[westie California]

#20289

Hello Dr Corenman,

I always like to start by saying thank you for all your help and time in answering our questions.

My question tonight is relating to cervical facet joints and pain that they may cause. I’m now two weeks post ACDF C7/T1, so to date I am fused anteriorly from C3-T1 and C3-C7 posteriorly. I am told that technically all facet joint pain should resolve since no movement will happen at these levels. I’m a bit concerned since, every time I go for walks, my pain level at the base of my neck, arms, shoulder blades becomes unbearable. I know i am only two weeks post surgery, however, other doctors are telling me even with fusions its not unheard of to have facet joint pain and require radio frequency ablations. If you can explain this is, would be appreciated.

[westie California]

#20329

Hello Dr Corenman,

I would like to start by saying thank you for all your help and time in answering our questions.

My question tonight is relating to cervical facet joints and pain that they may cause. I’m now one month post ACDF C7/T1, so to date I am fused anteriorly from C3-T1 and C3-C7 posteriorly. I am told that technically all facet joint pain should resolve since no movement will happen at these levels. I’m a bit concerned since, every time I go for walks and sitting causes my pain level at the base of my neck, arms, and shoulder blades to become unbearable. I am told by other doctors that even with fusions its not unheard of to have facet joint pain. I researched some of your older posts and my understanding is any facet pain would be from a different level. So my continued pain should not be facet, since I am all fused? My other concern is did the laminectomy decompress all the nerves?

My question now is, do i go to a pain specialist and have them perform a selective nerve block? Need to figure out where the pain generators are.

[Donald Corenman, MD, DC]

#20382

Typically, facet pain is caused by inflammation or degeneration. If you have had a fusion from C3-T1, these levels should not cause any facet pain. Especially if the posterior fusion has been performed.

Your statement; “Every time I go for walks and sitting causes my pain level at the base of my neck, arms, and shoulder blades to become unbearable” makes me think of the facets or discs below the fusion level. I have seen cervical degenerative spondylolisthesis in the T2-3 and even in the T3-4 levels below a cervical fusion.

The C2-3 facets should cause base of skull or headache type pain so that level can be ruled out.

Make sure you have a solid fusion of the previous surgeries. A CT scan will be helpful here. If you have a solid fusion, I would focus on the facets or discs in the upper thoracic spine.

I will assume that shoulder disorders (rotator cuff syndrome among others) and thoracic outlet syndrome have been ruled out.

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.

[westie California]

#22075

Good evening Dr. Corenman,

I hope all is well with you. My neck continues to bother me on a day to day basis. The base of my neck, arms(biceps),shoulder blades and right side occipital headaches with dizziness.I’m still hearing popping and crackling when i move my neck in different directions. Any sitting or walking will significantly magnify the pain and discomfort.

Per my neurosurgeon, the MRI and CT scan shows post surgerical multilevel degenerative changes within cervical spine and multiple level facet hypertrophy. Recent EMG/Nerve conduction shows moderate chronic C5, C6, C7 radiculopathy bilateral nerve irregularity. The following reports was provided:

C3 Productive changes of the posterior elements mildly impinging the posterior aspect of the spinal cord

C3-C4 mild productive changes of the joints of Luschka and facet joint degenerative
changes causing mild left neural foramina narrowing

C4-C5 mild productive changes of the joints of Luschka and facet joint
degenerative changes causing mild right neural foramina narrowing

C5-C6 prominent facet hypertrophy and bony ankylosis of the bilateral C5-C6 facets

Straightening of the expected cervical lordosis

T2/3 & T3/4 left paracentral disc herniations are noted both levels deforming the thecal sac. Loss of disc space height and signal is noted at both levels.

T4/5, T5/6 and T6/7 disc bulges notes at all three levels deforming the thecal sac. Bilateral paracentral components are noted at T4/5. Right paracentral components are noted at T5/6 and T6/7.

T7/8 and T8/9, paracentral disc herniations are noted at both levels deforming the thecal sac.

My surgeon said nothing surgerical can be done. Pain doctor performed Occiptial nerve block which helped with headaches for approximately 4 days. The pain came back.

C5, C6 and C7 facet block on left and right side with minimal relief. Still have pain in base of skull and muscle spasms at injection site and levels below.

I also had a third party neurosurgeon review my scans and in his opinion my laminectomy did not decompress nerves. He would like to perform:

Foraminotomy

Laminotomy

Percutaneous Discectomy

Facet Thermal Ablation

I’m still in disbelief with how long this has played out. Any suggestions you would take with the above findings and issues? If you recalled I had 3 ACDF’s C3-T1
1 Foraminotomy (left side C6, C7) and 1 Laminectomy (bilerateral C3-C7).

Any suggestion would be appreciated.

Ashley

[Donald Corenman, MD, DC]

#22080

I worry that the C7-T1 level might not fuse. Fusion of one level below a long fusion above has more stress on it and chances of solid fusion drop somewhat. Watch this level for fusion status.

I am somewhat confused by your EMG report. Was the EMG performed before or after the cervical fusion? If you had a complete decompression and the EMG was performed after the surgery, then you either have chronic radiculopathy or continued compression of some nerve roots after surgery.

Was the MRI performed before surgery as the radiologist did not comment on post-surgery changes? This is not normal if surgery had been performed. I am concerned about the indications for surgery if you had a solid fusion of C3-T1. Not much makes sense with the EMG and MRI reports. Did you have a CT scan at any time after surgery? What is the status of the C7-T1 fusion?

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.

[westie California]

#22082

Hello Dr,

The EMG was performed after surgery.My Surgery was August 2015 and EMG April 2016.

A CT scan was performed and states solid fusion with C7-T1, with post surgerical degenerative changes throughout cervical spine.

Thanks

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