Tagged: symptoms after an ACDF
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Hello,
In 2011, I had a fusion at C4 thru C7. I still have CONSTANT pain in the neck which goes all the way up to mid level in my skull and affects both shoulders. My pain level never gets below 4. Every activity aggravates it, from standing or walking for more than 5 minutes, household chores – cleaning, dishes, cooking, etc., carrying objects even weighing less than 10 pounds, working at the computer (which I have to do every day for my job), driving….there is not one thing that I can do that doesn’t aggravate it. My pain gets so bad that it feels like my head weighs 25 pounds and I just want to take it off my neck and throw it away.
It has been 5 years since surgery and I am still in constant pain. I have done PT, I have had so many trigger point injections, and the relief I get from them is no more than a week to 10 days. I recently had a bi-lateral Radiofrequency Ablation (3/25/16 and 4/1/16) with no relief. If anything, it made the pain worse.
The last cervical MRI I had (5/16/14) showed a Combination of endplate and small left Para central disc herniation is moderately effacing the ventral theca.I also have a minimally bulging disc at T 4/5. My thoracic pain is a constant BURNING sensation along with pain that goes ALL THE WAY AROUND my mid-back to the front. I have also had trigger point injections at this level with minimal relief, again, not lasting any more than a week to 10 days. I recently (4/14/16) had an Epidural at this level, but with no relief at this time. I can no longer get relief from using a heating pad, because now it feels like the heating coils are INSIDE me and I am being burned. I can use ice, but only for so long.
By the end of my 8 hour work day, I am in so much pain (neck and thoracic) that it makes me nauseous and it has actually been so severe at times, that I literally cry for long periods of time because it is unbearable. I can no longer enjoy the things I use to do…walking, bike riding, or even going for rides in the car. My quality of life is non-existent. I am so tired of living in constant pain.
PLEASE HELP ME – ADVISE ME WHERE TO GO OR WHAT TO DO FROM HERE
From Bea491959
The last cervical MRI I had (5/16/14) showed a Combination of endplate and small left Para central disc herniation is moderately effacing the ventral theca. This was noted at C3/C4 level.We have to go back to the period before your ACDF surgery to gain some information. What were the symptoms prior to the surgery and how did the surgery change your symptoms? Did the symptoms continue to become worse after surgery? was it just the intensity of symptoms or did the symptoms change in a different pattern? What was the reason for the three level ACDF?
Did you have a workup after some time post surgery? A CT scan? X-rays with flexion/extension views? Did you see your surgeon and if so, what did he say about your ongoing symptoms?
When you had your diagnostic injections, did you aggravate your symptoms prior to your injection and did you keep a pain diary for the first three hours after (results after three hours do not matter for diagnostic purposes). The results of trigger point injections do not help with diagnosis.
Try and differentiate your symptoms now into above the fusion level (upper neck), below the fusion level (lower neck) and arm symptoms. Redescribe symptoms in those terms.
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.The SYMPTOMS PRIOR TO SURGERY were – severe headaches, pain between shoulder blade, going down right arm, numbness and tingling down right arm, right hand was always cold and pain in the thoracic region.
THE REASON FOR 3 LEVEL FUSION – Results of MRI PRIOR to being seen by neurosuregeon.
There is degenerative desiccation in the discs of the cervical spine, most prominent at C3 through C7. Disc space narrowingin noted at multiple levels wiith posterior changes at C3 through C7. Mild posterior changes are present on the right at T4 though T5. There is straightening of normal cervial lordosis.
At C3-C4, there is broad posterior convexity of the disc, likely due to degenerative changes and protrusion. There is encroachment on the thecal sac, flattening of the anterior spinal cord and narrowing of the AP diameter of the canal to 11 mm a the midline, Stenosisi is borderline. There is mild encroachment on neural foramina due to uncovertebral arthrosis and disc disease
At C4-C5, there is posterior convexity of the disc traversin the midlinen and on the left ssecodary to degenerative changes and likely old spondylitic protrusion. There is encroachment on the thecal sac, mild deformity of the spinal cord and narrowing of the AP diameter of the canal to 10.5 mm at the midline. Stenosis is borderline. There is encroachment on the neural forminea bilaterally due to unconvertebral and disc disease.
