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  • aprokop
    Participant
    Post count: 16

    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
    Post count: 8409

    “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
    Post count: 16

    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
    Post count: 8409

    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.
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