[biker]

#10798

I am a physician specializing in pediatric physical medicine and rehabilitation. I have a friend with neck and shoulder pain. A year ago, she had a C5-6 level ACDF. A few months later, she had recurrence of pain in her neck and deltoid area bilaterally. Here is her mri a few months ago. What are your thoughts? thank you

FINDINGS:

Straightening of the cervical spine with minimal kyphosis at
the level of C4-C5 is identified on this examination in a
patient is undergone anterior spinal fusion at C5-C6. Marrow
signal, vertebral body heights and prevertebral soft tissues
are unremarkable.

The cord signal is unremarkable.

C2-C3: Unremarkable.

C3-C4: Bilateral facet joint degenerative change and
uncovertebral degenerative change left greater than right
creating mild right and moderate left neural foraminal
compromise. Degenerative disc disease with mild broad-based
disc bulging also noted. No definite focal herniation. No
significant central stenosis.

C4-C5: Degenerative disc disease with posterior disc osteophyte
complex and uncovertebral degenerative change identified. Mild
left and moderate right neural foraminal compromise is
identified on this examination best on the oblique sagittal
images. There may be mild central stenosis also.

C5-C6: Status post fusion. Uncovertebral and facet joint
hypertrophy is identified bilaterally left greater than right
with severe right and moderate to severe left neural foraminal
compromise.

C6-C7: Mild disc desiccation without stenosis or herniation.

C7-T1: Normal.

IMPRESSION:

This study demonstrates multilevel disease as described above,
please see above report.

[Donald Corenman, MD, DC]

#10803

Welcome to the forum.

As I am sure you know, neck pain and deltoid pain can refer from C5, C6 C7 and C8. Does you friend have any neurologic findings like sensation change with Wartenberg pinwheel, weakness or reflex deficit?

I would not expect a Spurlings test positive with continued radiculopathy at a prior fusion but does she have a Bakody’s sign?

There is continued compression after the ACDF at C5-6. Her initial relief followed by return of pain in two months could be from this level or from C4-5. If C4-5 is a pain generator, she might have a positive Spurlings test.

I would use highly selective nerve root blocks to identify the pain generators. If this yields no relief, I would consider looking at the facets at C4-5 with facet blocks and finally, if no relief is gained, a discogram at C4-5.

This is all assuming that the pain is enough that she wants to consider intervention of course.

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.

[biker]

#10812

Thank you

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