[cincic1]

#33390

Hi Dr. Corenman,

Hello,

I recently had C3-C6 laminectomy decompression and fusion surgery – 10/20/2020.
This was for Cervical Spondylotic Stenosis with Myelopathy.
I also had herniated disks and Foraminal Stenosis at those 3 levels, and nerve root impingement (including C5).
The surgical notes said there were bilateral foraminotomies done at those levels.

When I was recovering in the hospital, I was fine for the first 3 days after
surgery.

Then, they came at me with the flu shot.
3 days after that (still recovering in the hospital), I woke up with pain in my right shoulder, loss of sensation

in the upper outer arm, and most of all (devastating), could no longer lift my right arm
at the shoulder (flexion and abduction).
The pain subsided in around two weeks. Maybe there is a faint pain at this point, but nothing to speak of.

My surgeon said a few inconsistent things, which really make me worry about his interest in getting to the bottom

of this. First he said it was Frozen Shoulder. The Physical Therapist agreed with me that it was not, because I

could do passive range of motion. Then the surgeon said it was because I have been laying around in the hospital

and have not been actively using it, completely ignoring the fact that a) it is only happening in one shoulder,

not both, and b) I can’t move it around if there is something preventing me from getting the muscle to move.

From previous experience with foot drop after a surgery, I know what it feels like when
a nerve is not sending signals to a muscle. That is what the feeling is.

He then told me to trust him in that this type of thing will take a lot of time (months) and MY hard work in

Physical Therapy. I don’t agree. I do not think Physical Therapy can do anything for a muscle that is not

receiving nerve signals.
I feel that I cannot just trust him and wait, because I know how there is a certain time window for nerves, and

if you miss it, then you can never get it back.

At this point I still have the loss of sensation and the inability to use my shoulder in the way described above.
Did not get many answers, so I was forced to research on my own.

I feel like my symptoms line up with both Brachial Neuritus (sometimes associated with a very recent flu shot)
and
C5 Palsy (known to be a possible complication of the surgery I mentioned)

I have not had any diagnostic tests yet, but an MRI and EMG are on the list of tests to be taken as soon as I can

schedule and go to them.

I profoundly regret having let them give me the flu shot, because… that is muddying the waters, as far as why

this happened.

My major fear is whatever nerve damage there is (and I strongly suspect there is nerve damage, but I just don’t

know which nerve(s) ), is not going to heal.
I have read that it can, and people sometimes get their function back ‘spontaneously’, but I can’t help thinking

this is something of a fairy tale. My former foot drop experience has left me hopelessly pessimistic.

Please give me your thoughts on what you think I should do.

Thank you,
Cathy

[Donald Corenman, MD, DC]

#33391

You are absolutely correct that this is most likely a C5 nerve palsy probably from a stretch radiculopathy which is not rare due to a posterior laminectomy. The other possibility is a Parsonage Turner Syndrome (brachial plexopathy) although all of the PST I have seen involve more than the C5 nerve, normally at least C5 and C6. I agree with you that the flu shot was not timed well which is why I require at least 6 weeks between the shot and the surgery (on either side).

The C5 root involvement is most likely from the cord drifting back when the laminectomy removes the roof of the canal which in turn stretches the root. It is a well known complication but I have only seen it twice in my patients but many more times from a second opinion after surgery. Most of the time, the root recovers almost fully to fully but we are talking 6 months out.

A new MRI would be helpful to make sure there is no screw stenosis or bone fragment that inadvertently became lodged in the foramen. I would obtain a neurologist consultation with an EMG/NCV of the involved extremity to hone in on the potential cause. You need to be at least 3 weeks out from the onset of symptoms to get an EMG.

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.

[cincic1]

#33403

Hi Dr. Corenman,

Thank you so much for this incredibly swift response.

If I can follow up a bit more with you…

I agree with you that a new MRI would be in order for the reasons you state.
The surgeon was working right in that C5 area with the foraminotomy, and… I believe it would
really eliminate a lot (or reveal a problem) about the status of anything pressing on a nerve
in that area. After all, a discectomy was not done as a part of this procedure, and this really
makes me feel uneasy about the fact that the herniated disc at C5 is still there.
Sadly, I even asked the surgeon about this prior to the surgery, and somehow he convinced me
that the herniated discs do not have to be removed when the procedure is the Laminectomy.
I don’t think I am still convinced about this.

Also,
One of my pre-surgical symptoms was pins/needles in fingers of both hands, and this did not
improve at all.
I realize there could be many reasons for this, but… one I can think of would be that the
C5 nerve roots were being impinged beforehand (the pre-surgical MRI indicated this), and…
Maybe they still are being impinged, with maybe even an additional impingement of a different
area of the root that is now causing the new right shoulder problem.

One problem I am having is that the surgeon is pushing back against the idea about getting
this post surgical MRI, and I really don’t think he should be.
He is saying that it will not reveal if a screw is misplaced, and he is saying that I will
always show foraminal stenosis on an MRI from now on.
That may be (although I thought the foraminotomy was supposed to ‘open that up’),
but… even if so, shouldn’t it still show if there is nerve root impingement ?
It showed that before, so shouldn’t it show it now, if that is the case now ?

I don’t know how much of this is the surgeon not wanting to find a problem with ‘his work’,
or not.
Also,
Sorry to say this, but… I’m not confident that any second opinion surgeon would want to
‘turn against’ a fellow surgeon and give his true opinion that something is not right with the
surgical work.

I am so very confused and I don’t know where to turn and feel like time is running out when
it comes to nerve damage.

So questions are:

Do you have thoughts about the herniated disc being left in place—if that is likely
to cause this type of problem ?

If, somehow the possible scenario you brought up, were the case:
” screw stenosis or bone fragment that inadvertently became lodged in the foramen. ”

Do you think this type of thing could present in a delayed fashion—in my case 6 days
after surgery, or would it likely appear immediately after surgery ?
From my layperson’s point of view, it would seem to me that it would likely be immediate
rather than 6 day delay.

Any other thoughts you have in addition would of course be appreciated.

Thank you so much,
Cathy

[cincic1]

#33440

Hi Dr. Corenman,

I was so hoping that you could respond to my most recent post of 11/25/2020 7:49 AM.

Thank you so much,
Cathy

[Donald Corenman, MD, DC]

#33443

If you have a C4-5 disc herniation and a C5 root palsy, even after a laminectomy, the prudent step is a new MRI and if the compression is still present, an ACDF at C4-5 would be advisable. The root may recover without extra surgery but the more information, the better.

A good second-opinion surgeon will not “cover the tracks” of the first but should give you a reasonable opinion that is valid and reliable. I don’t believe this is a “club” where you have to worry about slanted opinions. It might be helpful that the second-opinion surgeon is not a partner in the same group but even then, the surgeons I know will give an honest and independent opinion.

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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