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  • jefish
    Participant
    Post count: 7

    I am writing you on behalf of my wife. We live in SC. I have family that lives in Castle Rock, CO. I would like to have a phone consultation with you Dr. Corenman about her condition if you do those. Two days ago (January 28, 2015) she had MRI with/without contrast and a flexion X-ray. It revealed a pseudoarthrosis from her ACDF surgery according to her surgeon. She had ACDF surgery (C4-C6) on September 20, 2013. She did well for three months and then for the last 12 months gotten progressively worse. She has really bad neck pain and her left arm has gotten weaker. She has pain from her neck to her elbow. She has very little bicep strength in her left arm. She is now experiencing pain on her right side (from neck to shoulder) that she has not had before pre / post surgery. The only relieve she has gotten from severe arm / shoulder / neck pain is from facet joint injections (C4-C6) on both sides. It helped the arm pain but the deep aching neck pain remained. Her surgeon is recommending Posterior fusion and foraminotecmy on left side of C6 and possible C5 nerve root. I question him about her having pseudoarthrosis 6 months ago when she was having so many problems. Back then He had her have a CT scan and said she was fusing but not fused completely. He showed us the movement (pseudoarthrosis) on the Xray from still position to flexed. Below are links to her images for you to review for your opinion if you will. Your website would not allow me to post URL’s so just place the addresses below into the address bar of your browser to see the images. Thank you for your time Dr. Corenman.

    moodoweb.com/flexed.jpg

    moodoweb.com/straight.jpg

    moodoweb.com/mri.jpg

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Pseudoarthrosis is not uncommon after ACDF surgery, especially if PEEK cages are used. I can understand the reluctance of the surgeon to declare a non-fusion. A posterior fusion and decompression is not a bad idea. There are occasions that I feel a redo anterior decompression and fusion would be a better idea. It really depends upon the images, symptoms and examination.

    Dr. Corenman

    jefish
    Participant
    Post count: 7

    Hello Dr. Corenman,

    Since my last post my wife and I have gotten a second opinion for what is wrong with her and it was completely different than what her original surgeon said. I would like to know your opinion based on what this newest surgeon suggests. This Neurosurgeon has a reputation as one of the best in SC. He told us that my wife had multiple problems and they in his opinion should all be addressed. He said that she had pseudarthrosis from her past surgery and that the hardware was loose (from the movement in the straight and flexed imaging). He said she had severe compression on the nerve roots at both C5 & C6. He also stated that she had a reverse curvature or lordosis of her neck. He proposed fixing all of those things. I asked him were those PEEK cages the last surgeon used and he said Yes. His recommendation is to go back in Anteriorly and remove the loose hardware and decompress the nerve roots. He then said he would like to “rebuild” her neck to help give her a more natural curvature. He said he would do that by taking some of her bone and mix it with cadavar bone, etc. to form her neck at the levels of her surgery and a little above. He was extremely confident this would do the job. He told us if the hardware was not removed it would not fuse. What advice can you give from this new information? Thank you so much for your time Dr. Corenman. It is greatly appreciated!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    It sounds like this surgeon has good judgement. Removing the PEEK non-fused cages along with the non-fused instrumentation and replacing them with allograft and autograft is reasonable thinking. While he is there, realigning the neck back to a more normal alignment would also be a good move. You might have found a good reconstruction surgeon.

    Dr. Corenman

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