contractswriterMemberFebruary 7, 2013 at 7:42 amPost count: 2
Hello. 47yf, 2 years post ACDF C5-7. I have xray and MRI that confirms my C5-6 did not fuse, the other is good. I’ve had pain (burning last year that’s moved to severe acute pain lately). New NS said he would go in an fix non-union but to wait as long as possible, then sent me for facet joint injections. (History: last year when the pain started my previous NS ordered epidural injections…I had 3 and neither worked at all).
So 4 weeks ago the pain mgmt doctor did 4 facet joint injections (2 at C2-3 on right/left and 2 at C3-4 right left). Was miserable for a week and a half, and it didn’t stop my original axial pain (at the C5-6 level), it just gave me more pain at a new place. That eventually eased up, then 2 weeks later I went back for round 2. They didn’t even both asking how the last one did (seemed to me that should have been question 1) so I told them…it didn’t work, just made me miserable. Dr. looks at xray and says “oh, you have hardware” Sigh. I replied “Yes, yes I do, you looked at xray AND mri last time.” (I guess she forgot and failed to glance at my folder. She actually came in the room thinking she was doing a lumbar FJI). Anyhow, she tells me that she cannot do a facet joint injection where my pain is coming from…because I have hardware. I started to cry (exhausted from the pain and her not knowing what she was doing)and asked why I was even here. She said she didn’t know what to tell me. But then she recommended we try moving down and doing 2 at C3-4 and 2 at C4-5. What the heck, why not try it. So I agreed. That was another week and half of misery and it’s still not helped original axial pain. And that pain is getting worse. I used to feel better when I laid down and relaxed my head on pillow, now it’s painful to lay down on back or either side. The pressure it puts on my neck is too much and I’m up/down all night.
Anyhow, I have 3 questions: 1) can you do a facet joint injection at the site of pain even if you have a plate and screws? If you can’t, why on earth would the NS even bother sending me for shots to try and alleviate pain (or try and find out where pain is coming from) if they can’t target that area? And why would the pain doc even attempt other areas?
Second question: I’ve scheduled an appointment with OS (spine) for 2nd opinion on surgery. My NS first saw my xray and said, “you have a collapsed disc” which scared me to death. Recommended I wear my neck brace until we got the MRI. The xray does look like most of the disc has disintegrated so I was nervous to even move. But after reviewing MRI (which looks exactly like Xray…disc is only 1/2 there and not fused all the way across) he said I wasn’t fused but was stable since I had the plate and had nothing to worry about. But if you look at my xrays over 2 years time you can see how it’s just wearing away. How can I be “stable” (even though I have a plate) if the disc is disintegrating? Wouldn’t that just keep on disintegrating?
3rd Question: In a non-union with a plate, can there be micro movement? Some are saying that the plate won’t let it move. But if the disc is getting smaller over time…I’m just so confused. And my appt with OS isn’t for another 5 weeks. In the meantime I’m researching everything I can, you tube videos, everything. I’m afraid to move my neck but want to live a semi-normal life while I wait.
Thank you.Donald Corenman, MD, DCModeratorFebruary 7, 2013 at 5:27 pmPost count: 8459
Pain generated by a pseudoarthrosis is difficult to diagnose by anesthetic blocks. The pain is generated by the non-fused bony surfaces and getting a block into that irregular interval is a heroic act by an injectionist.
Facet injection into C2-3 and C3-4 are generally reserved for base of the skull pain (occipital pain) and occipital headaches. If you have mid-neck pain from the pseudoarthoses, these upper neck blocks will not give relief as you have noted.
The question if blocks can be performed at the previously attempted fused level (pseudoarthrosis level) is yes but these blocks will not really yield any important information as the pain is generated by the non-united bony surfaces and not the facets in this case. I cannot comment on the previous plan.
With regards to “stability”, I think the surgeon means that the level will not “fall apart” with untoward activity. Your head will not fall off and roll down the stairs but It does not mean that the level is not degenerating or causing pain.
If the level is stable, there will be no motion and therefore no pain. Yes, a pseudoarthrosis can be painless and patients can live with it without symptoms going about their normal daily activities. Motion of the level (as noted by haloing of the screws or change in position with flexion/extension X-ray films) can cause pain. Progressive collapse of the graft noted on serial X-rays is an indication of instability.
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