[PhillyT]

#22089

Hello Dr Corenman and fellow Cal State Northridge grad!

December 2014 – Whiplash.
Neck pain, Arm pain, foot numbness with neck felxion.
August 2015, finally discover dynamic instability C6, hitting cord, causing arm and leg symptoms.
November 2015 – ACDF C6/7 Dr in Thousand Oaks CA
February 2016 – Arm and neck Pain persist. MRI shows bone spur and disc herniation C7/T1, Xray shows slight hardware collapse at fusion.

Current symptoms:
Left Arm pain into armpit, elbow, wrist, pinky finger. Outer forearm & pinky numbness. Pain at end of index finger and palm of hand under thumb.
Right arm – Pain into armpit/Inner arm. stops there. Pinky numbness.

Felxion Xray and Cat Scan cannot confirm successful fusion.

I’m seeing Dr in NYC for possible surgery to address this issue. He is having me do a SNRB at 6/7, then 7/1 to determine where the pain is coming from, since pinky pain and numbness could be from 6/7 or C7T1. Suspects fusion failure C6/7.

Facing a possible Posterior fusion at 6/7 and ACDF at C7/T1 in same damn day if both levels are causing pain.

If I went that way, I really don’t want to Fuse 7/1, but Riew says there are no discs big enough for 7/1 and there is little motion there to preserve. But I see where the Germans are putting M6 discs at C7/1 with success and frequency.

My questions to you…

1.
If this was your neck and you needed 7/1 fused, would you opt out and have an M6 installed instead of having C5/6 sitting on top of a double fusion?

I’ve seen on the ADRsupport.org page that a 45 year old male had an M6 ADR done at 5/6 and 6/7. A year later he is facing revision from bone spurs growing in his foramin.

2.
What is the bottom line on ADR and this bone growth problem. You don’t read about it a lot, but there are enough patients who have suffered through revision surgery that make it a scary decision for ADR.

3.
If I’m not fused at 6 months, and having micro movement issues at 6/7, would wearing my old collar for a month help restart a fusion process? Or is posterior fusion the only solution?

Thanks in advance for your time, Dr Corenman!
Tom F

[Donald Corenman, MD, DC]

#22101

Glad to hear from a former Matador.

Couple of considerations. First, did the symptoms resolve or at least change after the first surgery? If so, how? It worries me that “Xray shows slight hardware collapse at fusion” as this could indicate a pseudoarthrosis (non-fusion). Did you ever have a CT scan to determine fusion status?

Your symptoms “Left Arm pain into armpit, elbow, wrist, pinky finger. Outer forearm & pinky numbness” could indicate a C8 nerve root involvement, which originates from the C7-T1 level. “Pain at end of index finger and palm of hand under thumb” could indicate a C7 nerve involvement (nerve originates from your previously operated level and could be involved if a pseudoarthrosis occurred or the level was inadequately decompressed).

“Right arm – Pain into armpit/Inner arm. stops there. Pinky numbness” again sounds like a C8 nerve involvement and originating from the C7-T1 level.

I would not put an ADR (artificial disc replacement) at C7-T1 as this level moves very little and the ADR is not a good idea here. An ACDF is a good procedure at this level assuming the surgical anatomy is conducive (the clavicle is low enough for a safe approach).

Yes, ADRs can generate bone spurs and can cause recurrent nerve compression. This is one of the problems with ADRs.. The lack of fusion at C6-7 can regrow bone spurs and cause recurrent nerve pain. The reason for the selective nerve root blocks individually at C6-7 and then C7-T1 make sense to differentiate your symptoms by level.

It is rare that at 6 months, placing a collar will allow a non-fused level to fuse. You could try a bone stimulator but those devices are not too effective.

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.

[PhillyT]

#22108

Many thanks for the reply Dr Corenman!

I am currently under the care of Dr in NY at Columbia University Med Center. I hope he is a better surgeon than my last one who apparently used too small a tribecular metal interbody, and screws that are too short. Plus I hit my head 3 months after surgery which may have caused the collpase. So I’ll never know if it was the accident or not at this point. Are you familiar with Dr Riew? I hear is is very good, but that’s what everyone said about my last surgeon who screwed me up!!!

What I do know is that the posterior side of my spine at 6/7 widens slightly when I’m in flexion, but the Xray and Cat scan can’t conclude fusion because of the artifacts created by the stupid metal interbody.
Also, I am in a ton of dull achy pain when I look down in the slightest bit. So it makes sense that I’m not fused at this point.

He says we need the nerve block to guarantee where the source of pain is, prior to treatment.

If there is a lot of pain from 6/7 he wants to fuse posteriorly to stop the micro movements at this level, then flip me over and ACDF 7/1 in the event that the bone spur and disc herniation is the arm pain culprit at this level. I can’t even begin to imagine how painful this would be!!!!!!!!!!!!!!!

Riew said foraminotomies at 7/1 will not guarantee the pain will stop there. That’s a bummer since I was not wanting another ACDF!!!

But it makes sense if these two levels are causing pain.

So confused, but I guess the nerve blocks will give me a better solution to get out of this debilitating pain.

Thanks Dr!!
Tom

[Donald Corenman, MD, DC]

#22118

You are in the care of a good surgeon. The metal cage used for the ACDF I do not like for the exact reason you are having problems now. The cage does not allow adequate visualization of the fusion. The fact that the spinous processes widen with flexion/extension X-rays does indicate a probable non-union.

The posterior fusion is a standard way of getting the non-fused C6-7 level to fuse. This takes into consideration that there is not significant foraminal stenosis. A posterior foraminotomy sometimes is not adequate to decompress the nerve root. Your doctor intimated that this is the case as he wants to do an ACDF at C7-T1 instead of a posterior foraminotomy.

Another alternative plan is to do an anterior removal of the non-united cage at C6-7 and use autograft (your own bone) for C6-7 and for C7-T1 (if that level tests positive with the SNRB). This allows only one approach, fixes both levels and removes the offending non-united cage at the same time.

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.

[PhillyT]

#22165

Thank you for the information Dr Corenman. I took that suggestion to Dr R and before I could tell him about an anterior approach, he said that’s what he would do as well.

What complicates matters now is that I am having some difficulty swallowing since my ACDF 6 months ago. He said we will have to avoid that approach and do a two level foraminotomy and fusion at 6/7 and 7/1. He recommends fusing 7/1 since a foraminotomy alone won’t guarantee resolving the pain. He said the level is already bad and he would be worried if we didn’t fuse it.

So I’m looking at a posterior surgery June 1 with Dr R. I hope he’s better that my last surgeon and can fix this once and for all. I can’t wait to get this behind me and heal up. I hear it’s a brutal recovery :(

Thanks for your support Dr! I really appreciate!!! This spine surgery world is scary, confusing, and full of bad surgeons. It’s good to know there’s a bunch of good Dr’s out there like you and R!

Regards,
Tom

[Donald Corenman, MD, DC]

#22172

My pleasure-please keep the forum advised as to your progress.

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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