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  • Auric
    Member
    Post count: 22

    I had ACDF on C6/C7 in September of 2011.

    Now on an MRI report I received today, I read, “C6/C7: mild diffuse disc bulge and neural foraminal narrowing bilaterally right greater than left. No central stenosis.”

    How does one get a disk bulge after the disk has been removed?

    And does foraminal narrowing necessarily mean a failed fusion? The operation had been with a PEEK cage, without instrumentation.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The ACDF surgery should include a posterior decompression with the procedure. I can understand the “disc bulge” if the posterior decompression was not fully completed. Also, foraminal narrowing can occur if the foraminotomy (that goes along with the posterior decompression) is not thorough or the PEEK cage recesses into the vertebra body allowing collapse of the level.

    If there is an incomplete fusion (pseudoarthrosis), the cage could very well erode into the vertebral body and loss of disc height could occur. This could cause foraminal stenosis. Start with X-rays including flexion/extension views to determine if there is or is not a solid fusion. Possibly a CT scan might be needed.

    Dr. Corenman

    Auric
    Member
    Post count: 22

    Eventually I stop saying thank you because it seems so inadequate in light of your on-going help. I have been in contact with your office, and I intend to send you a package soon.

    So, I spend the day getting an x-ray script, go to the diagnostic center, and the tech tells me that extension / flexion was not requested on the RX. My doctor’s office is closed for the day. So I get the pictures taken anyway, according to the script I have.

    Dr. Corenman, would X-Rays without flexion / extension be of any value here?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Flexion/extension X-rays, out of all the images that can be viewed are the only images that reveal what motion and gravity will do to the segments in question. Yes, without them, diagnoses are still possible but these images are in my opinion indispensable for understanding the mechanics of the problem.

    Dr. Corenman

    exercise453
    Member
    Post count: 53

    Please excuse the interruption,

    I have two sets of cervical flexion/extension x-rays. One taken by a chiropractor about 18 months ago which has no report but includes the head turning left and right (8 views).
    The second taken a month ago at an mri center has 6 views but does not contain the left and right head turn.

    Is the head turn critical for the spine surgeons diagnosis???

    Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The use of flexion/extension X-rays is important in many situations but not all. Rotation (turning the head right and left) is much less effective to determine the presence of instability.

    Dr. Corenman

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