[sneely]

#35591

Hello Dr. Corenman,

I am still having debilitating neck pain (predominately right side and into shoulder) almost year after 2 level ACDF, C5-C7 using PEEK low profile spacers, anchorless, no cage nor clasp. A recent mylogram was deemed benign with the appearance of a solid fusion. but would you be able to give you opinion on the narrative from an MRI from 10/22? I have been told that the structure is good and nothing surgical is needed. thanks for your consideration
narrative:0/24/2022 9:12 AM

Study Result
Impression
1. Multilevel degenerative disc and degenerative facet disease with postsurgical changes at C5-6 and C6-7. Severe left foraminal narrowing is present at C3-4.

Please refer to the body of the report for a level by level description of the degenerative and postoperative changes with any associated areas of canal and foraminal encroachment.

Narrative
EXAM: MRI of the cervical spine without and with contrast 10/21/2022.

CLINICAL INDICATION/HISTORY: Neck pain. Right upper extremity radiculopathy since cervical fusion performed in May 2022.

TECHNIQUE: Multiplanar, multisequential images of the cervical spine were obtained before and after the administration of 15 cc of IV Dotarem.

COMPARISON: Cervical spine radiographs from 9/26/2022 and the preoperative MRI of the cervical spine from 3/30/2022.

FINDINGS: There is straightening and partial reversal of the cervical lordosis. Postsurgical changes are again noted status post anterior interbody fusion device placements at C5-6 and C6-7. There is straightening of the cervical lordosis. Multilevel degenerative disc disease is present with mild multilevel marginal osteophytic spurring. No compression fractures are identified. There is no significant spondylolisthesis.

The spinal canal and foramina are patent from the skull base to C2-3.

At C3-4, there is disc osteophyte complex with uncovertebral osteophytic spurring. The spinal canal and right neural foramen are patent. There is severe left foraminal narrowing.

At C4-5, there is uncovertebral osteophytic spurring but the spinal canal and foramina are patent.

At the postoperative C5-6 level, the spinal canal and right neural foramen are patent. There is mild to moderate left foraminal narrowing.

At C6-7, there is osteophytic spurring which is asymmetric to the left. Central canal stenosis is minimal. There is moderate right and mild to moderate left foraminal narrowing.

At C7-T1, the spinal canal and foramina are patent.

There is no abnormal signal in the cervical cord. The cerebellar tonsils are appropriately positioned above the level of the foramen magnum.

[Donald Corenman, MD, DC]

#35592

I assume the myelogram was also a CT scan and there was good evidence of a solid fusion. You still have moderate right foraminal narrowing at C6-7 so that could be a cause as well as degeneration of the C4-5 disc (which can radiate pain to the right neck).

The next step (assuming a solid fusion which is still on the table) is to perform selective nerve root blocks on the right at C6-7, then separately at C4-5. Keep a pain diary (read the hyperlink) and see which one gives you temporary relief. Then, if C6-7 gives relief, have a posterior foraminotomy performed. If C4-5 yields relief, have an ADCF at this level.

https://neckandback.com/treatments/diagnostic-therapeutic-neck/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

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.

[sneely]

#35593

Thank you Dr. Corenman. That is very helpful and I will discuss it at my next appointment with my pain management doctor.

[Donald Corenman, MD, DC]

#35594

Good luck and keep us posted.

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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