[SpinelessWench]

#8258

Dr. Corenman,

My cervical spine was first fused in 2001… anterior C3-C5 procedure, with traditional stainless plates and screws / cadaver bone. In 2006, I underwent a posterior cervical fusion of C5-C7, also with plates and screws. Due to failed arthrodesis in multiple areas, I underwent a complete cervical revision in 2008, resulting in removal of all posterior hardware and subsequent replacement with titanium dynamic stabilization instrumentation & BMP from C2 – T2. I healed well after the revision procedure in 2008, and have had only minor flare-ups with radiculopathy or acute pain.

Within the past 6 months, I’ve experienced an increasing frequency of loud “pops” in my fusion area, specifically around the C2 & C3 vertebral region. Since the revision fusion of 2008, I’ve obviously lost much of the ROM in my neck — from right to left, I’d guess a maximum of 7 degrees of movement now. These “pops” aren’t the occasional grinding sounds patients get… These are ~significant~ pops, and most commonly occur when I attempt to turn my head to the left — this occurs at least once or twice daily at this point in time. If I’m standing close to someone, they can actually hear it.

There’s no radicular pain associated with this “popping”.. Just some localized discomfort when it first happens. I’ve not had standard films taken of this area in a while, however I’m wondering if the facet joint in that area could be the instigator, or perhaps even some loose instrumentation. From my understanding, fusions are intended to stabilize an area and prevent movement, but popping (to me, anyway) is a sign of bony features interacting with one another. Can you offer any insight?

Any suggestions would be helpful.

S.W., NC

[Donald Corenman, MD, DC]

#8260

A fusion from C2-T2 is an extensive one and will place stress on the C1-2 and the T1-2 levels. This can eventually wear them out. Popping and clinking can be a sign of wear of the facet joints but also could be due to a pseudoarthrosis of one of the fused levels.

Pops can also be from the facet joint “releasing” similar to the pop caused by a chiropractor. Facet joints are under a vacuum and the pop is simply the release of the vacuum similar to the pop from taking a wet glass off a glass coffee table or granite counter.

The first diagnostic test other than a physical examination is standard X-rays with flexion and extension views.

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.

[SpinelessWench]

#8263

As always, thanks for your reply… Hope all’s well out your way.

S.W., NC

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