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Dear Dr. Corenman,
After my trapezikus muscle tore from my c-spine for a second time my surgeon used non absorbable sutures. Since then, 2 years ago, I have had severe burning pain along with a fever in my neck every single day. On the outside of my 6 inch incision there are no signs of infection but inside my neck it feels like a volcano trying to erupt with burning hot lava. My muscles spasm non-stop all day and pieces of sutures spit out frequently. There are also small cyst like bumps that form around my incision that really hurt but eventually go away. It does not help that I have had a total of 8 neck surgeries, 4 anterior and 4 posterior- the first 2 by Dr at St. Mary’s in Grand Junction to C-6,7 acdf in 2010, and C-5,6 acdf in 2011, neither fused so Dr in Durango performed a posterior fusion using some of my hip bone for graft in 2013, unfortunately 2 of the pedicle screws were mal-positioned in my epidural space leading to a 4th surgery with Dr at Sky Ridge Medical in Denver in 2015 to remove posterior hardware. Three months later I was back due to the trapezious muscle separating from my spine. Dr at Sky Ridge Medical diagnosed this as well as severe instability at C-4,5 and performed a double surgery of fusion at C-4,5 with a cage from C-4-6 then flipped me over to sew the trap muscle back together, this was in April 2016. Then imagine how thrilled I was 3 months later In July 2016 when the trap muscle had separated AGAIN. That is when the non absorable stitches were decided on and used to sew me back up. Since then the burning pain has been relentless as well as severe pain in the core of my neck. During recovery of the anterior fusion of C4,5 I began having trouble swallowing and my range of motion became even more limited with more pain, so after that level fused Dr performed one more surgery and removed the cage from C-4-6 in April 2017. This helped immensely not only with swallowing but the overall pain let up a bit too. I still have hardware in from the first 2 surgeries (2 plates and 4 screws) which to me feels like that could be a huge portion of the severe pain I feel in addition to the burning. I know I will never be pain free but I am sure something is still terribly wrong in there as the pain is not even staying the same, it is getting worse. My quality of life is ZERO and I am only 49 years old. Dr can’t figure this out and there is an issue now with my insurance as I am now disabled and have Medicaid. I cannot continue to live with this level 10 pain any longer.
Please help me, you are my last hope for a future for myself and my family. Could the burning and fever in the back of my neck and at the incision possibly be a low grade infection due to the non-absorbable sutures? Could the remaining hardware be causing the core pain? Could I possibly be allergic to the hardware as I have not had one day without the intolerable core neck pain from day 1 of the first fusion at c-6,7. On one of my MRI’S it looks like one of the original screws from C-6,7 is pressing into the spinal cord, the report from the radiologist says it looks like something is bulging at C-6,7 but is unclear due to artifact. Please, Dr. Corenman, I have heard you are the BEST at complex spinal issues and my situation is obviously complex, but not impossible I feel, if you were on my case. I really need your help to solve this mystery and get my life back. Sorry this is so long, but imagine recovering from surgery after surgery for 8 long torturous years and being in worse pain now than when it started. I can truly tell you “if you only knew what I wanted to say but didn’t”, lol. Thank you so much for your time in reading this and I will be waiting anxiously for your response.It is quite unusual to have the trapezius muscle tear off its origin without prior surgery. I will assume it happened but I still as suspicious of this tear.
You note “pieces of sutures spit out frequently” which worries me that you have some type of reaction to these sutures. I assume the non-resorbable deep sutures are not “spitting out” but the subcutaneous resorbable sutures are spitting. This might mean that these type of sutures cause a significant inflammatory reaction and are removed like a splinter would react under the skin.
Your note that “2 of the pedicle screws were mal-positioned in my epidural space” could indicate some chronic root or rootlet injury which might not fully resolve.
Your note that a doctor “performed one more surgery and removed the cage from C-4-6”. I assume that was really a plate removal and not a cage removal as a cage would be embedded into bone and a plate is superficial and removable.
What you need now is a new MRI and a CT scan. I can do a long-distance consultation with you to try and help you but unfortunately, my office does not take Medicaid, so You could not be a patient here at the clinic. At least I can try and give some advice to you and possibly direct you on the right path.
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.Dear Dr. Corenman, Thanks so much for your reply and offer for advice. I really wish I could be seen by YOU, everyone I’ve talked to has recommended you as The Best surgeon in complex spine cases, but I appreciate your offer of consulting with me and getting your advice. I know this is long and you are a very busy man, but I feel I must be detailed in my history so you will know what advice to give me.
