[kbmkris]

#26613

I am male 34. I had ACDF at C4-C5-C6 last October. I am started having pain in elbows and fingers. Meanwhile neck pain has also started right where incision was made and also at base of neck. I also feel something is pushing on my throat. Below is the recent MRI results. Could you please help to understand it?

IMPRESSION:
1. Postoperative changes of anterior cervical fusion at C4-C6, which limits detail and assessment.
2. Minimal posterior endplate ridging, uncinate process hypertrophy and posterior disc margin
irregularity at the nonoperative levels, as described above.

Narrative

MRI SPINE CERVICAL WITHOUT CONTRAST
CLINICAL INDICATION: Arthrodesis status. Status post anterior cervical fusion at C5-C7 with
interbody spacers and solid bony fusion on x-ray.
COMPARISON STUDY: X-rays from 9/18/2017 and MRI from 8/23/2016.
TECHNIQUE: Multiplanar MR imaging of the cervical spine was performed utilizing standard sequences.
FINDINGS: Postoperative metallic artifact/image distortion at C4-C6 from anterior cervical fusion
and interbody spacers limits detail and evaluation. Craniovertebral junction is grossly
unremarkable. Tiny hypoplastic cervical ribs are noted at C7, slightly larger on the left. Cervical
spinal cord is normal in morphology and signal intensity. Visible nonoperative level vertebral
bodies are unremarkable, without compression deformity. Disc desiccation is evident at the
nonoperative levels. Visible paraspinal soft tissues are grossly unremarkable.
At C2-3, no disc bulge or protrusion is identified. Minimal right uncinate process hypertrophy is
seen.
At C3-4, no disc bulge or protrusion is identified. Minimal left uncinate process hypertrophy is
noted. Findings result in mild left foraminal narrowing.
At C4-5, postoperative changes limit detail. No gross abnormality.
At C5-6, postoperative changes limit detail. Left uncinate process hypertrophy is suggested,
resulting in mild to moderate left renal narrowing. No other gross abnormality.
At C6-7, postoperative changes limit detail. No gross abnormality.
At C7-T1, minimal irregularity of the posterior disc margin is suggested with POSSIBLE superimposed
very tiny central/right paracentral disc protrusion, shown on sagittal series to 3 image 10 and
sagittal series 501 image 14. Clinical correlation is needed.

Thanks

[Donald Corenman, MD, DC]

#26647

You note “I am started having pain in elbows and fingers. Meanwhile neck pain has also started right where incision was made and also at base of neck” after an ACDF of C5-7. How did these current symptoms compare to the previous symptoms that were present prior to surgery? See https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/ to understand how to convey how symptoms have changed.

You might have a pseudoarthrosis (lack of fusion) that an MRI is a poor study to determine fusion status. At the very least, X-rays including flexion/extension views need to be performed. Much better would be a CT scan. You might still have some residual nerve compression according to the radiologist (“At C5-6, postoperative changes limit detail. Left uncinate process hypertrophy is suggested, resulting in mild to moderate left renal narrowing”). “Renal” is probably “foraminal” narrowing.

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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