Failed ACDF?? Next steps

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  • cgklein
    Participant
    Post count: 7
    #24327 |

    A bit of history is warranted. I had ACDF surgery on February 4th, 2016 at the age of 52. ACDF was performed on C4-C5 and C5-C6 with PEEK interbody graft filled with local autograft and allograft. The reason for the surgery was instability at C4-C5 and C5-6 along with moderately severe forminal stenosis and degerative disc disease. I had tingling and numbness in my left hand and moderate to severe pain in my left shoulder and upper arm.

    Throughout my recovery, I have continued moderate to severe pain in my left shoulder. A few months ago the shoulder and arm pain started in my right arm along with numbness in my right thumb and index finger. The pain switches from left to right side during the day but is never together.

    In June I moved to AZ and have continued to be in touch with my neurosurgeon. I last saw him in September 2016. In July, I found out that I have osteoporosis and vitamin D3 deficiency. I am taking Prolia and Vitamin D3 pills to address this. This was not known prior to surgery. In addition, I have CRPS in my left lower limb (diagnosed in 2012). I have a Medtronic SCS implant (paddle leads) which was “installed” in 2015 by the same neurosurgeon.

    I recently had a nerve conduction study performed with the following results, “Nerve conduction studies of the upper extremities are normal bilaterally. Electromyography of the left upper extremity show reinnervation changes in the C6 distribution. Study is consistent with a chronic C6 radiculopathy of the left upper extremity.” They did not perform a Electromyography of my right arm even though I requested it.

    I am taking Gabapentin for the nerve pain, which helps some as well as Percocet. I am tired of this pain and have waited the year for fusion. Sometimes that pain is better lying down sometimes it makes it worse.

    My neurosurgeon says that my nerve healing could take 12-18 months (email) but has not made any specific recommendations on next steps even though I have asked.

    My question is, what should I do now? I know that it is possible that I have permanent nerve damage but it seems really weird that the pain moves from left to right side and back. Do I wait longer, see a neurosurgeon or a neurologist or ???

    Your thoughts are appreciated, CK

    Dr. Corenman
    Moderator
    Post count: 5602

    Unfortunately, EMGs are not very effective for understanding nerve pain origin as pain nerves are too small to be tested with the EMG. I would suspect that you might have one of three problems; a failed fusion (pseudooarthrosis), continued nerve compression in spite of solid fusion or chronic radiculopathy. A new MRI and a new CT scan would be very helpful to start your diagnostic workup.

    Also, a spine surgeon would be a good sext step (an orthopaedist like me who specializes in spine) as we have more experience in revision work.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    cgklein
    Participant
    Post count: 7

    Dr. Corenman, thank you for your response. I will find a spine surgeon and follow-up with a CT scan or MRI. If my issue is a failed fusion, how does my osteoporosis and/or CRPS affect my ability to have a successful fusion in the future? Since it has been over a year since my ACDF surgery and the x-ray shows that the fusion is not complete, would this indicate a failed fusion or could it take longer than a year to fuse?

    Thank you, CK

    Dr. Corenman
    Moderator
    Post count: 5602

    After one year, if you have a pseudoarthrosis, it is highly unlikely it will heal in the future. CRPS will not inhibit healing but Vit.D insufficiency however will impair healing. Osteoporosis generally does not inhibit healing but will allow the grafts to subside into the vertebral bodies in some cases.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    cgklein
    Participant
    Post count: 7

    Dr. Corenman, thank you again. Two follow-up questions. First, since it appears that I have pseudoarthrosis and I know that I have a pinched C6 nerve, is it okay to use my home traction device or would this potentially cause additional damage to the pseudoarthrosis? Second, during the past year during my recovery of my ACDF, I used Voltaren Gel on my shoulder. Could this have impacted by fusion?

    Thanks you, CK

    Dr. Corenman
    Moderator
    Post count: 5602

    Traction in the face of a pseudoarthrosis is OK. Voltaren is a non-steroidal anti-inflammatory and as such, can affect the fusion in the first two to three months.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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