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My hx is an injury to my neck with a herniation at C5-6 in 1992. Cervical fusion at C5-6 C6-7 in 2006. 2009 I was in an accident where I was rear ended. Prior to the accident I did not have much discomfort, only occasional muscle discomfort. After the accident, muscle stiffness in my neck & upper thoracic area that worsened gradually & increased within the first month that required me to seek medical attention. I should have gone sooner but I didn’t want to admit I had a problem & didn’t want to have this dominate my life as the first injury did.
In the three yrs post accident, the pain has become worse & is causing new symptoms that somewhat mimic my symptoms prior to my surgery. I am developing carpel tunnel in my right & starting to show signs of it in my left, ulnar pain right, starting in left. I have discomfort when I sleep in both hands but only in my small & forth finger & forearm on my left. I have pain at work when holding my computer & charting with a stylet which I feel is related to position & angle of my neck when holding the device. I have a tingle in my scapula area that developed following the accident that is always there to varying degrees.
I went to my original surgeon following the accident who took flex & ext xrays & stated I had no movement at the fusion levels & said I had a solid fusions. He sent me to a pain clinic which I have been working with since. The doctor has me do PT mostly & recently I caved in & had an epidural injection with little benefit. The pain & muscle spasms increased greatly when the therapist tried traction to take the pressure off at the fusion level. It felt good when in traction but caused spasms & pain following.
I then had a CT with intrathecal contrast that the doctor said didn’t show much for changes. Showed nonunion at C5-6. He sent me to see a different surgeon who said he couldn’t see any one thing he could put his finger on that he could fix that he felt would give me significant improvement. He suggested I get a second surgical opinion. That is scheduled for April 30.
On April 12th, I coughed to clear my throat & had a zing down mostly my left arm into my 4th & small finger that put me in severe muscle spasms in my neck. Severe enough that my supervisor & several nurses I work with noted swelling in my neck muscles & could see spasm. They wanted to take me to the local ER. I work at a surgical hospital as a nurse so one of the surgeons looked at me. He put me on pain meds, muscle relaxers & ordered a new MRI. He has yet to go over the results with me but I looked at the radiology report that really shows nothing new.
All the reports are saying bony fusion at c6-7 & suspected pseudoarthrosis at C5-6. I have had EMG’s of both arms, neck xrays post fusion,post accident & recently. MRI post surgery, post accident & this month & the CT scan with contrast done in March.
My neck pops & grinds, I have a spot in my right scapula area that is like a zinger of varying levels of discomfort that has been there since not long after the accident. I wake up every night with varying degrees of tingling in my hands, right mimics carpel tunnel, left 4th & small finger & forearm. The only relief I get is I am now taking muscle relaxers 3 times a day & a pain pill at bedtime to help me sleep. I hurt 24-7 & I am not getting any answers.
Could the pain be from the non-fusion at C5-6 or could it be from the whiplash? I can usually cope pretty well but this is starting to interfere with all aspects of my life & work. I’m sorry this is so long but I am scheduled with a neurosurgeon April 30th & I would like to go into that appt. with some peace of mind if they are going to tell me this is as good as it gets. My original surgeon has since retired & I’m not sure where I would go if I needed another surgery. I hope you have some insight. My pain doctor, Dr. Bret Lawlor in Rapid City, SD suggested I contact you.
Thank you in advance. I look forward to your reply.
CathyYou have noted two particular problems from the accident, bilateral carpel tunnel syndrome and aggravation of a pseudoarthrosis (lack of fusion) at C5-6. The carpel tunnel syndrome is probably easy to treat. If you consult a good hand surgeon, most likely the first steps will be night time cock-up splints and a steroid injection into the carpel tunnels. If that is ineffective, then surgical releases are a relatively easy surgery with good success and quick recovery.
The neck pain is most likely from the pseudoarthrosis but a thorough work-up needs to be completed. The aggravation of the pseudoarthrosis is a typical finding from a motor vehicle accident. The fibrous tissue that held the two vertebra together (should have been solid bone) was damaged with the “whiplash” forces that occurred and is now painful. If that is the case, a surgical repair of that non-union level should return you to pre-injury status.
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.Since seeing you in your clinic in Sept, I went back to my surgeon in my home town. He once again told me he didn’t feel he could help me. He went so far as to say maybe he is losing his edge. He referred me to another surgeon who is new to our area. He recently finished his Fellowship in Houston, TX. This surgeon agreed with your recommendation for surgery but felt he doesn’t have enough experience to do the surgery. That being said, I feel my only option is to come back to your clinic for surgery even though it means traveling & having to make plans for follow up care. I do have some questions I would like answered & if this is not the place to address them, I will be contacting your office.
1. How much experience do you have with redo fusions & with this being redo of C5/6 & new fusion of C4/5, will it all be done from the anterior approach?
2. If I have surgery there, will it be in the hospital associated with your clinic?
3. How long will I need to stay in the area following surgery? Cost does become a factor since we will be coming from out of town.
4. Will I need to return to Vail for follow up care or can some of my therapy be done in Rapid City following guidelines from your clinic?
5. How long is the recovery time following a redo surgery?
6. Will I need any additional test such as having my vocal cords checked prior to surgery or will I just need to see my primary care provider for clearance?
I thank you in advance for the service you provide to patients & look forward to your response.
CathyAbout 50% of my work is revision work (from patients who have failed prior spine surgeries performed elsewhere).
Yes, the revision is generally performed from the anterior approach.
The only hospital I use is Vail Valley Medical Center.
About 60% of my patients are from out of town. You would generally need to be in the hospital for two days after surgery and stay in the valley for another 2-3 days. We have discounted rates for all the major hotels in the area including the Evergreen, 20 yards from the hospital, the Four Seasons if you desire 100 yards from the hospital and the Sonnenalp, a quarter mile from the hospital (they have a driver).
For all out of town patients, almost all post-operative care can be done in your home town. At six weeks, X-rays are taken by your family doctor or local hospital and you would then FedEx the image to us. Physical therapy starts at six weeks in your home town and continues for four to twelve weeks. Generally, twelve weeks after surgery another set of x-rays are taken and if the grafts have incorporated by then, you are free to do whatever activities you like.
Vocal cord checks are typical if a patient has had prior cervical surgery. If however, the same side is approached and the prior surgery did not leave you with a “breathless voice”, there is less concern about vocal cord checks. In that case, the anesthesiologist in Vail can check the cord status.
All patients need a primary care giver clearance. I look at all surgeries as I would a space shuttle launch. All systems need to be “go” or the surgery is scrubbed. This is rare but in the best interest of safety.
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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