[CJ Wood]

#29831

3.5 years ago I had acdf 5-7 due to myelopathy, pain, muscle spasms and hyper-reflexia of patella tendon along with positive hoffman’s test. It was my right side that was most affected by this. Continued to have muscle pain after surgery then started to have tingling and numbness on left side pinky and ring finger. Tried all the different injections including facet, medial, epidural, rfa and trigger points with little to no relief and had ncv/emg which was normal except for mild carpal tunnel.

Was referred to neurosurgeon 1.5 years ago for foraminal stenosis at c3-5 and had laminectomy for this a month after that visit. Developed severe pain after surgery which included both nerve and muscle pain. Tried trigger point injections, pt and had numerous x-rays, mri, ct scan which were all normal. A year ago I had ncv/emg and was told had mild carpal tunnel and c7 radiculopathy. Released by neurosurgeon as nothing they could do to help me.

I have tried to do the lightest theraband exercises and this brought on pain starting 24-36 hours later. Tried to use arms on treadmill or exercise equipment for a couple minutes and this also brought on pain so stopped all intentional arm exercises. This past summer tried to do grip exercises without any resistance and this brought on pain starting 24-36 hours later. I call these flares and they are progressively getting worse. Pt brought one on that lasted 3 weeks with nausea almost 24/7. Trigger point injections now bring on intense pain flares.

I see a pain management dr who is assisting with the pain and was referred to physical medicine dr recently. Still have hyper-reflexia now in arms and legs along with positive hoffman’s. Recent MRI was unchanged but new ncv/emg shows c6 radiculopathy on left side and c7 radiculopathy bilaterally. Was told extensive carpal test done and do not have carpal tunnel.

With all this in mind, where do I go from here as the nerve damage/compression is happening in the area I had surgery on 3.5 years ago but mri shows nothing wrong. I still have myelopathy symptoms which is most evident in feet and this is being helped by 2 nerve meds. Since nerve damage/compression seems to be spreading, any help or suggestions is appreciated on this.

[Donald Corenman, MD, DC]

#29833

Your first complaint after a C5-7 ACDF of “started to have tingling and numbness on left side pinky and ring finger” indicates involvement of the C7-T1 level which can occur if there was some previous degeneration that was unrecognized and then loaded with an ACDF above.

Your interventions (“Tried all the different injections including facet, medial, epidural, rfa and trigger points with little to no relief”) probably did not include a selective nerve root block (SNRB) at the C7-T1 level.

You were then operated on for foraminal stenosis at C3-5 probably by a posterior foraminotomy (“Was referred to neurosurgeon 1.5 years ago for foraminal stenosis at c3-5 and had laminectomy for this a month after that visit”). You then developed “severe pain after surgery which included both nerve and muscle pain” which can occur after a foraminotomy if the nerves are manipulated to open the foramen.

The EMG was interesting as you had an ACDF at C6-7 but still had radiculopathy (“A year ago I had ncv/emg and was told had mild carpal tunnel and c7 radiculopathy”).

Have you had a new MRI and a CT scan to look for the current state of nerve compression and fusion status?

It is possible that you have no current nerve compression but still have residuals could result from the previous nerve injury that is now gone due to the surgery. I think a new CT scan would be helpful.

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.

[CJ Wood]

#29835

Thank you for the quick reply. I had 2 mri’s since my last surgery and one ct. I have pasted the results below. I have not had SNRB and did not realize until I pasted the results below that ct notes issue at C7-T1 as no one ever addressed this. I was told both my mri’s and ct were normal by ordering dr. I do meet with my pain mgmt dr on Tuesday to discuss results of latest mri and ncv/emg and any suggestions you have would be appreciated. I would like to find out and stop the nerve compression that was not there before my last surgery but has gotten worse in the past year as I had c7 radiculopathy last year and c7 along with left side c6 now. Thank you.

Contrast Used:results Contrast Used: Gadavist 8
Compared to 4/3/2017.
Previous ACDF with anterior plate fixation at C5-6 and C6-7.
At C3-4 there is mild disc narrowing with mild anterior posterior osteophytes and mild posterior disc bulging without significant spinal stenosis or spinal cord compression.
At C4-5 there is mild disc narrowing with anterior osteophytes and mild posterior disc bulging without significant spinal stenosis or spinal cord compression.
No residual or recurrent spinal stenosis at the fused C5-6 or C6-7 levels.
No intramedullary or intradural abnormality.
IMPRESSION:
1. Previous ACDF at C5-6 and C6-7 without residual or recurrent spinal stenosis.
2. Mild degenerative disc disease and disc bulging without significant spinal stenosis or spinal cord compression at C3-4 and C4-5

Examination Date: 10/26/18 with contrast
C2-3: Unremarkable.
C3-4: There is mild disc bulge and mild bilateral uncinate hypertrophy without significant stenosis. This is unchanged.
C4-5: There is mild disc bulge and endplate spurring and mild bilateral uncinate hypertrophy without central stenosis. Thisis unchanged.
C5-6: ACDF without residual stenosis. This is unchanged.
C6-7: ACDF without residual stenosis. This is unchanged.
C7-T1: There is mild narrowing of the foramen from facet hypertrophy. This is unchanged.
T1-T2: Unremarkable.
IMPRESSION: There is mild multilevel disc degeneration without significant stenosis. There is prior ACDF at the C5-6 and C6-7 levels residual stenosis. These findings are unchanged. Cord is normal in signal intensity. No abnormal
enhancement.
Examination Date: 12/04/17
The appropriate dose reduction devices or manual techniques for moderation of exposure have been applied.
Estimated Radiation Dose (CTDI vol): .
Estimated Radiation Dose (DLP): 252.43 MGY CM

COMPARISON: August 31, 2017, MRI of the cervical spine.
TECHNIQUE: Noncontrast helical images of the cervical spine were acquired and reformatted in all 3 planes.
FINDINGS: Prior anterior cervical discectomy and fusion C5-C7. Solid osseous bridging seen across the fused segments.
No hardware complication or failure.
A well-corticated linear groove seen at the inferior margin of the left C4 facet series 500 image 32. Given it has wellcorticated margins, this is thought to be old and may be sequelae of an old injury. There is facet joint space narrowing bilaterally at C6-C7. C7-T1 facet arthropathy is present, more so on the left than right. Mild upper cervical disc space narrowing C3-C4 and C4-C5 incidentally noted. C3-C4 uncovertebral arthropathy is present
Cranial occipital junction is preserved. C1-C2 minimal spurring present.
Visualized intracranial contents are unremarkable.
Visualized mastoid air cells are clear.
IMPRESSION:
1. No acute fracture.
2. Mild upper cervical degenerative disc disease and uncovertebral arthropathy.
3. Prior anterior cervical discectomy and fusion C5-C7 with solid osseous bridging, and no hardware complication.

[Donald Corenman, MD, DC]

#29866

You have one report that might implicate the C8 nerve root (“C7-T1 facet arthropathy is present, more so on the left than right”). A SNRB here might be helpful to elucidate the cause of your symptoms.

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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