[ima164]

#7722

I am a 48-y.o. woman s/p ACDF C4-C5 and C5-C6 9/11/2012. I present now with left neck pain. My hx was prior severe right neck pain and arm numbness/weakness + many, many failed nerve blocks, facet injections and epidurals.

My MRI from this past week shows:

“….discectomy and fusion of the C4-C5 and C5-C6 levels….At C5-C6 there is some osseous productive change of the uncovertebral joins with moderate narrowing of the left neural foramen. There is minimal narrowing on the right.”

I didn’t want to bother with the rest of the report, because this is the part which seems abnormal in the area where I am experiencing moderate to severe neck pain. There is extension to my shoulder, but not down my arm/hand. I am just confused because the discectomy surgery seems fine and I did not really have pain on the left neck prior to the surgery.

Thanks for any clarification/advice you can provide me with.

[Donald Corenman, MD, DC]

#7727

The question is where is the origin of the left neck pain. If the pain radiates into the shoulder or down the arm, the origin could be from the foraminal narrowing of the left C5-6 level that compresses the nerve root here. I would also be suspicious of a pseudoarthrosis (lack of fusion) at one of the two levels of your prior surgery. This can be revealed by X-rays including flexion/extension views.

If there is no pseudoarthrosis present, a selective nerve root block (see website) of the C6 nerve with good temporary relief (see pain diary) would indicate that compression of the C6 nerve is the most likely cause of your pain. If this is the case, a posterior foraminotomy can be performed (see website) to decompress the nerve. This is of course assuming that you have failed conservative therapy.

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.

[ima164]

#7729

Thanks doctor. I did have that x-ray done, but unfortunately do not have the results. I will try to get those results and if the fusion is fine, I will look into a nerve root block of C-6 with my pain management anesthesiologist (who just did a L-4 right epidural for me last week – I’m a mess ;-)…).

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