Non-fusion of cervical spine

///Non-fusion of cervical spine
Non-fusion of cervical spine
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  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7070

    If you have a long cervical fusion C3-C7 or T1 and you have a “grade 1 spondylolisthesis that moves slightly” at C3-4, then you might need to eventually have this level fused. I do have many patients who can tolerate a mild slip so it is not imperative than you consider fusing this level.

    I have not found that osteopenia affects fusion rate and HRT might help with speed to fusion but HRT can also cause blood clots so you have to be careful.

    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.
    AvatarJellyhall
    Participant
    Post count: 84

    Thank you for your reply.

    I have just received the cervical CT report, which is not completely conclusive (to me anyway).

    I quote :
    “There remains evidence of anterior cervical discectomy and fusion surgery involved the C3-C5 vertebral segments with interposed intervbertebral disc cages at the C3-4 and C4-5 interspaces. Some osseous bridging is noted with near osseous fusion of the vertebral bodies of C3 on C4 and to a lesser extent at C4 on C5.

    The combination of uncovertebral and facet joing degeneration seen to cause narrowing of the neural exit foramina on the left at C3-4 and C6-7 as well as bilaterally at C4-5 and C5-6

    The rest of the imaged neural exit foraminal and vertebral canal osseous diminsions are adequate.”

    Am I correct in thinking that neither level is properly fused, with the C4 on C5 being worse? (That is the level that looks like there is a gap between the implant and vertebra at the upper surface.)

    I am definately noticing increasing neck pain, headaches, especially when lying in bed and both arms and hands are getting worse burning and stabbing pains.

    I suspect that I may need to have another surgery done on my neck at some point. If the levels of narrowing of the neural exit foramina needed to also be treated, I am concerned that I could be left with other levels of pseudarthrosis. What do you think?

    I will also be having flexion/extension x-rays and a 3Tesla MRI scan done.

    • This reply was modified 1 month ago by Avatar Jellyhall.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7070

    The radiologist is noncommittal in his or her description of the fusion “Some osseous bridging is noted with near osseous fusion of the vertebral bodies of C3 on C4 and to a lesser extent at C4 on C5”. I am not sure what “near osseous fusion” means and then especially “lesser extent” to the level below. If you see a gap on x-ray and the CT is not convincing of bone crossing the disc, then there is a high possibility of a pseudoarthrosis. Flexion/extension X-rays are very helpful to match against the CT scan. The MRI generally is not helpful to determine fusion status. The neural foramen are tight at multiple levels which can cause radiculopathy.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7070

    Your reply for some reason did not translate to the forum. Please repost.

    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.
    AvatarJellyhall
    Participant
    Post count: 84

    Remembering mostly what I wrote;
    Thank you for your opinion Dr Corenman,
    I also felt that the radiologist wasn’t committing as to whether my neck was fused or not. It sound to me like neither level is completely fused, with C4/5 being the worst. This is after 7 years! A real surpirse to me, although I have never had relief of my symptoms and they are getting worse and more frequent. It is a shame that the radiologist doesn’t qualify the amount of osseous bridging, either as a percentage or whether it is inside the spacer or outside the spacer as I have read that less than 50% fused, or only osseous bridging inside the spacer indicates pseudarthrosis.

    I am hoping to have the flexion/extension x-rays done before the end of November. My appointment to really hear if I am fused or not is not until February next year.

    Am I correct in my thinking about the statement “The combination of uncovertebral and facet joint degeneration seen to cause narrowing of the neural exit foramina on the left at C3-4 and C6-7 as well as bilaterally at C4-5 and C5-6”? On x-ray images that were taken about 10 weeks after surgery, it looks to me that behind the spacers, and on the coronal view the openings for the nerve roots, have all been cleared and opened up. Am I right in thinking that the fact that the degeneration of uncovertebral and facet joints are causing narrowing of the neural exit foramina, indicates that the surgical levels of C3/4 and C4/5 are unstable? I would think that if they are solidly fused, there would be no movement and so osteophytes would not form at those levels.

    Comparing the x-rays done 10 weeks after surgery with the flexion/extension x-rays done a year ago, it appears that there has been osteophyte growth on the vertebra above the C4/5 spacer which looks to have pseudarthrosis, making it look like that vertebra is hanging over the one below by quite a bit.

    I really appreciate you sharing your opinion with me.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7070

    Uncovertebral spurs can still be present after an ACDF but should not grow larger with a solid fusion. These spurs can grow in the face of a pseudoarthrosis however. It is quite difficult to determine spur growth with an X-ray.

    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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