[mocka300]

#35130

Hello, I have chronic neck, hand, arm, feet, and leg pain; shooting, burning, zapping, and pins and needles It started out as neck pain that worsened after a car accident. I had a complete workup from a Rheumatologist, Neurologist, Orthopedic, and Neurosurgeon. My Rheumatologist diagnosed me with Fibromyalgia. I have been convinced that the pain is coming from my neck. My MRI showed that I had a central herniation abutting the spinal cord. Latter the pains became more often and more intense after I worked in my sister’s bathroom installing tile. I had another MRI done and it showed that the herniation was worse and that it was indenting the spinal cord. I went to pain management and had cortisone shots and facet joint shots. It seemed like the cortisone shot helped a little. I also went through numerous rounds of PT. My symptoms worsen when I am sitting a certain way bending my neck and on the computer. I ended up having ACDF at the C5/6 level. After surgery, my feet were worse. They were tingling and numbness constantly for several weeks. Now it’s on and off throughout the day but all my pain and symptoms are worse since surgery. Some of the pain is very sharp. I also had zapping down my spine but that has subsided. I get headaches as well. I had the Orthopedic Surgeon order an MRI several months after my surgery but he said I needed to followup with the my Neurosurgeon sense he did the decompression part of the surgery. After seeing him, he had me get a nerve conduction test that came back fine. The appointment ended with doctors can’t fix everything and that everything looked good and I have to learn to live with the pain. I think it’s possible I have Fibromyalgia as well, but I don’t know. Here is the last MRI report. I am wondering if I should get a CT scan or not.

Status post ACDF at C5-C6 since prior study of 9/18/2021. Some residual encroachment upon the right ventral aspect of the spinal canal cannot be ruled out, but is accentuated by blooming artifact from metallic hardware. Consider CT evaluation for more accurate depiction of osseous structures and metallic elements.
2. Mild central disc protrusion at C4-5, unchanged from prior examination.

[mocka300]

#35131

This is the full MRI report.
EXAM: MRI CERVICAL SPINE WITHOUT CONTRAST
HISTORY: 55 year old female states neck, right shoulder and arm pain for several years, increased February 2022.
Widespread pain and pins and needles. History of cervical fusion surgery October 20, 2021. TECHNIQUE: Using a 1.5 Tesla magnet, multiplanar T1 and T2 weighted images were acquired. COMPARISON: Preoperative examination of 9/18/2021
FINDINGS:
General Observations: Since the previous examination, an anterior cervical discectomy and fusion has been performed at the C5-6 level. Two screws are present in each vertebral body, slightly eccentric towards the right.
The C1-2 through C3-4 levels are unremarkable.
At C4-5, there is mild central disc protrusion abutting the spinal cord without displacement or compression. The neural foramina are patent. No change from prior.
At C5-6, the two fusion screws appear to extend to the right posterior margin of the vertebral body, and there appears to be some residual endplate hypertrophy indenting the thecal sac and abutting the cord. This is not as pronounced as the disc protrusion noted previously, is accentuated by the blooming artifact caused by metallic hardware. There is no cord edema or myelomalacia. There is no definite foraminal stenosis.
At C6-7 and C7-T1, there is no disc bulge or herniation. Uncovertebral and facet joints are normal. No central canal or foraminal stenosis.
Spinal cord: No cord edema or myelomalacia. Paravertebral/Prevertebral soft tissues: Unremarkable.
IMPRESSION:
1. Status post ACDF at C5-C6 since prior study of 9/18/2021. Some residual encroachment upon the right ventral aspect of the spinal canal cannot be ruled out, but is accentuated by blooming artifact from metallic hardware. Consider CT evaluation for more accurate depiction of osseous structures and metallic elements.
2. Mild central disc protrusion at C4-5, unchanged from prior examination.

[Donald Corenman, MD, DC]

#35132

You note after the C5-6 ACDF; “After surgery, my feet were worse. They were tingling and numbness constantly for several weeks. Now it’s on and off throughout the day but all my pain and symptoms are worse since surgery. Some of the pain is very sharp. I also had zapping down my spine but that has subsided”. All of your symptoms are non-specific so further description could be helpful. I’ll include a hyperlink noting how to give a good history at the bottom. Normally, myelopathy (problems due to compression of the spinal cord) causes incoordination and paresthesias in the feet but not pain.

The radiologist notes; “appears to be some residual endplate hypertrophy indenting the thecal sac and abutting the cord. This is not as pronounced as the disc protrusion noted previously, is accentuated by the blooming artifact caused by metallic hardware. There is no cord edema or myelomalacia”. This means there is some smaller residual abutment of the cord, but not as bad as before surgery. However, you could have developed a pseudoarthrosis (non-fusion) of the C5-6 level which could leave you with greater neck pain than before. A fine-cut CT scan would be quite helpful to evaluate the fusion, residual compression and will get rid of the “blooming artifact” noted to obscure the image.

https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

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.

[mocka300]

#35138

Dr. Corenman, I want to thank you for your reply. I found it to be very helpful.I am working on putting together a better description of my pain/symptoms using the guidelines from the link you provided. In the mean time, my primary ordered the CT scan, which I am having done today. I will give an update soon.

[mocka300]

#35139

Hi Dr. Corenman,

Here are my CT results from 7/11/22. I had my ACDF on October 20, 2021. Is “significant partial osseous incorporation” considered normal at the stage of healing? I am still waiting to hear back from my primary doctor on these results.

HISTORY: 55 year old female. Radiculopathy, cervical region.

TECHNIQUE: Spiral CT was performed, and multiplanar images were created. One or more of the following dose reduction techniques were used: automated exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique.

COMPARISON: Cervical spine CT from 04/20/2021

FINDINGS:
ACDF C5-C6 with intact orthopedic hardware in place. Interbody fusion at this level with significant partial osseous incorporation. The vertebral bodies have a normal appearance and the bony alignment is normal. No abnormalities are seen at the craniocervical junction or the C1-C2 level. No fracture, dislocation, lytic or blastic lesion is seen.

IMPRESSION:
ACDF C5-C6 with intact orthopedic hardware in place. Interbody fusion at this level with significant partial osseous incorporation.

[Donald Corenman, MD, DC]

#35140

To my mind, “significant partial osseous incorporation” is most likely a solid fusion meaning a successful immobilization of this level. This would mean that local neck pain generation should not be possible at C5-6. It is interesting to note that he does not comment on the decompression of the spinal canal or nerve roots at C5-6 or at any other level.

This means that either you have pain generation at another level, you still have compression at this level or you have a chronic nerve injury that continues to cause pain even though it has been decompressed. The only way to find this out is to undergo diagnostic testing with facet blocks and nerve root blocks. See here:
https://neckandback.com/treatments/diagnostic-therapeutic-neck/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/
https://neckandback.com/treatments/facet-blocks-and-rhizotomies-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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