[westie California]

#30748

Good evening Dr Corenman,

I thank you in advance for your continued help and informative responses. My question again is in reference to a stand alone peek cage at c7/t1. I am told again this time by pain management that my peek cage is deforming the thecal sac and placing pressure on the nerves within the thecal sac. I am told this pressure can cause inflammation and symptoms. Have you ever seen or heard about this before?

As an FYI:

I’m fused anteriorly C3, c4, c5, c6 and c7 with fusion plates at c3/c4 and c6/c7. The posterior is fused from c3 thru t2, all posterior instrumentation has been removed. Thanks again,

[Donald Corenman, MD, DC]

#30756

If you are fused posteriorly at C3-T2, then there should be no motion at C7-T1 where you have that peek cage. Is the cage displaced and projecting into the canal? That is the only way that your pain doc could be right. Could you supply the radiological report where they comment on the placement of the cage? How long ago was the surgery where the cage was placed?

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.

[westie California]

#30759

Good morning Dr Corenman,

That is correct, pain doctor is stating cage is displaced and projecting into the canal. The surgery was performed in 2015. My spine surgeon stated that I have at c7/t1 kyphosis(not sure if this information helps). The radiologic report performed May 2018 states the following:

“At C7/T1, disc bulge is noted deforming the thecal sac. There is no evidence of neural foraminal stenosis. Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration”.

Additional Information on this report:

At the C2/C3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central stenosis in conjunction with posterior ligamentous hypertrophy. There is no evidence of neural foraminal stenosis. Loss of disc signal is noted with preservation of disc space height.

C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Graft placement associated with discectomy and fusion procedures are noted at the C3/C4, C4/5, C5/6 and C6/7 disc space levels. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/4 mild left neural foraminal narrowing is noted in conjunction with facet and uncinate hypertrophic changes. There is no evidence of right neural foraminal stenosis at C3/4. Neural foraminal stenosis is not suggested at C4/5, C5/6 or C6/7 currently. Cervical spine straightening is noted which meets criteria for muscle spasm.

The Previous MRI dated July 2017 by a different radiologist states:

“Shallow desiccated annular bulges arise at C2-C3 and C7-T1. These disc mildly efface epidural compartment and thecal sac”. Facet joints and uncinate processes exhibit sclerosis. C3-C4, C4-C5 and C5-C6 right neuroforamina appear contracted.

I hope this information can explain why I’m still having headaches, base of skull, base of neck, shoulder’s, and bicep’s pain, that at times run into my pinky and ring fingers. The base of neck pain worsens standing, turning my head left, right and up (the worst), looking down, and left and right causes base of skull pain to worsen. Thanks again Dr Corenman.

[Donald Corenman, MD, DC]

#30763

Your reports are confusing. You note the disc at C7-T1 was operated on but there is no radiological report that indicates there was an ACDF with PEEK cage at the C7-T1 level in your collection. The most recent report from May 2018 notes an intact disc at C7-T1 (“At C7/T1, disc bulge is noted deforming the thecal sac. There is no evidence of neural foraminal stenosis. Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration”).

Do you have a more recent MRI or X-ray report that indicates cage placement and/or malposition?

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.

[westie California]

#30765

Dr Corenman,

I agree this is very confusing and frustrating. The 2018 report is my latest MRI. The C7/T1 ACDF was performed in 2015, why two additional MRI’s were performed after my surgery stating disc and not peek is beyond me.

It sounds from your previous response that only a displacement of the cage would cause a compression on the thecal sac?

Thanks in advance Dr Corenman

[Donald Corenman, MD, DC]

#30768

What you report makes no sense based upon the reports. If you had a PEEK cage implanted at C7-T1 in 2015, the radiologist should not miss this finding on subsequent images as it should be very obvious, let alone 3 different new MRI readings. Check the operative report for your 2015 surgery as maybe you misunderstood what surgery was being performed.

If you have a solid fusion of C3-T2 posteriorly, the reported cage at C7-T1 should not displace unless it was implanted in a displaced fashion initially.

Many things can cause compression of the thecal sac but with prior decompressions and a solid fusion, there should not be any biological reason for new compression in the operated areas.

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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