I am sorry I wasn’t clear on the topic of my trapezius muscle separating from my spine. You are correct about me having surgery before this occurred. I had 2 prior Posterior surgeries before this happened. The first was a posterior fusion with 2 rods, plates and 6 screws in October 2013, and the second was the removal of the posterior hardware 2 years later in October 2015, and it was after this my trap muscle separated. So the posterior fusion in 10/2013 was an attempt to correct 2 prior anterior fusions to c-6,7 in 5/2010 and c-5,6 in 10/2011. After the 2 fusions I actually was in worse pain than before the surgeries. I went through physical therapy of course, tried epidural injections and other therapies without success. I was referred to Dr. in Durango, CO who diagnosed zero fusion at 6,7 and only partial fusion at 5,6. He recommended a Posterior fusion to C-5-7 and performed this using my hip bone as graft. There was finally fusion at these levels but I continued every day with even more severe nerve pain than before along with radiculopathy in my right arm. Dr. said it could take up to a year or longer before nerves healed but after waiting 18 months in excruciating pain I knew there was a problem.
A new MRI and CT scan showed 2 of the pedicle screws at C 7 extending into my epidural space. When Dr. Youssef called about the CT he told me that I may be having an adverse reaction to the hardware and he would be glad to remove the hardware for me. When I asked him about the pedicle screws positioned in my epidural space and the excruciating pain I had been in while waiting for nerves to heal that were never going to because of the screws he referred me to the consent page I signed before surgery which states sometimes hardware is mal positioned but that is not the fault of the surgeon.
I found an orthopedic surgeon at Skyridge Medical Ctr. in Denver, CO to remove the posterior hardware right away, which he did in 10/2015. I had immediate relief when I woke up after the surgery and slowly over the next few months the nerve pain eased up dramatically. Unfortunately about 3 months after the hardware removal I began having a burning sensation and major pain in my neck muscles more so on the right along with my right shoulder popping in and out of place frequently, which was a new symptom and also super painful. I went back to Skyridge Medical in March 2016 and found that my trapezius muscle had separated about 2-3 inches apart from my spine. This was diagnosed by Dr, a collegaue of the surgeon who removed my hardware who works in the same office. He also looked at recent images and found moderate to severe instability at C-4,5 and recommended an anterior fusion there and during that surgery he would sew up the trap muscle.
In April 2016 I had the double surgery of the C-4,5 anterior fusion which he used what he called a cage – a semi circular piece about 3 inches long with 6 small screws that went from C-4 to C-6. I asked him if he could please remove the plates and screws from my first two fusions before he put the cage in, but he said he did not think it was necessary and part of that hardware was encased in the bone now. After the anterior fusion he turned me over and sewed the trap muscle back together. This was most excruciating and while recovering i felt the trapezius tear again! So only 3 months later in 7/2016 I was back in surgery having the trap muscle sewn back together, this time Dr. used non-absorbable Ethibond sutures. Since this surgery I have not had one day without burning hot pain not only inside along the area of my 6 inch incision but also a fever on the skin outside. I am not exaggerating when I say it feels like a volcano erupting with hot lava then these tiny pieces of suture spit out. I also have weird cyst like bumps that frequently come up around my neck and my neck muscles spasm constantly all day along with nerve pain also occuring near the C-6,7 area with weakness back in my right arm.
I had the anterior c-4-6 cage and screws removed in 4/2017 because of pain, difficulty swallowing and increased limited range of motion. I again asked if Dr. would please remove the other hardware from the first two surgeries since he had to be in there again anyway, but he still did not want to do it. After the cage was removed I had such immense and immediate relief I cannot even explain how much better I felt. My range of motion improved and swallowing was much better. I healed in less than 2 months and couldn’t believe how much relief that gave me.
However the back and core of my neck remain in excruciating pain and it is intolerable. A recent MRI shows possible movement of one of the screws of the anterior hardware. I really suffer as I am unable to take pain meds or muscle relaxers like normal people. I get little sleep, 2-4 hours tops, and that is interrupted every 15 minutes due to pain. With zero quality of life right now and in such excruciating pain I am desperate for answers and even desperate enough to go through another surgery to remove my remaining anterior hardware so I can at least be free of the metal plates and screws. Is there a possibility the remaining hardware is the culprit? Since I have such a huge feeling of relief when I have hardware removed maybe my system cannot tolerate the metal in there? Could a reaction to the stitches be similar in that my body wants to reject the sutures? I have recent MRI’s and a CT from 11/2017 but could ask my PCP for a new ct if needed. I will be anxious to hear what you think.Your history indicates you could have pain from multiple sources which would be hard to distinguish based upon your prior multiple surgeries and complications. I would be suspicious of hardware failure based upon an MRI scan (“A recent MRI shows possible movement of one of the screws of the anterior hardware”) as metal on an MRI image does not show up in sharp relief. It would be much better to have flexion/extension X-rays or a CT scan to indicate if this hardware is loose.
I am also doubtful that your anterior plate could be causing all your symptoms. Normally, the severity of pain you experience is generated by injured nerve roots, mechanical problems like disc or facet degeneration or occasionally from the muscles and fascia scarred from previous surgeries.
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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