At C5-C6, there is broad posterior spondylitic protrusion at and to the right of midline encroaching on the thecal sac and deforming the mid and right anterolaterial spinal cord. The AP diameter of the canal measures 9.6 and stenosis is mild. There is encroachment on the right neural foramen secondary to uncovertebral athrosis and spondylitic disc protrusion. There is mild encroachment on the left neural foramen due to uncoverterbral arthrosis.
At C6-C7, there are posterior spondylitic changes due to degeneration with eccentric prominence to the right of midline causing encroachment on the thecal sac and flattening of the aterior spinal cord. The AP diameter of th canal measures 12 mm at the midline. There is uncovertebral arthrosis encroaching on neural foramina, left greater than right.
AFTER ACDF SURGERY – all symptoms in the right arm and hand went away. Still had headaches and pain between shoulder blades and in the thoracic region.
Yes, I had seen the surgeon for all of the follow-up appointments. Xrays were done with flexion/extension views? Everything looked good.
On the day of my last follow-up appointment, I seen the surgeon’s assistant – I had one of the severe headaches and I was given an injection into the back of my skull (lower right side), I think it was the occipital nerve. I was told to follow up with my pain management doctor from this day forward – which I have been seeing on a continuous basis.
When I had the diagnostic injections by my pain management doctor – I was told to go home and do things that would normally aggravate and increase the pain level. I vacuumed and mopped the floors, I carried groceries up 3 flighths of stairs to my apartment, I carried laundry up and down 3 flights of stairs, I dusted the furniture, I stood at the stove and cooked dinner, and I stood at the sink washing dishes. I DID NOT HAVE ANY INCREASED PAIN until after 3.5 to 4 hours when the numbness from the injections went away.
NOTE: Just doing ONE of these chores would always increase my pain, if I tried to do all of the chores listed above in any one day, my pain level would be a 10+, I would have to take pain meds or muscle relaxer and call pain management and get in for injections (which only provided short term relief).
You aske me to descirbe Symptoms above the fusion level (upper neck), below the fusion level (lower neck) and arm symptoms.
Symptoms above the fusion level–upper neck–constant headache, (varies in degree of pain), up to middle of skull, sometimes goes into the right side of the skull
Symptoms below the fusion level–lower neck–constant pain, left, middle and right side of neck, right side is normally the worst. Pain is achy, and burning. Feels like I have a weight on my neck (meaning my head feels like it weighs too much for my neck to support it. I just want to rip my head off to aliviate the pain in my neck.
Symptoms in Thoracic region, constant burning sensation, pain also in between shoulder blades – aching and burning sensation.
I have constant pain from my mid skull down to my thoracic region. I use ice pack intermittenantly to numb the spine. Only provides temporary relief. I can also sometimes get temporary relief in the thoracic area by laying across backwards on a large exercise ball.
I will assume that you had a solid fusion from C4-C7 but that assumption might be wrong leading down a different path than the one that will be discussed here.
After surgery, right upper extremity symptoms disappeared so you obviously had right cervical foraminal stenosis which was cured with the surgery.
Headaches can be caused by many problems not associated with the cervical spine but if these are cervicogenic headaches (ones generated by the cervical spine), these headaches normally are generated by C2-3 and C3-4 (rarely by C1-2). These levels were not addressed by the surgery.
The lower neck pain will probably be generated by the C7-T1 or rarely, the T1-2 level (assuming no pseudoarthrosis at the fusion levels). Pain in between the scapula generally is referral pain from the lower cervical spine but can rarely be generated by thoracic spine degenerative changes.
The injections have been diagnostic (numbed the pain generators) so it would be helpful to know where these injections were 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.The last cervical MRI was done 2 years ago, will be having one done on May 6th.
2014 MRI report —
C2-3 – the central canal and neural foramina are patent with no disc herniation
C3-4 – Combination of endplate osteophyte and small left paracentral disc herniation is moderately effacing the ventral theca. The dorsal theca is preserved.
No mention of other levels that you mentioned.
I believe the Radio-frequency injections were at the following levels – C3-4, C6-7 and the 3rd occipital nerve. I am certain the 1st and last levles are accurate, but not for sure about the 2nd one. I will find the notes on it..And yes, it was a solid fusion.
As i mentioned, I will be having an MRI of both cervical and thoracic regions on May 6th.
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