[bethf]

#8095

Hello and thank you in advance for your professional guidance.

I am a 46 yo woman who has had a 4 level cervical fusion April 2011 from C4 – T1 anteriorly with cages and bone grafts. It was required due to the chronic DDD, spinal stenosis, Osteoarthritis of the facets, spondylolisthesis, spondylosis, radiculopathy, etc…. The fusion was successfulm as the “fusing” worked per my orthopedic surgeon.

Presently I have been having lower back issues – severe buttock pain, leg numbness, foot pain, extreme upper neck headaches that are relentless and horrible. I went to a neurologist for pain management hoping this would be beneficial since it has become significantly worse.

The neurologist sent me for an MRI of my lumbar spine and performed an EMG test in her office (plus some visual tests) At a follow up a few visits later, with the MRI results in her hand – (showing bone on bone S1-L5 and a 14 mm spondylolisthesis L5-L4, 6 mm hiernation at S1-L5, bulges at 4 other levels, chronic DDD of the entire lumbar spine, and so on) blood tests ruled out RA and Lyme disease….
Her diagnosis was that – she was giving me lyrica for nerve pain and She told me she wanted to send me for a “sleep study” at her facility to find out why I wasnt sleeping at nights. Needless to say, I already told her it was due to the pain that was waking me every night. She never mentioned the results on the MRI in front of her and only told me I had moderate to severe carpal tunnel in both hands as a result of her EMG test (hands which are numb too – but NOT my main complaint. I did have carpal tunnel surgery on both hands approx 10 yers ago)

Feeling frustrated since I was able to see on the MRI for myself – it was evident to see and read the radiologists diagnosis, I finally went to my family physician with the same complaints and she sent me for X-rays – which also showed the same slipped disc findings.

I decided to then go back to my orthopedic surgeon and now have a 2 level lumbar fusion scheduled for 3/12.

The New Neck Issue:
Upon the complaint of the new painful headaches and upper neck pain with the popping and grinding noise I hear in my neck – I had new x-rays of my cervical spine in his office. Both segments above the fusion at C3-C4 and C2-C3 show a 2 mm spondylolisthesis at each level (this is a new issue) The surgeon said all we can do is keep an eye on this and get x-rays again in a few months.
I know the worse outcome would be fusion of the entire cervical spine should things progress, which is not a pleasant thought. But with the pain I am in now, I almost feel it would be worth it if it comes to this.

My question is this: How significant is a 2mm slippage on these upper cervical discs?? I am finding it to be a hard time researching anyone elses disgnosis similiar to this to get a better understanding of my condition. I know they are given in “grades”, but i don’t know what is the average vertabrae size in mm (length and width)?

How typical is it to have adjacent segment degeneration happen as quickly as it seems to have occurred on these upper levels?

When (at what grade and millimeter) would you reccommend a “total fusion’ is the slippage worsens?

Thank you again for your insight and professional opinion
I really appreciate a second opinion regarding my neck.

[Donald Corenman, MD, DC]

#8100

You have to take symptoms and match to the findings on an MRI. Degenerative slips of 2mm by themselves do not concern me too much. The headaches however do fit with these slips as degenerative facet disease at the upper two levels can aggravate the C2 (greater occipital nerve) and C3 (lesser occipital nerve), both of which radiate into the base of the skull and head.

With this possibility, a patient with this disorder that I would treat would then have selective nerve root blocks of these two nerve or facet blocks of the C2-3 and C3-4 levels (pain diary-see website). Good temporary results would lead to facet rhizotomies (see website).

At this point, there is probably no need for surgery of these two levels.

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.

[bethf]

#8245

Thank you for your previous reply. I appreciate your time.

I have had recent fusion L4-L5 and L5-S1 done on 3/12/13.
I had intermittant leg weakness in my right leg prior to surgery for several months.
After surgery, for the 1st 3 days when up and walking, my right leg would go out and I had a hard time walking without aid. By day 4 I could walk without aid.
10 days later I started with intermittant severe right leg cramping, especially in the calf region and down to my foot. The pain is so severe it brings tears to my eyes. The pain starts a couple minutes after standing or walking. It can be described as a bad charlie horse that won’t go away when walking/standing on it.
I will start PT in 4 days and hope maybe this will help, and I have been active as instructed since home with walking and leg stretching excercises.
can you give me any advice as to what could be the cause of this calf pain?? (it is not a blood clot – this is confirmed)
I appreciate your expert opinion. Thank you!

[Donald Corenman, MD, DC]

#8247

Fusion surgery of the lumbar spine involves using pedicle screws to fix the vertebra in place and restrict motion. The surgery itself involves nerve manipulation many times. Post-operative hematomas can form (blood pooling which can displace nerve roots).

By the sounds of your symptoms, you have developed a radiculopathy. Muscle cramping is somewhat common if the nerve is not functioning well (the muscles will cramp if the nerve supply is incomplete to the muscle making the muscle work harder).

I assume you did not have a large dural tear in surgery.

Ask your surgeon if he or she would consider a post-operative MRI. This scan can reveal many of the disorders that can occur to the nerve post-operatively.

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.

[bethf]

#8261

Thank you for the quick response and information.
I don’t know if I had a large dural tear or not. Would the Dr have told us this after the surgery?? or is this something we need to ask?

I did have an excruciating headahce in the base of my skull for 3 days and NOTHING worked to relieve the pain. I just read that a dural tear can cause this type of headache. The nurses (from several shifts) told me I either was having a caffeine withdrawal…(i have no clue where they got this information since caffeine is not a big deal to me.) Or the nurses told me that the headache was most likely from the IV medication I was given for pain.
I was under the assumption the headache was the same aas the ones I had been having that i recently told you about in my previous posted question.

the pain level of my back after surgery was a 9 for 4 days straight, the head ache pain level was a 12. (on a scale of 1-10)

can i ask my doctor for written report of my surgery?
thanks again

[Donald Corenman, MD, DC]

#8262

Normally, if a dural tear occurred, the surgeon should inform you of this. Headaches at the base of the skull are consistent with a dural leak which accompanies a dural tear. These headaches normally are related to head position with head up increasing the headache and head flat reducing the headache. Significant tears can cause headache pain for some days.

It is true that headaches can be caused by medications also.

If you have not received an “op report”, please ask for one. Your physician should be happy to give you the report or if not, ask the hospital for the report.

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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