[failedACDF]

#12138

The posterior fusion was on December 9th, and I started a 7 day supply (I am 5 days into it now) of 300 mg total of prednisone on January 28th (7 weeks after the posterior fusion). Could asking the doctor to extend perhaps the 7 day dose to 10 days and for instance increasing the aggregate dose to 400mg lead to greater success? Or could it also prejudice the posterior fusion? Thanks again.

[failedACDF]

#12247

Hi Dr. Corenman,

I just wanted to update you. As you may recall I had ACDF at C5-7 on May 12th, 2014, and a posterior laminoforamintomy on December 9th, 2014, with right-sided instrumentation.

I was completely better for three weeks after the December 9th surgery, and then my right arm became numb again, followed by very bad shoulder blade pain.

On the left side of my neck where the hemovac drain was, I developed signifcant swelling (that I still have) about the time that the surgery stopped working and an ultrsound didn’t show anything of significance there.

I was on a dose of oral prednisone (370mg over 9 days) 7 weeks after surgery. This helped for about a week and then stopped working.

A CT was performed ten days ago and notes the following:

C5-C6:Uncovertebral joint hypertrophy with moderate right and mild left foraminal stenosis (the pre-foraminotomy CT report showed severe right and moderate left–so I am baffled as to how the left could improve when only the right was operated on.).

C6-C7: Uncovertebral joint hypertrophy with moderate left and mild right foraminal stenosis (the pre-foraminotomy CT report showed moderate to severe left and severe right).

So according to the post-right sided laminoforaminotomy CT report, the operated on portions are certainly improved, however the non-operated on portions improved as well, which could mean that someone just read the report differently. My surgeon looked at the images and said that the operated portions are definitely improved, and I seem him again this week.

The recent CT report also states that “there is minimal fusion anteriorly across the C6-C7 disc space which is new from the October CT and the fusion across the C5-C6 disc space appears increased.”

So here I am almost three months post the second surgery, with very bad shoulder blade pain and arm numbness. I had never been sick a day in my life, but have not been able to go back to work yet, but have started doing some work from home. The shoulder blade pain gets much worse when I move my neck or sit up. It is in the area of the supraspinatus, infraspinatus, deltoid, and teres major.

Based on a “Tender Points in Cervical Radiculopathy” chart by Letchuman that I looked at, these points all coincide with C6. Additionally, prior to my second surgery, the numbness was in my middle finger and now it is in my thumb. Accordingly, my C7 radiculopathy (as confirmed on an EMG/NCS) prior to my second surgery now seems to be a C6 radiculopathy.

So at this point I am not sure what the next step should be, but I am very frustrated and don’t want to keep giving it more time or go for further surgery right now. I would greatly appreciate your advice, as always.

Thanks

[Donald Corenman, MD, DC]

#12248

Symptoms in your shoulder and arm could be from sources other than the neck or could be from incomplete nerve decompression or from chronic radiculopathy.

I do not have a section yet on rotator cuff syndrome but shoulder and arm pain can be generated from that disorder. Thoracic outlet syndrome which is on this website can also cause some of these symptoms. Unfortunately, chronic radiculopathy can also cause these symptoms and treatment of this disorder is just time and medications.

One of the ways to diagnose compressive radiculopathy is with a nerve root block (see website) and to keep a pain diary (again-website). This block will not unfortunately differentiate from chronic radiculopathy but at least will identify the nerve root involved and differentiate from TOS or rotator cuff syndrome.

A good evaluation from an orthopedist will help to determine if you have rotator cuff syndrome and an injection into the shoulder will help to identify this disorder.

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]

#12252

Thanks very much for your quick reply.

I saw a shoulder surgeon before the second surgery, and he said that my shoulder was normal. The shoulder imaging studies state: There is no fracture or dislocation. The glenohumeral joint is well-maintained. Acromioclavicular joint is present. There is mild subacromial spurring.” The shoulder surgeon had viewed the problems as coming from my neck, and he replicated the symptoms when he moved my neck.

So it looks like my ACDF from last May is starting to fuse, with more fusion occurring over the last few months, and the Posterior surgery CT looks better than the pre-Posterior surgery CT. However the quality of life is pretty bad with the pain, and I really wanted to be back at work by now.

I know that your view was that the best approach was to re-do the ACDF. At this point I am somewhat desperate for relief, but don’t want to race into a third surgery in less than a year.

Do you think that time would let things heal (they seem to be getting worse rather than better). I feel like I am definitely worse after the second surgery. Is it possible that a posterior laminoforaminotomy could actually make the symptoms worse instead of better?

If it is chronic radiculopathy, how long does that take to heal generally?

If it is compressive radiculopathy, which makes sense, I would have thought that the posterior surgery would have helped, based on the CT findings, despite the anterior opsteophytes?

If the front fuses fully, will that help the pain and numbness?

Thanks so much.

[Donald Corenman, MD, DC]

#12260

Posterior laminotomy surgery carries with it the risk of nerve problems. I am seeing a patient now who underwent a prior laminoforaminotomy from a different institution and now has significant motor weakness that was not present prior to surgery. I am seeing more of that problem lately and I do not know why.

If your pain is greater in the neck than the arm, full neck fusion should yield some relief. If you have more arm pain, fusion is less likely to give relief. Chronic radiculopathy is variable. It takes about 1 1/2 years to know how much improvement will occur.

The reason posterior surgery may not give nerve pain relief in cervical surgery is that the anterior osteophyte off of the uncovertebral joint (see cervical radiculopathy) is not addressed with this approach. This bone spur may still tent the nerve root from the front. It really depends upon how large the osteophyte is.

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]

#12261

Thanks.

Do you think an MRI would make sense for me now, or is the CT scan sufficient?

If I fuse fully, do you think that would help the shoulder blade pain?

I know that you had said that an ACDF redo is harder if the front fully fuses. However, does the fact that I have instrumentation (rod and screws in the back on the right) in the back now, make a possible ACDF redo harder or easier or have no impact. What I mean is if the back is fused, would that make an ACDF redo easier or harder?

Lastly, is it unusual to have such a lengthy recovery from posterior surgery (I’ve been out from work 10 weeks)? Would your advice be to give it more time to see how this progresses (especially since the CT looks better) or do a third surgery this year in the form of a revision ACDF?

Hopefully, my case has proven interesting to you. Your advice has been extremely helpful.

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