[Lisa1979]

#26900

Thank you so much Dr. Corenman!!

Would it be in my best interest to repeat the c 5/6 nerve block, or is there another study that would be part of the ‘work up’ prior to a posterior revision, to ensure the posterior was the best approach?

If I chose anterior and used my own bone this time, what are the chances (in your experience) of another non union? (last time was a cadaver bone, with also NSAID use beginning at week 6) No one knows for sure why I didn’t fuse.

in your opinion, Overall is this just a big gamble? what would you recommend your patients to do, anterior or posterior?

Thank you so much for your time.

Lisa

[Donald Corenman, MD, DC]

#26903

If you really trust that this injectionist was great and meticulous, then there is no need to repeat this block. I talk with my interventionist all the time to get a “feel” for his block technique on specific patients.

I do like reconstruction anteriorly and always use the patient’s own bone (autograft) for a revision. The posterior approach is however “tried and true” and I can’t remember any patient who had a failed anterior fusion not go on to fusion after a posterior fusion repair.

The reconstruction approach really depends upon current stenosis (narrowing of the nerve exit hole) and the appearance of the failure. If the graft in front has eroded away and the level is in kyphosis (front angulation) or there is stenosis present, an anterior approach is required. If there is no stenosis and no significant angulation, a posterior approach is probably better.

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.

[Lisa1979]

#26910

Hi Dr Corenman thank you for your quick reply!

If there’s no nerve compression showing on CT with this non union, what would be the cause of my arm pain? Both sharp and burning pain in my arms. Is arm pain common with a failed fusion? On ct the nerves have lots of space and the cadaver bone is almost absorbed. If there’s no compression showing, would a fusion relieve arm pain?
Do you think thoracic outlet syndrome is s possibility?

Also can I come and be seen you? I have providence premera/blue cross insurance. I would like you to possibly do my redo fusion

Thank you
Lisa

[Donald Corenman, MD, DC]

#26930

Arm pain can be caused by foraminal stenosis, instability or thoracic outlet syndrome. There also is the possibility of chronic radiculopathy (old injury to the nerve which does not heal). If you have instability without obvious nerve compression, sometimes this can cause arm pain.

You can certainly come and see me. Please call 888 888-5310 and talk to Lori.

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.

[Lisa1979]

#27552

I talked with you this fall. Thank you for your help.
Quick recap: healthy 38 year old female Registered Nurse. 120 pounds. No other health problems. Active, non smoker, no drinker, H/o headaches, otherwise benign health history. Successful C6/7 acdf in 2013 – fused at 6 weeks.
Fast forward: 2015 – 2 MVAs 90 days apart required surgery c5/6 acdf oct, 2016- now a pseudoarthrosis at that level

I have a failed c5/6 neck fusion I’m trying to get fixed. 16 months out now. Bilateral arm pain sharp and burning pain. No numbess tingling, or weakness. Burning Pain, sharp and heavy arm are pain symptoms. Bone scan shows c5/6 inflammation, EMG is negative. In search for a cause for arm pain and nerve involvement, did a CT Myleogram. Results- Obvious pseudoarthrosis at c5/6, but also There’s a moderate sized herniation at C7/T1. No foraminal stenosis. No nerve compression showing on scan.
For another opinion, I went to the other side of the state and the surgeon there says the C7/T1 is the cause of the arm pain. The surgeon here (that did the surgery) says it’s not. He says the pain is from micro motion from the c5/6 pseudoarthrosis.
I was ready to schedule a repeat c5/6 ACDF and then when they threw in this other level as a possibility I don’t know what to think. Questions for you:
1) How does this arm pain get diagnosed? C7/T1 Epidural injection? Or nerve block. (Tried c5/6 nerve block already with nothing noticeable)
2) can this failed union be turned into an artificial disc?
3) can a hybrid surgery be done? C5/6 fusion and c7/T1 artificial disc?
4) would it be best And move forward with a repeat ACDF at c 5/6 and just see if the arm pain resolves?

I can’t see doing a fusion on both of those levels c5/6 and c7/T1 Because then I would have all three levels of fused at 38 years old. I am healthy, active, and really want to be pain-free and active again. With 3 levels fused I think the otter levels would go so quickly! What’s the best route for outcome and relief of arm pain in your opinion. Thank you!

[Donald Corenman, MD, DC]

#27609

First, the symptoms have to match the herniation or pseudoarthrosis. This means that a herniation at C7-T1 should cause pain into the little finger side of the hand (if the pain radiates down that far-the symptoms may only radiate into the shoulder). I am a big fan of the selective nerve root block for diagnosis. IF a local injection around the nerve (not too big a volume or other nearby structures will be blocked also) give good temporary relief, then you can assume that the structure anesthetized is causing the pain that was temporary relieved (see https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/).

No fusion level ever should be turned into an artificial disc. The immobilization due to pseudoarthrosis will cause the facet to fibrous (stiffen).

Yes, a hybrid surgery can be performed with both a fusion and an ADR (artificial disc replacement) but the C7-T1 level generally has very little motion so an ADR does not help as much at this level. Also, this level is prone to degenerative spondylolisthesis so make sure this condition does not occur here before an ADR is suggested. This condition will be seen on flexion/extension X-rays or the CT scan.

I think your best bet is the SNRB for diagnosis. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/

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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