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  • Jellyhall
    Post count: 90

    Dr Corenman,
    I am hoping that you will help me to understand my neck problems.
    Last August, a neurosurgeon shocked us by stating that he thought I was going to need another surgery on my neck because he didn’t think it was fused. He sent me for flexion / extension x-rays and a CT scan. He also requested a new 3T MRI scan to see my cervical and thoracic cord.

    I had an ACDF of C3/4 and C4/5 done 7 and a half years ago. At the time the two levels below this were also not good, but the neurosurgeon said he would only fuse the two upper levels where my cord was being compressed because if he did all four levels there was a much higher chance that not all of them would fuse. The surgeon used two Titanium CeSpace implants. He didn’t used a plate or screws and didn’t use bone graft and I didn’t wear a collar. He explained to me that he had used this method for the last 10 years and it did work. He said that he would rough up the vertebrae to make it bleed and that my own bone would then grow through the hole in the spacers to fuse my vertebrae together. He said that the spacers had ‘teeth’ in them that would hold them in place while I fused.

    Most of my symptoms remained after surgery, but the surgeon had warned me that it might not help them and that he was doing the surgery to get the compression off the cord to stop the damage that was happening. He did say that I might need another surgery from the back later. When he last reviewed my neck about 3 years ago, he said that he didn’t need to do another surgery on my neck because there was still just enough room for the spinal fluid to flow around the cord. He did mention surgery on my thoracic and lumbar spine and emphasised that they would be very invasive. His follow up letter didn’t mention anything about surgery and it didn’t sound like there was much wrong with them. I wondered why he had talked about surgery during our appointment. After this, my GP felt that we should get another opinion. which we did.

    So I was very surprised to have another neurosurgeon tell me that he thought my cervical spine wasn’t fused. I am in the UK where we have to wait for a long time to see specialists. I had to wait until the beginning of February this year to get the results of the scan and x-rays to find out if I was fused or not. I was very disappointed to be told at that appointment that the registrar wasn’t sure if I was fused or not but it looked ok to her. She wanted to view the scans with the Consultant, but he was on leave, and she would write to me when she had done that.

    Today I received her letter. She mentioned that C2/3 had slight movement on the extension x-ray. I knew about that and there is a degernative grade 1 spondylolisthese there, but I don’t think that is a problem at the moment. She mentioned that the MRi of the whole spine showed degenerative changes throughout, but I knew that. There is just one sentence specifically related to my neck. I quote ‘Complete fusion has not yet taken place in the cervical spine’. Now this could sound like there is still time for my neck to fuse, but I feel doubtful that it will happen now, 7 and a half years after the surgery. My neck is becoming progressively more painful and the level of pain in both arms and especially the hands is also getting worse, and both neck and hand pain are significantly worse that before the ACDF. Back in August, the Consultant neurosurgeon pointed out the stenotic foramen to me. I hoped that if I needed a revision cervical fusion surgery, that he would be able to deal with that at the same time.

    In the letter today, no mention has been made of another surgery, just that they will continue to follow up in the outpatient clinic. I now have an appointment in August this year. I don’t think that this registrar neurosurgeon knows how long ago my surgery was. At the start of our appointment a few weeks ago, she was under the impression that my ACDF had been done at that hospital 6 months previously, and clearly hadn’t read any of my notes. Ideally, I would hope that when she viewed my scans with the Consultant, they would have read the notes and seen how long ago the surgery was done, but I know that he is a very busy man, very much in demand and overwhelmed with the number of patients he overseas. She does say that they do not advise any particular restriction to my mobility.

    So, my questions are,
    * is my neck likely to fuse itself now after over 7 years?
    * Is it ok to just leave it unfused? I do think that NHS patients are often left for much longer before surgery than in the US because of the waiting lists.

    I am feeling very grateful to you for the opportunity to come to your forum and ask my questions.

    Donald Corenman, MD, DC
    Post count: 8660

    Your neck will not fuse after 7 years. Non-fusion can on occasion be OK as long as there is no neck pain from the motion around the implants. If there is motion noted and associated neck pain, further surgery can be indicated.

    You also probably have broken down somewhat at the levels below if they “did not look good” 7 years ago. You note “the level of pain in both arms and especially the hands is also getting worse” which could indicate nerve compression at C5-6 and C6-7 as both of those nerves radiate into the hands.

    It seems the wait for spine care in the UK is much longer as I think this care is put on the back burner.

    Dr. Corenman

    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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