosis as a lot of the pain has come back and they noticed that the bone wasn’t healing/fusing as quickly as they wanted it to back in March.

    This was my Xray results as of last week:

    “FINDINGS:

    Anterior fusion C6-7 levels identified with possible subtle lucency midportion of the superior screw appearing since prior exam. Metallic hardware including interbody spacer is otherwise unremarkable and in satisfactory position.

    No visualized fracture. Vertebral bodies are well aligned.

    No prominent osteophyte production.

    Intervertebral disk heights are maintained.

    IMPRESSION:

    Possible fracture through the screw along inferior endplate of C6 vertebral body appearing since prior study. Repeat x-ray with oblique views or CT scan is suggested for further evaluation.

    Exam is otherwise unremarkable”

    I’m just not too sure what “possible subtle lucency midportion of the superior screw” means. Some type of possible fracture/breakage of the hardware?

    Thank You!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Actually, your current situation might be somewhat beneficial for you. If you had a solid fusion with continuing nerve and spinal cord compression (and continuing symptoms), then you might have more of a problem solving your issues. However, it seems like you have a pseudoarthrosis (non-fusion) due to the lucency seen on X-ray and the presence of a broken screw. Both are an indication of pseudoarthrosis.

    A careful look at the CT scan and review of flexion/extension X-rays will confirm this problem. A non-fusion means you are a candidate for an anterior revision of this level which can solve most of your problems. Removing the plate and graft, revision of the residual bone spur compression of the cord and root and re-fusion could be accomplished. I would advise using your own bone (iliac crest bone graft) if you do have this surgery as this is the best technique to get a pseudoarthrosis to heal from the front. The broken screw tip might have to stay in as sometimes removing it is more destructive than leaving it. As long as it is embedded in bone, it should be OK.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Actually, your current situation might be somewhat beneficial for you. If you had a solid fusion with continuing nerve and spinal cord compression (and continuing symptoms), then you might have more of a problem solving your issues. However, it seems like you have a pseudoarthrosis (non-fusion) due to the lucency seen on X-ray and the presence of a broken screw. Both are an indication of pseudoarthrosis.

    A careful look at the CT scan and review of flexion/extension X-rays will confirm this problem. A non-fusion means you are a candidate for an anterior revision of this level which can solve most of your problems. Removing the plate and graft, revision of the residual bone spur compression of the cord and root and re-fusion could be accomplished. I would advise using your own bone (iliac crest bone graft) if you do have this surgery as this is the best technique to get a pseudoarthrosis to heal from the front. The broken screw tip might have to stay in as sometimes removing it is more destructive than leaving it. As long as it is embedded in bone, it should be OK.

    Sdc1213
    Participant
    Post count: 8

    Thank you for the great input. The only issue now is that prior to surgery I had two things going on; Myelopathy and Moderate to severe spinal stenosis. Even after waking up from the procedure I had complications during the healing process.m Major pain going down the arm, shoulder, etc. I ended up getting a second opinion through a well known Neurosurgeon in my area who deals with both brain and spine and he said you’re fixing one issue, but not the other. The disc has been replaced but the bone spurs are pressing on the nerve on the back of the vertebrae.

    The question is, would it be more beneficial for a revision as a posterior fusion and foraminotomy instead of going through the front again? if they have to release the pressure on the nerve in the back anyway, would it make more sense to fix the disc that way?

    I’m assuming they can’t do a foraminitomy anteriorly since there’s bone and nerve bundles blocking the access to the back?

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