c4-5 fusion failure

///c4-5 fusion failure
c4-5 fusion failure
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  • karengriff
    Participant
    Post count: 2

    Dr. Corenman,

    I had a fairly severe whiplash injury in a high-speed car accident in 2003 and ended up with herniations at c2-7. I managed it fine for quite a while until we had a blizzard in 2010 and I shoveled the driveway by myself, which apparently was too much to do. I woke up in the morning numb, in pain and unable to walk. I had a fusion of c5-7 shortly after that, which was successful and fused well. A few years later, I developed spinal stenosis again at c4-5 that led to another fusion in 2014 to merge c4 with c5-7. It is clear in every mri/ct that we’ve done recently that c4-5 failed to fuse, even after 4 years. The hardware is still intact and in place, though, and there’s no spinal stenosis but the bone is obviously not fused.

    I’m concerned and thinking I should get it fixed but not sure how concerned I should be. Compared to the previous times that I was considering surgery, I have mild symptoms with no spinal stenosis anywhere. The symptoms that led to the recent round of imaging were fairly severe but were mostly caused by a medication that led to ataxia. Once I stopped that med, most of my issues went away in a few days. Leftover is some intermittent numbness in my hands/feet, some weakness, some balance/clumsiness issues (I would fail a field sobriety test), and some neck pain/stiffness that is constant but not bad and doesn’t require any painkillers. I also fell twice on steps, which had never happened since the accident, so that was weird. My symptoms before the two surgeries were much more severe, minus the falls which were new.

    So with a failed fusion but intact hardware and mild symptoms, how concerned should I be? The falls were not ideal but can surgery wait? Can this get worse or even lead to stenosis again? I have a lot going on and it would be difficult to fit in a major surgery. I just beat cancer, I have no vacation time left, I’m getting laid off in August and I’m hoping to move about 3 hours away in 2-3 months. This isn’t a good time. My surgeon is leaving it mostly up to me. What are the pros and cons here?

    Thanks
    Karen

    Donald Corenman, MD, DC
    Moderator
    Post count: 6369

    if you had a fusion at C4-5 above a prior C5-7 fusion that did not go on to fuse (pseudoarthrosis), this is not uncommon depending upon the graft used for fusion.

    If this level did not fuse but the hardware is not loose or broken, you have a stable pseudoarthrosis. About 50% of pseudoarthroses do not cause pain and can be left alone. There is a higher chance of pain activation with injury due to the “less stable” nature of this pseudoarthrosis but still can be left alone if your symptoms are tolerable (“some neck pain/stiffness that is constant but not bad and doesn’t require any painkillers”).

    Your current imbalance symptoms (“Leftover is some intermittent numbness in my hands/feet, some weakness, some balance/clumsiness issues (I would fail a field sobriety test”) are probably residual symptoms from the previous cord compression as long as you don’t have ongoing canal stenosis (narrowing).

    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.
    If this forum has helped you, please let Dr. Corenman know!

    karengriff
    Participant
    Post count: 2

    Dr. Corenman,

    Thanks for the response. Good information to have.

    Couple more questions…

    What do you think are the chances that I could end up in surgery with this again just from normal wear and tear from here on? (There was no stenosis anywhere on my last MRI in March.)

    I’m 41 now, 26 at the time of the accident, 32 and 36 at the time of the first and second fusions, respectively. My healing ability is only going to get worse from here and I’d rather not go through another surgery. The first two acdfs were not horrible but definitely not something I want to revisit if I can help it. What can I do to minimize my risk of needing to redo the second fusion at c4-5?

    Thanks again.
    Karen

    Donald Corenman, MD, DC
    Moderator
    Post count: 6369

    You do have a propensity to wear segments as noted by two separate surgeries at two different levels so I cannot predict if can live your life without further intervention.

    Significant impact (falling off a horse, getting a blow to the head or a fall off skis while traveling at a good rate of speed) can activate a pseudoarthrosis. Playing chess has never caused a pseudoarthrosis activation to my knowledge.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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