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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    By this report, you do not have a fusion at C2-3 or C4-5. Is that true? The levels fused seem to be solid according to this radiologist and there is no posterior screw that is affecting any of the roots by his eyes. If C4-5 is not fused and it rests on a long segment fusion (C5-T1) with a fusion above (C3-4), the C4-5 level can wear faster, especially with a prior laminectomy. Why the surgeon wants to remove posterior hardware if these screws are not irritating the roots, I would wonder about. Now, if you had local pain in the posterior neck, sometimes removing hardware can be helpful to reduce this local pain.

    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
    Participant
    Post count: 138

    Good morning Dr Corenman,

    A few months ago my surgeon performed removal of C4-T2 posterior segmental instrumented fixation and fusion exploration. Plastic surgeon was consulted due to an open wound of the neck and upper back along with inter operative extensive scar tissue. Excision and debridement of the upper back and neck wound and scar was performed. Reconstruction with right and left trapezius myocutaneous flaps was completed.

    The pain at the base of the neck never improved, and i still have left and right bicep, and shoulder pain. To answer your previous question in reference to C4-C5, I’m not sure why the CT scan does not show a fusion at this level? per my surgical notes an ACDF includes this level and Laminectomy/fusion includes this level also.I’m very thankful you pointed this out.

    I completed two months of physical therapy and no improvement. Was told by two therapist, that there is significant muscle spasms in my traps, and my pain radiating into the shoulders, arms, and back of head, does not appear “local it’s deeper than that”. After hearing this, I sent a number of my scans and reports to surgical center’s for a free review. A couple reported that a peek implant for ACDF especially below a C3-C7 fusion would be extremely likely to have a failed fusion.

    My question is can one have pseudarthrosis at C7/T1 although they have a peek cage acdf and posterior fusion? and second question is if the radiologist is correct and I’m not fused at C4/C5 can that cause base of neck pain, arm and shoulder pain? Thanks again Dr Corenman!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Your information seems to be incomplete. You have an open wound in the posterior neck which indicates very poor wound healing or an active infection. Why did you have an open wound? When the fusion mass was explored, what was the conclusion? Did you have a solid fusion or were there segments of non-union?

    PEEK cages are more commonly associated with pseudoarthrosis and can be one of your pain generators. A pseudoarthrosis at C4-5 can contribute to your symptoms.

    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
    Participant
    Post count: 138

    Hello Dr Corenman,

    My second procedure in 2013, there was a dura leak and it appeared that I had a cord injury.After 10 days in the hospital, was discharged to a sub acute facility for seven weeks, it was during my time there that i developed two large boils on the back of my neck (towards the base). I was transfered back to the hospital for consultation, and no-one knew what it was, some said CSF fluid still leaking, one doctor said it could be an infection. Over time the boils disappeared and I developed this very large dehiscence.

    In reference to fusion mass exploration was told I have a solid fusion. My surgeon is scratching his head, the base of neck is tight and when i turn to left and right a few times i can hear crackling and it tightens even further. It’s becomes at times unbearable, and i have radiating pain into shoulders and arms. I also feel at times pain in ring finger and pinky finger left side more than right.

    Is it possible to have a non union at that peek cage level (C7/T1) that would not be picked up from a posterior fusion exploration? There has to be something that’s being overlooked. Thanks

    westie California
    Participant
    Post count: 138

    Dr Corenman,

    I have an additional question please? If one is diagnose with an ACDF Peek Pseudarthrosis at C7/T1 my understanding is the best treatment option is a 360 degree fusion. If one was to have a posterior fusion (180 degrees) to correct a C7/T1 non union, does a posterior fusion exploration confirm fusion for 360 degrees or just 180 degrees? Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    If you had large “boils” after a posterior spine surgery and then a dehiscence, my first thought would be infection. I would not rely on a “solid fusion” report after a posterior surgery with dural leak and infection to try and fix a pseudoarthrosis at C7-T1 ACDF with a PEEK cage. I would be much more comfortable with a fine quality CT scan to let me know of your fusion status.

    A posterior fusion is an acceptable practice for repairing an anterior non-union (pseudoarthrosis) but I then don’t understand why you developed a dural leak as there was no reason to go into the canal and that is the only way to develop a dural leak unless it was hardware entering the canal (which however would also explain why you might have had a spinal cord injury-“My second procedure in 2013, there was a dura leak and it appeared that I had a cord injury”).

    The best way to fix a pseudoarthrosis is a “360” but commonly, that is unnecessarily too much surgery. Many times, taking out the PEEK cage from the front, filling the space with iliac crest bone graft and then using a small plate will take care of the pseudoarthrosis.

    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.
Viewing 6 posts - 55 through 60 (of 61 total)
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