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  • AvatarDonnakruis
    Participant
    Post count: 4

    Hello,
    I have had Two fusions.
    ACDF 2011. C7-T1
    ACDF 2013, C5-C6

    For more then a year I have been experiencing sharp pains in right elbow, right shoulder and right clavicle. Also experiencing balance issues.
    I am in a new state since prior surgeries so I have new doctors.
    Neurologist ordered Cervical MRI and XRays. Referred to neurosurgeon. First appt was with his PA, who also ordered a CT scan.
    Referred me to Pain management and PT. Epidural is scheduled for this Tuesday Jan 14th.
    Below are my test results.
    Any input would be greatly appreciated

    CT Scan:
    Anterior subluxation of the inferior most aspect of the plate by approximately 3mm at the level of C7-T1. Otherwise hardware is intact. Anterior fusion construct demonstrates osseous bridging of the vertebral bodies
    Adjacent segment degenerative changes at C4-C5

    X-RAY:
    Minimal lucency surrounding the superior most screw the C5 veteran body.
    No evidence of left-sided foraminal stenosis.
    There is severe right sided foraminal stenosis at C4-C5. Moderate right foraminal stenosis at C5-C6
    Degenerative changes are visualized at C4-C5.

    MRI:
    Moderate to severe right sided foraminal stenosis at C4-5 which have progressed in comparison to the prior study

    In your opinion, will PT help with any of these issues?

    AvatarDonnakruis
    Participant
    Post count: 4

    Edit: other symptoms include right pinky and ring finger numbness. Right arm weakness.
    In addition to balance issues, both legs feel weak and heavy.
    Coughing/sneezing causes extreme clavicle pain. Symptoms seem to be progressing quickly.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7569

    You have had an ACDF 2011 of C7-T1 and an ACDF in 2013 of C5-C6. This means that the C6-7 level is sandwiched between two fusions which can cause some increased stress of this level.

    The CT report is curious. “Anterior subluxation of the inferior most aspect of the plate by approximately 3mm at the level of C7-T1. Otherwise hardware is intact. Anterior fusion construct demonstrates osseous bridging of the vertebral bodies Adjacent segment degenerative changes at C4-C5”.

    There is no mention of the fusion at C5-6, no comment of the health of C6-7, a cryptic comment about the inferior plate and no mention of foraminal stenosis at any level where the X-rays have a notation about foraminal stenosis (“There is severe right sided foraminal stenosis at C4-C5. Moderate right foraminal stenosis at C5-C6”). There is much confusion here.

    Do you have an MRI?

    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.
    AvatarDonnakruis
    Participant
    Post count: 4

    Dr Corenman,

    I was able to pull up more details from my reports
    Thank you so much for your time.

    CT C Spine w/o contrast:

    Acdf changes visualized between C5 and T1. Anterior subluxation of inferior most aspect of the plate by approximately 3mm, anterior to the C7 and T1 vertebral bodies.

    There is osseous bridging across the anterior portion of the fusion construct.

    There is no evidence of fracture, there is straightening of the usual lordosis with reversal of usual cervical lordosis between C2 and C4.

    Crainocervical junction is intact.
    Visualized intracranial structures are unremarkable.
    Lung apices are clear

    C2-3 unremarkable
    C3-4 Unremarkable
    C4-5 Loss of disc height. Central disc osteophyte with mild canal stenosis. Left foramen patent. Right uncovertebral hypertrophy with moderate to severe right foraminal stenosis.
    C5-6 No evidence of canal stenosis. Right uncovertebral hypertrophy with moderate to severe right forminal stenosis. Left foramen patent.
    C6-7 no evidence of canal stenosis. Right neural foramen patent. Left neural foramen patent.
    C7-T1. No evidence of canal or foraminal stenosis.
    Acdf between C5 and C7 as above.
    Ajacement segment degenerative changes at C4-5

    MRI C Spine w/o contrast
    Redemonstration of Acdf between C5 and T1
    C1 dens interval is maintained
    C2-3 unremarkable
    C3-4 unremarkable
    C4-5 broad central protrusion resulting in mild ventral dual compression and canal stenosis. Right uncovertebral hypertrophy contributes to severe right foraminal stenosis. This has progressed slightly to the prior study. Foramen patent. Facet joints unremarkable.
    C5-6 no evidence of canal or left foraminal stenosis. Small right foraminal disc osteophyte with mild right foraminal stenosis.
    C6-7 no evidence of canal or foraminal stenosis
    C7-T-1 no evidence of canal or foraminal stenosis.

    MRI T-spine:

    Limited visualization of anterior cervical discectomy fusion at the mid to lower cervical spine.
    C5-T1 the alignment, bone marrow signal and vertebral body heights are normal. There is no bone marrow edema or bone marrow replacement identified.
    No cord edema identified. Multilevel facet arthropathy present with mild to moderate bilateral neural foraminal narrowing from T2-T3 through T4-5. There is a small central disc protrusion T8-T9 with mild ventral impression on the subarachnoid space. No cord enhancement noted.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7569

    You did have a fusion between C5 and T1 (three levels). “Acdf changes visualized between C5 and T1. Anterior subluxation of inferior most aspect of the plate by approximately 3mm, anterior to the C7 and T1 vertebral bodies”. It sounds like the fusion plate is 3mm “proud” from the anterior bony surface of the T1 vertebral body. This can occur from the initial implantation during surgery where the plate is left “proud” or if there is a subsequent lack of fusion and then the plate displaces.

    There is discrepancy between the statement “Acdf changes visualized between C5 and T1” and the last statement “Acdf between C5 and C7 as above”. This of course makes no sense unless it is a missed dictation.

    It sounds like you have breakdown at C4-5 with severe foraminal stenosis compressing the C5 nerve root (“C4-5…Right uncovertebral hypertrophy contributes to severe right foraminal stenosis”). See this and look at symptoms from the C5 nerve root to see if it fits your symptoms. https://www.neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

    There is no mention of solid fusion at C5-T1 (or not).

    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.
    AvatarDonnakruis
    Participant
    Post count: 4

    Thank you so much for your response.
    I read the link you provided and do indeed have many if not all of the symptoms.

    In your opinion,
    Would this need to be fixed surgically?
    Epidural at C4-5 last week has done little to ease my discomfort as has Physical therapy but I’ve only had 5 Physical therapy sessions thus far.

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