[PhillyT]

#22183

Thanks for the well wishes Dr.

My final question has been born out of fear and confusion quite honestly.

There are a lot of people that swear the posterior approach will leave me with permanent issues due to the fact a lot of tissue will be damaged.

I know the posterior recovery is excruciating compared to the anterior approach, but I’m more concerned with the permanent damage, bio mechanical changes, pain, etc involved in this posterior approach. My Dr says none of his patients have pain once healed, but when you read the forums, you see a lot of people have not benefitted from this procedure.

What is the bottom line in your opinion as to the real outcomes of a posterior approach; ie, is there a significant group of people that are left in pain due to this approach?

I’m trying to get the real story on this approach. The real outcomes.

Thanks Dr!

[Donald Corenman, MD, DC]

#22186

The posterior approach is more uncomfortable than the anterior approach due to the muscle retraction and yes, this approach can leave more discomfort than the anterior approach. The residual pain is however not a significant problem for most people. Your physician is worried about your swallowing difficulties that occurred from your initial surgery and this seems to be the reason for this recommended approach. Another anterior approach could aggravate your swallowing difficulties. Maybe you could ask for an ENT consult to see if there is anything that can be learned about the swallowing problems if you would prefer an anterior approach.

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]

#22408

Hello Dr Corenman,

Well, I rolled the dice and went with a posterior fusion for my failed C6/7 union and for the herniation at C7/T1 on the left side. I did a two level posterior fusion 6/7 and 7/1 since I had swallowing issues from my ACDF in November, but now that I had my posterior fusion, my swallowing issues are gone! I guess the inflammation at the C6/7 area had something to do with my swallowing.

It was a VERY painful recovery which I’m still dealing with. Dr R told me, because I was on narcotics prior to surgery, I will have great pain with this posterior procedure, and he was right. It’s been brutal!

My question for you…

Pre surgery I had very little arm pain on the right, while I had tremendous pain on the left arm down into my pinky.

Post surgery, I have very high pain in the right pinky/ring finger and no pain in the left arm.

It’s like the symptoms simply switched arms/hands!!

I rushed back to NY for an EMG which was normal for the C8 nerve in my right arm. The post op MRI shows what may be a tiny blood clot on the C8 nerve which the body will absorb if this is the case.

I’m 4 weeks post op and still have tremendous pain and numbness in my right pinky and ring finger. It has not improved at all since it started two days after surgery. Dr R says it could be from positioning my neck from surgery, and/or the blood clot on the nerve.

Have you seen this before with your posterior fusions where this level of radiculopathy is created from a blood clot or positioning from surgery? I have a horrible feeling he doesn’t know what’s wrong and that I’m going to be stuck with this issue forever. How could neck positioning cause this level of radiculopathy?

When I press the Dr for help, he dismissed me as someone who can’t handle pain, calling me a poor candidate for any future spine surgeries and to focus on something else. It literally feels like my fingers are being crushed by a boulder 24 hours a day and that’s the response I now get from the world renowned surgeon.

Thanks for your time Dr!

[Donald Corenman, MD, DC]

#22410

Posterior fusions are painful compared to anterior fusions (ACDF). Your new opposite sided arm pain is not typical and needs to be looked into. It could be from instrumentation (I assume that screws were used) and the MRI can be helpful but since titanium metal can obscure imaging, a CT should be performed. Was there any decompression performed of the right side or just a posterior fusion and left sided decompression?

An EMG will generally not demonstrate painful nerve roots-only motor weakness which would be unusual from a posterior surgery.

A selective nerve root block might be helpful to calm down the nerve root.

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]

#22413

He said there was a very small herniation on the right side that was removed. They left side had a big herniation that was removed and that arm is fine.

I was in so much pain post op in the hospital that they did a CT scan and an MRI the day after my surgery. The CT scan showed all the hardware was ok. Then two days later is when the right arm went into serious pain.

Wed – Surgery
Thursday – uncontrollable pain/MRI and CT scan
Friday – went home
Saturday – Right arm pain starts.

So I asked if something may have happened between the MRI and getting home. This was his response.

Tom,
You had bruising on your forearm but that should all be gone by now. I do
think that your pain is due to the irritation and trauma of surgery and
that we put your neck in an extended position to make the alignment as
good as possible. That should all settle down as the bone heals. The MRI
will not show anything abnormal with this. If you want an MRI, I have no
objection to it but I would suspect that there is <1% chance that it will
show anything abnormal. You have post-op pain that will subside in time. I
know it it difficult but short of doing the anterior operation that I told
you about, there is nothing that can be done. The more you worry about it
and think about it, the worse you will feel about it. The more you ignore
it and try not to think about it, the less it will bother you. The mind is
very powerful. When it is distracted, it feels less pain. The more you
concentrate on the pain, the more it will hurt. So at this point, your
choice is to wait for the 3 months for the bone to heal or choose the
anterior surgery – with all the risks that it entails. But given your poor
response to the 2 operations you have had in your neck, I would be VERY
wary about ever doing another operation on your spine ever again.

dan

Dr Corenman…
My finger pain is so intense I just don’t know what to do. His point about focusing on the pain is 100% valid but it’s hard when it’s excruciating and neurotin isn’t helping. I can handle pain. I had my hip reconstructed and took zero narcotics after the surgery. It’s so frustrating when you’re not being taken seriously.

Thanks!

[Donald Corenman, MD, DC]

#22414

OK-he did all the right things in addressing your pain post-op. If there is no nerve compression and he did do a decompression at the right C6-7 and C7-T1 levels, then this is root swelling and needs time. You might consider asking for a SNRB to calm the nerve down.

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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