[westie California]

#22141

Hello Dr,

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

A CT scan was performed and states solid fusion anteriorly from C3-T1 and C3-C7 posteriorly.Report states post surgical degenerative changes throughout cervical spine.

I sent my CT and MRI scans for review and was told laminectomy did not decompress nerve roots. So I’m back to the drawing board. Any thoughts?

Ashley

Thanks

[Donald Corenman, MD, DC]

#22144

You can try selective nerve root blocks (SNRB-see https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/) to determine if the nerve that is anesthetized is participating in your pain. The one problem with a positive SNRB (positive means temporary relief of pain) is that this block does implicate the nerve as the pain generator but does not differentiate compression from internal nerve injury. This means that a surgical nerve decompression could be performed well but still not give the relief expected.

If you have a solid fusion in front (ACDF) and the nerve is still compressed, you could undergo a posterior foraminotomy to give the nerve a chance to heal. See https://neckandback.com/treatments/posterior-cervical-foramenotomy/.

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]

#25260

Good evening Dr Corenman,

I am currently post op 5 months (6th spine surgery), and fused posterior (C3-T2) and anterior (C3-T1). My surgeon noted cervical radiculopathy from severe foraminal stenosis and pseudoarthrosis (Mobile facet joint at C7-T1). He performed:

1)posterior cervical laminectomy with foraminotomies, medial facetectomies at C5-C6, C6-C7 and C7-T1.

2)Posterior segmental instrumentation from C5-T2.

3)Use of local autograft.

4)Use of morcellized allograft.

I commenced physical therapy two months ago and still having several issues. After surgery my right arm pain went away, however its back. The left bicep never improved. The pain is really bad on both sides of the base of my skull, both traps and at C7/T1 area both sides with a lot of muscle spasms. In addition my headaches in the occipital area has worsened (right side only). I also have pain in both shoulders, dizziness, left elbow pain, all my fingers are tingling at times.

My surgeon also noticed severe muscle spasms gave me a month of muscle relaxants (Valium). After a month of muscle relaxants he performed an evaluation and referred me to pain management. Pain management performed an evaluation gave me a script for Zanaflex, gave me a number of injections. His diagnosis is myofacial tissue damage, fibrosis (trapping nerves), osteoarthritis and muscle atrophy.I was also given a brochure for an implantable spinal cord stimulator that may help, wants me to think about it.

My question now is, how should I proceed in terms of finding out what is the pain generators? My understanding is once your fused, the pain and spasms should not come from facets. Do i start from selective nerve root blocks, and go from there, or do we start from an MRI and or CT Scan, or is it too early to expect pain relief?

Thanks in advance for your help

[Donald Corenman, MD, DC]

#25261

Residual pain 5 months after an extensive surgery, there are many potential pain generators. I assume you have had more than one surgery. You note “A CT scan was performed and states solid fusion anteriorly from C3-T1 and C3-C7 posteriorly.Report states post surgical degenerative changes throughout cervical spine. I sent my CT and MRI scans for review and was told laminectomy did not decompress nerve roots”.

Is every level fused as you had surgery down to T2? Not uncommonly, radiologists will either not comment on fusion status or can misinterpret films and occasionally call a non-fusion a fusion. Pseudoarthrosis can cause neck pain.

You have continued compression of the nerves (“was told laminectomy did not decompress nerve roots”). This could be a cause of some of your pain. Also, the C2-3 level commonly can cause headaches with facet or disc degeneration (as well as C1-2 but pain generation from this level is unusual). You really need an expert to look at your films, take a detailed history, perform a meticulous physical examination and then have you undergo diagnostic blocks to full evaluate your pain generators. Only after a full work-up can assumptions be made as to your pain sources and what can be done to help you.

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]

#25269

Good Morning Dr Corenman,

I really appreciate your feedback. My surgeon did not decompress T1 and T2. He added instrumentation from C5-C2. I have one last question please, my thoracic MRI before cervical surgery indicated the following:

T1/T2, a disc budge is noted deforming the anterior margin of the thecal sac. Right proximal neural foramina extension is suggested. There is no evidence of left neural foramina stenosis.Loss of disc signal is noted with anterior hypertrophic changes and anterior disc extension.

At T2/T3, a disc budge is noted deforming the thecal sac. Left proximal neural foramina extension is suggested. There is no evidence of right neural foramina stenosis.Loss of disc space height and signal is noted with anterior hypertrophic changes and anterior disc extension.

At 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 question is can the above be a source of my pain generators? Thanks again

[Donald Corenman, MD, DC]

#25279

You need to list every surgery you have had in the chronological sequence, why the surgery was necessary and what symptoms were relieved or even initiated after each surgery to clear up this confusion.

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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