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  • westie California
    Participant
    Post count: 138

    Happy Holidays Dr. Corenman,

    I have questions surrounding facets and discs issues below fusion levels C3-T2, so in this case T2-T3 and perhaps T3-T4. If one has cervical degenerative spondylolisthesis in the T2-3 and even in the T3-4 levels below a cervical fusion with disc herniations(MRI states both “T2/T3 & T3/4 disc herniations deforming thecal sac with bilateral paracentral components”), how does one ascertain if the fusion extension from T1-T2 should stop at T2-T3 or continue to T3-T4?

    If fusion is extended by one level (T2-T3), can one expect that after segment is completely fused that
    pain level at the base of my neck, arms, and shoulder blades will improve? or does T3-T4 also play a factor? Thanks in advance!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    If there is significant degeneration below a proposed fusion level, that level should be included in the fusion planning. Normally, most longer cervical fusions can stop at T1 or T2 but with lower degenerative changes, T4 is not out of the question.

    Because of rib stability, there is often no need to go lower but exceptions do exist. You have one of these with “degenerative spondylolisthesis in the T2-3 and even in the T3-4 levels”. I would include down to T4.

    Dr. Corenman

    westie California
    Participant
    Post count: 138

    Good evening Dr. Corenman,

    So I wanted to give you an update, last week my surgeon performed surgery. The pre operative plan was to perform a T1-T2 revision surgery to address pseudarthrosis at this level using iliac crest bone graft and to open up nerve channels that were tight.

    My surgeon informed me the next morning after surgery, that the procedure went well however, there was no pseudarthrosis at T1-T2, and the level below was significantly degenerative, so he performed a fusion to T3. He added rods and screws from T1 to T3 with bone morphogenic protein. In reference to nerve channels, it was decided that procedure wasn’t required because all the nerves channels were open.

    This did not sit well with me. I’ve gone to several surgeons, including pain management, and even my CT Scan and MRI scan reported foraminal stenosis. So now, I’m really concerned, nervous and anxious to know if my base of neck, arms and shoulder blades pain will improve? I did tell him during my office visit’s that SNRB blocks especially at C3, C5 and C7 did help and were pain generators. I showed him CT scan report again stating stenosis and all he said was, ” When I looked they were open”. So now all I can do is pray that my symptoms improve.

    I do have questions in that:

    1. Is this normal to have a surgeon and neuro radiologists disagree?

    2.Is the likelihood of a T2-T3 degeneration causing my issue higher than foraminal stenosis? My CT performed 5 months ago report: C3-4 Bilateral uncovertebral spurring and bilateral facet arthropathy, There is associated mild right and moderate to severe left foraminal narrowing.C4-5, C5-6, C6-7, C7-T1: Postsurgical changes. No significant disc disease. Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, mild on the right at C4-5 and C5-6, mild on the left at C6-7. No significant foraminal narrowing at C7-T1. No significant central canal stenosis at any of these levels

    3. How long of a period after fusion is usually warranted to know if this fixed my problems?

    Thanks in advance Dr. Corenman

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    It’s unusual to see a pseudoarthrosis on the CT scan but solid fusion in surgery. Nonetheless, testing the level with a distraction device is a good way to determine fusion status. Stranger things have happened. If your pain was from your degenerative spondylolisthesis, then fusion of this level will take care of your pain. If the foraminal stenosis is the pain generator, then occasionally, fusion without decompression can be helpful. If for some reason, the pain does not improve, you could wait until you develop a solid fusion and then have a foraminotomy and the instrumentation out at the same time.

    If you still don’t know where the pain is originating, selective nerve root blocks would be the next step.

    Dr. Corenman

    westie California
    Participant
    Post count: 138

    Good evening Dr. Corenman,

    In reference to selective nerve root blocks, they were performed earlier this year at C3, C5 and C7 bilaterally. My pain doctor told me all three levels were bad, however C3 was the worst. This is why I was raising the question, can this level cause base of neck, arms and shoulder blades pain? Thanks Dr. Corenman, I appreciate your feedback.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    SNRBs performed are worthless diagnostically if you did not keep a pain diary. See https://neckandback.com/treatments/diagnostic-therapeutic-neck/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

    Yes, the C4 and C5 roots can cause base of neck, arms and shoulder blades pain.

    Dr. Corenman

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