[Craggy]

#28820

Hello Dr Corenman,
I underwent a Bilateral foraminotomy and posterior fusion of C4/5 and C5/6 on the 27th June 2018.
I have previously had an ACDF of the same levels in January this year.
During the ACDF, a foraminotomy was only performed on the symptomatic left side.
It was successful in returning my biceps reflex and reducing the pins and needles and numbness. By 8 weeks post op, I had some minimal numbness on my left outer arm and some neck pain. Any pain I had was controllable with paracetamol and Celebrex

8 weeks post op I had a minor car accident which brought on numbness of my right deltoid, biceps, forearm, thumb and index finger.
Weakness of my biceps, deltoid and rotator cuff area followed, along with some muscle atrophy. I had a 7 day course of dexamethasone, which had no affect on my symptoms.

I was advised that I could undergo a foraminotomy to help decompress the nerves and that rods and screws would be placed to ensure the fusion was solid.

I awoke from surgery with the C5 and C6 dermatomes in my right arm dead numb. Absolutely no feeling at all and also complete muscle weakness. I couldn’t flex at the elbow or raise my arm in any direction. I couldn’t pronate or supinate the hand or forearm. My right arm was a dead weight.
As the weeks have progressed, the muscle atrophy has become severe and I have lost approximately 5 kilograms in muscle mass alone. My traps have also significantly atrophied.
I have since regained the ability to flex the elbow, but I cannot have any weight in the hand whilst doing so….not even a phone.
I still have no deltoid and rotator cuff function, and the numbness remains unchanged.
I’ve had a large visible external swelling running the length of my incision which is approximately 3 inches in length. This has reduced a fair amount over the last few weeks.
I underwent a CT scan which I was told was routine, just short of 2 weeks post op.
My surgeon says that from the scans, the hardware is all in a good position and that the foramen are totally free from any impingement.
He says I have very minimal swelling and that technically, everything was perfect and the surgery was a success. I should regain use and feeling in my right arm over the coming months.

CT report reads as follows:
Clinical History: Status post-C4/5 and C5/6 anterior/posterior fusion. (One
week ago posterior, six months ago anterior).

Findings: There has been previous anterior fusion from C4 to C6. There is an
anterior plate with C4, C5, and C6 vertebral body screws. There are interbody
cages with graft in situ at C4/5 and C5/6. There is some interbody osseous
bridging at both C4/5 and C5/6 noted. There is also posterior fusion. Note is
made of bilateral posterior graft. There are bilateral posterior element screws
at C4, C5 and C6 screws with interconnecting rods. The metallic hardware
appears intact. The right C5 screw extends through the right inferior articular
process. It appears to extend into the superior aspect of the right C5/6 facet
joint. The tip is at the level of the lateral aspect of the right C5 foramen
transversarium. It is likely just lateral to the right vertebral artery. There
is no evidence of nerve root impingement. Note that artefact does significantly
obscure the central canal and intervertebral foramina from C4 to C6. The degree
of foraminal encroachment is difficult to assess at CT due to artefact. I note
previous MRI of 21/5/2018 demonstrated right C5/6 and left C4/5 and C5/6
foraminal encroachment. There is a partial laminectomy noted. No obvious
fracture is identified. There is a collection seen posterior to the cervical
spine and extending into the subcutaneous tissues extending from the lower C2
level to C7, consistent with haemorrhage and/or fluid. This measures
approximately 76mm (superoinferior) x 29mm (anteroposterior) x 26mm (right to
left).
Comment: Appearances following laminectomy and fusion from C4 to C6 are
demonstrated. There has been anterior and posterior fusion. The right C5 screw
extends inferior to the right inferior articular process of C5, however there is
no convincing evidence of vascular or neural impingement.

Can you please advise if the report contains anything I should be concerned about?
Thanks for your time and sorry for the lengthy post.

[Craggy]

#28845

Hello….please do you have any advice for my post above?
Thank you.

[Donald Corenman, MD, DC]

#28859

“8 weeks post op I had a minor car accident which brought on numbness of my right deltoid, biceps, forearm, thumb and index finger”. “Weakness of my biceps, deltoid and rotator cuff area followed, along with some muscle atrophy. I had a 7 day course of dexamethasone, which had no affect on my symptom”. Did your surgeon comment on this finding as generally the deltoid is supplied by the C5 nerve (C4-5 level) and the C6 nerve (C5-6 level) supplies the biceps? Why you should have two damaged nerves on the opposite side after a minor car accident 8 weeks post-op is very confusing. Did the grafts move or was there any change in angulation of the implants?

“I was advised that I could undergo a foraminotomy to help decompress the nerves and that rods and screws would be placed to ensure the fusion was solid”. “I awoke from surgery with the C5 and C6 dermatomes in my right arm dead numb. Absolutely no feeling at all and also complete muscle weakness. I couldn’t flex at the elbow or raise my arm in any direction. I couldn’t pronate or supinate the hand or forearm. My right arm was a dead weight”.You underwent a decompression and fusion posteriorly at C4-6 and woke up with a right dead arm. These two nerves were already on the edge of disfunction and possibly the manipulation of the nerves during surgery caused serious malfunction. I think an immediate MRI scan was called for to determine if anything was fixable post-op but that never happened.

“I’ve had a large visible external swelling running the length of my incision which is approximately 3 inches in length. This has reduced a fair amount over the last few weeks”. This is explained by the fluid collection found on the CT scan; “There is a collection seen posterior to the cervical spine and extending into the subcutaneous tissues extending from the lower C2 level to C7, consistent with haemorrhage and/or fluid”. This should absorb and disappear over time.

“The right C5 screw extends through the right inferior articular process. It appears to extend into the superior aspect of the right C5/6 facet joint. The tip is at the level of the lateral aspect of the right C5 foramen”. and “There is no evidence of nerve root impingement”. It is hard to determine how significant the placement (or malplacement) of the right screws could be. The radiologist notes “no impingement” so we have to take his or her word for it but occasionally, radiological reads are incorrect.

I think an EMG from a good neurologist could be helpful to determine what damage occurred to the C5 and 6 roots and the chance for recovery.

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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