[Donald Corenman, MD, DC]

#12082

The decompression works (hopefully forever) but what can happen is that disc can settle or lose height. This will narrow the opening even more. This can take time to occur.

Another problem that can occur is either hematoma (a small collection of blood) or swelling of the tissues in the foramen (although I would expect that to occur in 1-2 weeks).

There are rare occasions that a root can be irritated with surgery by manipulation (retraction).

It is not too soon for an MRI. A CT might be helpful but CT scans are not the best choice for soft tissues.

I am confused in your reference to “the right side has now had instrumentation” as I would assume that both sides have instrumentation.

An ACDF should have no effect on the fusion level above.

Peyton Manning had two posterior foraminotomies. The first one gave him about one year of relief from my understanding. The problem resurfaced the next year and a repeat foraminotomy did not solve the problem (as to be expected). He needed to have the foraminal height restored and an ACDF was the obvious choice. He was lucky in that his C7 nerve recovered and he regained his triceps muscle strength. Without the triceps muscle, he could not launch the ball far downfield.

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.

[failedACDF]

#12083

Thanks again for your insight.

The instrumentation was only placed on the right side where the laminotomy and foraminotomy were performed. The c5-7 facets were opened just about 50% and then the instrumentation was placed on that side both to help stabilize it, but also because motion was detected in front where the ACDF hadn’t yet fully fused. I assume this added stabilization could make a future ACDF more successful from a fusion perspective?

Interestingly, I did develop the large swelling on the left (opposite side) around the same time as the numbness came back, so perhaps there is a hematoma in the foramen? Does that show on an MRI or does it typically resolve with time?

The thing that still puzzles me is how could I now be worse after this surgery, since I assume if it didn’t work, I would be the same as I was before? Should I give it some more time? Do you think an oral dose of steroids could help? Is it too soon to try a selective nerve root block only 7 weeks after surgery? Also, wouldn’t a nerve root block be temporary at best?

Thanks as always.

[Donald Corenman, MD, DC]

#12090

It is really unusual that instrumentation was not placed on both sides of the spine for a fusion. I am also confused that you note that C5-7 facets “were opened” and that instrumentation was placed. Was instrumentation placed in all levels (indicating that the C5-7 levels were both fused)? If an additional level was fused (C6-7) and only one side was instrumented, this creates a potential non-fusion situation for this additional level.

Oral steroids could help and might be worth a try. SNRBs place the steroid directly on the root vs an oral steroid which distributes throughout the body significantly diminishing the concentration at the nerve root level through the oral route.

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.

[failedACDF]

#12091

Thanks again. Instrumentation was placed at all levels (C5-7), but only on the right. I think this was both to stabilize the right and to help the front possibly fuse. My assumption is that it was better to fuse the right, then not fuse from the back at all, if the front was not fusing? Pehaps fusing from both sides posteriorly would have been more invasive. I remember after my ACDF, the MRI showed a lot of shadows. Would an MRI now show a possible foramin hematoma or what may be going on?
Thanks

[Donald Corenman, MD, DC]

#12092

So to make this clear, you initially had a fusion at C5-6 in the front (ACDF) which did not heal (pseudoarthrosis). You then had posterior foraminotomies at C5-7 on the right and a posterior instrumented fusion only on the right?

I do not understand why there was no instrumentation placed on the opposite side. Was there difficulty getting to the opposite side or some type of anomaly that prevented the exposure of this side? Did the surgeon fuse the opposite side without instrumentation? Did I misunderstand and you had failed fusions at both C5-6 and C6-7?

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.

[failedACDF]

#12093

In May I had ACDF at C5-7, but had continuing bad shoulderblade pain and numbness and right arm pain and numbness. After 5 months this area only had a little bit of fusion. So in December, laminoforaminotomy was performed on the right side of C5-7. After that surgery the numbness and pain were completely gone. The numbness returned three weeks after surgery on the right arm, and six weeks after surgery the shoulderblade pain and numbness returned.

The relevant portion of the operating room notes pertaining to the recent surgery state in part:

“The C7 nerve root was identified in the lateral recess and followed out of the foremen and was completely decompressed.

I then worked at the C5-6 level where I was a little broader in terms of the bone removal because this was a tighter area. Again excellent decompression was achieved. C6 nerve root was seen and was nicely pulsatile. There was a small bit of movement between C5-6 and because of the amount of bone resected, I elected to instrument this area.”

The report describes the instrumentation on the right as being screws and a rod and autografts.

Hopefully this clarifies things.

Thanks

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