Neck pain after ACDF 1 year post op

Tagged: Neck pain still present after ACDF

Viewing 6 posts - 1 through 6 (of 6 total)

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aprokop
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January 2, 2019 at 9:31 am

Post count: 22

#29959

Dr. Corenman

I had a ACDF on my C5/C6 January of 2018. I still have right shoulder stiffness and pain in my upper neck and trap area. I also have some pain that shoots up towards my right ear. My bicep and grip is still good. I can’t play catch or shoot a basketball with my son because that motion causes great pain.

I have tried Physical therapy, steroid injections, trigger point injections, massages etc since the surgery and nothing seems to work. I take muscle relaxers, Tylenol and advil with little relief. The surgeon doesn’t think a non union is the problem. He doesn’t see movement in the flex and extension x rays. However nobody can tell me if I fused yet at the C5/C6 levels. I only hear that there are signs of fusion and they don’t think it is the problem.

I had an MRI this August and here is some of the findings:

The C3-C4 interspace demonstrates mild central canal, moderate to marked left neural foraminal, and marked right neural foraminal narrowing secondary to a minimal broad-based disc bulge with hypertrophic changes. Interspace otherwise negative.

The C4-5 interspace demonstrates mild central canal, mild left neural foraminal, and mild right neural foraminal narrowing secondary to a minimal broad-based disc bulge with hypertrophic changes. Interspace otherwise negative.

The C5-6 interspace demonstrates mild central canal, mild left neural foraminal, and moderate to marked right neural foraminal narrowing secondary to significant spur involving the right uncovertebral joint. Interspace otherwise negative.

The C6-7 interspace demonstrates mild central canal, mild left neural foraminal and minimal right neural foraminal narrowing secondary to a minimal broad-based disc bulge with hypertrophic changes.

Why do I still have narrowing and a significant bone spur at the C5/C6. Shouldn’t my surgery taken take of that? What can I do about the bone spur?

Do you believe that my problem comes from the C3/C4 area?

Do people that have a 3 to 4 level fusion live without daily pain?

Honestly I have almost lost all hope. I’m only 40 years old and I want to be able to golf, coach and be active again and I hoped the first surgery would have led to that but it seemed to make it worse. I’m nervous and afraid to have another surgery since the first one didn’t help but I’m not sure what else I can do. This pain is really wearing on me.

Thanks,

Andy

Donald Corenman, MD, DC
Moderator

January 2, 2019 at 11:27 am

Post count: 8660

#29960

“I still have right shoulder stiffness and pain in my upper neck and trap area. I also have some pain that shoots up towards my right ear”. Obviously seems like a right sided problem.

C3-4 has a “marked right neural foraminal narrowing”. This would be the C4 nerve which has a similar distribution as your complaints.

What is confusing is that I expect this MRI to be performed after your ACDF but the radiologist does not mention anything about the surgery Not necessarily unexpected as I have seen some radiologists either miss the surgery or be lazy. “The C5-6 interspace demonstrates mild central canal, mild left neural foraminal, and moderate to marked right neural foraminal narrowing secondary to significant spur involving the right uncovertebral joint”. You should have had the spur eliminated or at least significantly reduced with surgery.

If the surgery was performed based upon this MRI, I assume that you had no diagnostic testing first (a SNRB)-see 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/ and https://neckandback.com/treatments/diagnostic-therapeutic-neck/.

You need a diagnostic SNRB (selective nerve root block) of the C5-6 and then on a separate day, a C3-4 SNRB, both with a pain diary. Most likely, you would need a CT scan of the neck to make sure you did or did not have a fusion of C5-6 if the C5-6 block gave you relief. If C5-6 gave you great temporary relief and you had a failed fusion (pseudoarthrosis), you would need a revision ACDF. If you had a solid fusion, then you would need a posterior foraminotomy.

If C3-4 gave you the relief instead of C5-6, then you would need a C3-4 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.

aprokop
Participant

January 2, 2019 at 12:24 pm

Post count: 22

#29961

Thanks for getting back to me.

I had a CT scan this October and nothing in the report says if I have fused or not? I’m pretty frustrated with the lack of answers on that topic. How can I get someone to give me a answer on that?

If I ended up with an ACDF at the C3/C4 level would you remove the C4/5 as well or leave it? Since I already have a fusion on the C5/C6 level.

Is the success rate the same for revision surgeries?

Lastly how invasive and painful is a posterior foraminotomy? I have heard that posterior surgeries are very painful and you can miss a lot of work. How long do most people miss work with this surgery? I’m a middle school teacher. “Mostly computer work”.

Thanks,
Andy

Donald Corenman, MD, DC
Moderator

January 2, 2019 at 1:05 pm

Post count: 8660

#29962

The CT should be definitive regarding fusion status if the scan was of good quality. You can get ahold of the radiologist report which is separate from your surgeon’s report. It was generated by the place that had the CT scanner and all scans have to be read by a radiologist. He or she should have commented on the fusion status.

You might be a candidate for an artificial disc (ADR) at C3-4 if you have not lost too much disc height. If not an ADR candidate and C4-5 is not too degenerative, then an ACDF would be acceptable. If your C4-5 disc is significantly degenerative, it might have to be included as a fusion or even artificial disc.

Posterior foraminotomies are generally more uncomfortable in the first two weeks but have about the same amount of total time for recovery (6 weeks). You should be able to be back to work in 2-3 weeks.

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.

aprokop
Participant

January 11, 2024 at 1:28 pm

Post count: 22

#35944

Referring to your advice. It has been determined I have a solid fusion at C5/C6. If I have a nerve block on C5/6 and the pain goes away then I should I get a foraminotomy on that level even though I already had a fusion at C5/C6? If that doesn’t work and I get a nerve block on C3/C4 and find relief would a foraminotomy work on that level?

Donald Corenman, MD, DC
Moderator

January 12, 2024 at 2:24 pm

Post count: 8660

#35947

Ist, is there still residual foraminal compression at C5-6 based upon the CT scan? If so, and the block yields great relief, a foraminotomy should be helpful.

“If a nerve block on C3/C4… find relief would a foraminotomy work on that level?” Depends upon the pain you have, the CT anatomy (compression present) and the results of the block. Is your pain consistent with a C4 nerve compression?

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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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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