[westie California]

#22881

Hello Dr. Corenman,

I hope all is well and that your enjoying the remaining days of summer.

My question continues to relate to my neck and the constant day to day pain. The base of my neck, arms(biceps),shoulder blades, shoulders and right side occipital headaches with dizziness. I’m still hearing popping and crackling when i move my neck in different directions. Sitting or walking will significantly magnify the pain and discomfort. Also chin tucks brings on additional pain around the C7/T1 bone area in the back part of my neck.

My recent EMG/Nerve conduction shows moderate chronic C5, C6, C7 radiculopathy bilateral nerve irregularity.

8/23/16 MRI states the following:

C3/4-C6/7 post surgerical changes are now identified. Anterior fusion plate is noted with anterior fixation screws transversing the C3,C4, C5, C6, and C7 vertebral bodies. Post surgical changes compatible with discectomy and fusion are noted at C3/4-C6/7. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/4 mild left neural foramina narrowing and C5/6 mild right neural foramina narrowing are noted in conjunction with hypertrophic changes.

At C7/T1, a disc budge is noted deforming the thecal sac. Neural foramina stenosis is not suggested.Loss of disc signal is noted with partial loss of disc space height.C7/T1 disc bulge represents mild progression compared to prior study.

At T1/T2, a disc budge is noted deforming the anterior margin of the thecal sac. Right proximal neural foramina extension is suggested. There is no evidence of left neural foramina stenosis.Loss of disc signal is noted with anterior hypertrophic changes and anterior disc extension.

At T2/T3, a disc budge is noted deforming the thecal sac. Left proximal neural foramina extension is suggested. There is no evidence of right neural foramina stenosis.Loss of disc space height and signal is noted with anterior hypertrophic changes and anterior disc extension.

Cervical spine straightening is noted.

Pain doctor performed Occiptial nerve block which helped with headaches for approximately 4 days. The pain came back.

Over the past 2 months pain doctor performed bilateral C2, C3, C4, C5, C6 and C7 radio frequency ablation. The bulk of my pain resides at my lower cervical spine area.

My spine surgeon started I have a solid fusion, however the laminectomy was not performed well by my previous surgeon. He would need to revisit C5, C6 and C7, extend fusion to T2 with instrumentation and perform foraminotomy.

My question is before going forward with an additional surgery (which would be my 6th),would it be worthwhile to have a thoracic block and possibly an RFA and see what happens before undergoing the knife? Thanks in advance for any input.

[westie California]

#23012

Hello Dr. Corenman,

Since we last spoke, I’ve been to two additional spine surgeon consults and my pain doctor.

My pain doctor wants me to stay away from any additional surgeries. The main reason is, in his opinion, fusions should be reserved for severe cases, i.e fractured vertebra, deformity) . He would like me to trial an implantable spinal cord stimulation device. We spoke about Discogram, SNRB,Epidural injection, and Facet blocks. He is open to performing an Epidural injection and provided to me a brochure that explains the spinal cord stimulation process.

Spine surgeons had different opinions, the first, agrees with pain doctor, he would also recommend spinal cord stimulation device and avoid additional fusions. He believes there is a musculoskeletal issue due to my laminectomy procedure. The issue is a disfunction, the lamina bones are removed, so the muscles are now tied together, rather then being connected to lamina. He also was concerned with the number of surgeries, (5 cervical, 1 inner ear), all procedures performed within the past 5 years.

The second surgeon agrees with my current surgeon. He noted that anteriorly I am fused from C3 to T1 (solid). He would also extend the posterior fusion to T2 (currently fused from C3-C7–instrumentation removed) and add instrumentation from C5. There are degenerative changes, however more importantly he feels there is instability, that a fusion would address.

Would a flexion/extension X-rays show this instability? Thanks,

[Donald Corenman, MD, DC]

#23022

You already have a fusion from C3-C7. This length of fusion will put strain on the C7-T1 disc and I expect you might need a stabilization of that level in the future. It already is problematic (“At C7/T1, a disc budge is noted deforming the thecal sac. Neural foramina stenosis is not suggested.Loss of disc signal is noted with partial loss of disc space height.C7/T1 disc bulge represents mild progression compared to prior study”).

In addition, the upper thoracic levels are failing (T1-3). This is unusual but not rare in some individuals.

Your pain doctor is not correct regarding his assessment regarding your neck. Fusions are performed every day for severe nerve and especially spinal cord compression for good reason. In your case, I cannot comment regarding the need for your C3-7 fusion without much more information.

In fact, this physician performed ablations at levels that were already fused (“Over the past 2 months pain doctor performed bilateral C2, C3, C4, C5, C6 and C7 radio frequency ablation”) which was not necessary as fused levels generate no pain in the facets.

Your surgeon wants to perform posterior decompression and fusion surgery (“My spine surgeon started I have a solid fusion, however the laminectomy was not performed well by my previous surgeon. He would need to revisit C5, C6 and C7, extend fusion to T2 with instrumentation and perform foraminotomy”). I am unclear as to the indications for the further decompression and I an unclear as to the reasons (at least at this point) to continue the fusion down to T2. Even if there were indications to go to T2, by the radiological report findings, T2-3 is a degenerative level and should also be included in the fusion. This begs the question of the health of T3-4.

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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