mom4kids4catsMemberApril 16, 2013 at 12:06 pmPost count: 6
I am 10 years out from an anterior fusion of C5-6 and a posterior laminectomy (one month after my first surgery) and 4 years out from an anterior fusion of C3-5. I have had pain in my right arm since my very first surgery and was diagnosed with cervical radiculopathy this year-most likely from the C6-7 nerve area. All the information I can find on this is pre-surgery and how it resolves on its own. I have been unable to get a straight answer from anyone as to the permanent nature of this condition. I am in PT and just starting on Neurontin. The PT has helped my muscle pain in other areas (shoulder, trapezius) but has not touched the pain in my upper right arm. At times it is intense and disabling-I am trying to keep working as disability payments would only be a fraction of what I am earning in my new position. After 10 years I suspect this is permanent but can never get an answer to this question. Help!Donald Corenman, MD, DCModeratorApril 20, 2013 at 10:38 pmPost count: 8468
You now have a fusion of C3 through C6. The C6-7 disc has broken down and you have pain in your upper right arm. The question you pose is whether you have new pain from the C6-7 level vs. pain from chronic radiculopathy (the injured nerve or nerves that did not heal after your first, second or third surgeries).
I would assume that your pain is probably chronic radiculopathy as this pain has been present by your statement; “I have had pain in my right arm since my very first surgery”. See the sections on the website “chronic radiculopathy” and “nerve injuries and recovery” to understand this condition. I also assume that you mean the pain in your arm did not “go away” after the first surgery and did not occur as a result of your first surgery.
The way to determine if the C6-7 level is causing at least some of your arm pain is with a highly specific C7 nerve root block. This will temporarily anesthetize the nerve root. The relief you gain in the first three hours after the injection will indicate how much pain is generated by the C7 nerve root (see “pain diary” on this site).
The injectionist has to be meticulous and precise. Too much numbing medication injected into the C6-7 foramen can flood the canal and “travel up” the spine. This medication can also anesthetize the other roots in the canal giving a false positive test. This means that you would gain temporary relief as maybe the C5 or C6 nerve was also unknowingly but inadvertently numbed and the good results were thought to be from only the C7 nerve.
You can use this technique to also identify the individual nerve that was initially injured if the C7 block yields no relief. This test is useful to determine if other treatment is to be considered such as a spinal cord or peripheral nerve stimulator is contemplated.
Dr. Corenmanmom4kids4catsMemberApril 21, 2013 at 12:12 pmPost count: 6
Thank you for the reply! Unfortunately I am a bit skittish about nerve blocks and injections in my spine. I recently found out that the pain clinic I went to put down the incorrect diagnosis and gave me injections in the thoracic and not the cervical spine. This was right around the time that patients who received these shots got meningitis. Thankfully, this did not happen to me; however, I did not get pain relief (obviously). I was set to get an implant for pain when I found out what happened with the first pain clinic mess up. The emg that I had in the meantime suggested that the nerves in my arm were ok but I had “large units” of old/chronic cervical radiculopathy. When I called to ask if the Dr. could be more specific-the nurse responded rudely with, “I don’t know how much more specific you want him to be!” I guess I will have to deal with large units of pain because the medical establishment has entirely failed in my case. Thank you for a great site-your information is the best I have found online! Having knowledge and answers to questions about my health is just as important (if not more so) than medication.Donald Corenman, MD, DCModeratorApril 21, 2013 at 8:42 pmPost count: 8468
“Large units” of old/chronic cervical radiculopathy” most likely means that the EMG/NCV noted course firing when the examiner asked you to contract certain muscles while the needle recorded the muscle activity. This occurs due to chronic nerve injury and “nerve budding” (see the section under “nerve injuries and recovery”). It would be helpful to know what muscle or muscles were tested and found to have course firing. Get a copy of the consultation. This is your property and you should have all the office notes and dictations from your examinations as well as the doctor’s conclusions.
I understand your reluctance to have spinal injections from all the terrible problems due to the infections from injections. This debacle occurred due to some injectionists wanting to inject a similar product that was cheaper in order to make more profit. These injectionists purchased from this lousy “compound pharmacy” where the product was more inexpensive but the quality control was obviously faulty. The problem has been remedied and in the future, I do not think any injectionist will use any company but the actual manufacturer. You should however ask where the source of the injection material is from just to be sure.
Checking on your diagnosis and correct treatment algorithm is important to prevent mistakes which can inevitably occur in some practice situations. The implant suggested to you sounds to be a spinal cord or peripheral stimulator. Find the best person in your area to do this procedure or call the office and we will give you the name of the one we think is the best.
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