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  • westie California
    Participant
    Post count: 135

    Good afternoon Dr. Corenman,

    I was reviewing my cervical laminectomy operative notes from 2013 due to the fact that I’m still searching for answers on why I still have neck pain, bicep pain, headaches, shoulder’s pain, muscle spams, etc. and have a few questions on bone grafts utilized during cervical laminectomies. It reads “OPERATION PERFORMED: Bilateral decompressive laminectomy from C3-C7 with bilateral posterior instrumentation and fusion using Medtronic’s instrumentation at C3, C4, C5, C6 and C7 with fusion from C3-7 bilaterally using allograft bone graft with Grafton bone protein bilaterally as well as autogenous bone bilaterally”.

    My questions are:

    1. Grafton bone protein is this off label for cervical spine?

    2. Can Grafton bone protein side effects include neck pain, chronic radiculopathy, trapezoids spasm, etc.?

    3. What can be done if this is an issue?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8140

    Grafton bone protein is really more of a “bone filler” and not too effective for fusion by itself. Allograft is also fair but not great. Your own bone taken from the laminectomy site and moralized would be the best graft second only to BMP (bone morphogenic protein) but some surgeons would not use BMP in the neck posteriorly (and especially anterior).

    Grafton bone protein I don’t believe is off label for the cervical spine posteriorly.

    “Can Grafton bone protein side effects include neck pain, chronic radiculopathy, trapezoids spasm, etc”.
    No, that sounds to be more likely lack of fusion, residual compression and/or malalignment.

    “What can be done if this is an issue”. A full work-up including a good examination. new MRI and CT scans and probably diagnostic blocks.

    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
    Participant
    Post count: 135

    Good evening Dr. Corenman,

    Thank you so much! The EOS scan shows solid fusion from C3-T1 and so does CT Scan. The surgeon stated that there is residual foraminal compression, however it’s not severe in his opinion, more like moderate. The neuroradiologist states in his report severe, surgeon say’s he looks at things from a different perspective. Also mentioned to me was at T2-T3 there was cervical spondylotic myelopathy and just because that level is now decompressed does not mean the nerves are fully recovered or will ever fully recover.

    In reference to malalignment, he performed some measurements and said T1 slope and SVA is borderline acceptable. He gave me measurement of C2-C7 SVA at 39.9 mm and said over 40.0 mm normally requires surgical intervention. The imaging showed “straightening of cervical lordosis and thoracic kyphosis. Slight exaggeration of the lumbar lordosis with mild anterolisthesis at L5-S1 and minimal retrolisthesis at L3-L4. underlying mild multilevel discogenic degenerative changes. Mild bilateral hip osteoarthritis. Mild bilateral knee osteoarthritis”.

    From your previous comment if one has moderate residual foraminal compression and some kind of malalignment (kyphosis) there is a high probability this is where my pain is coming from? Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8140

    The way to determine if the segment (or nerve root) is a pain generator is to perform a selective nerve root block. Temporary relief would indicate if that nerve is a pain generator. This does not confirm that the compression is the absolute cause as this relief could also be a chronic nerve injury (CNI) and lidocaine will relieve pain in both compression and CNI. Don’t worry as much regarding alignment lines as they can be misleading.

    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
    Participant
    Post count: 135

    Good afternoon Dr. Corenman,

    I had selective nerve root blocks back in May and there were some pain relief at C3 and C5 and not at C7. Before my T2-T3 procedure, this was communicated to my surgeon and I asked if he needed something in writing from pain management and he said no and that he would open up nerve channels that are tight. To my surprise he told me after surgery nerve channels were not too bad, so he didn’t perform.

    I’ve had consults with 2 different pain management doctors, who don’t work with each other, and a neurosurgeon and was told in their opinion, there’s residual compression. The neurosurgeon explained the bone spurs originate from the uncovertebral joint’s and should be approached from the front. He asked around in his office if anyone performs anterior foraminotomy and no one does. When I shared this with my orthopedic surgeon, he said there’s no way to fix this problem because bone spurs are imbedded with fusion. I believe you sent a message saying that the only way to correct this issue is with an osteotomy?
    So at this point I’m stuck with pain and severe muscle spams and don’t know where to go. I spoke to pain management again and was told, my epidural space is deformed and to avoid any injections or SCS. Thanks as always for your continued support.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8140

    Did you have any anterior fusions (ACDF)?

    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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