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  • Avatartrenee
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    Post count: 15

    I had a 3rd ACDF last Oct. Had increased pain immediately following. The pain started toward the back of my neck and shoulder blade on the left side. I informed my Dr what was going on at my 1st follow up and he told me it was normal due to how bad my neck was. Abou5 4 weeks into my “recovery” the pain increased and i noticed a lump on the shoulder blade on the left side. I also noticed swelling in the front part of my neck (chest area ). I loose my voice all the time and have major swallowing trouble. A recent CT with contrast shows hardware problems. A screw I the right side is backing out of the plate. Will i have to under go surgrey again to fix this

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7315

    You note three prior ACDFs. Were they all at the same level or were they different levels? You should not have increased left shoulder pain after an ACDF but could have temporary increased “between the shoulder blades” pain due to restoring the collapsed disc height.

    “Losing your voice” (dysphonia) can occur with the surgical approach, especially if the approach was performed on the right side. The recurrent laryngeal nerve (RLN) is susceptible to retraction injury on that side. Normally recovery occurs within 6 months and you are now 10 months out. Maybe a visit to the EMT doctor for a consultation could be considered.

    Dysphagia (swallowing difficulty) also can occur and is generally also temporary however, with a screw that is backing out, this can put pressure on the esophagus and cause further swallowing problems. This is another reason to visit an ENT and possibly get a barium swallowing study to look for screw irritation.

    The screw that is backing out is also an indication that you are not going on to fuse this level. A CT scan of the neck would be a good next study to determine fusion status.

    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.
    Avatartrenee
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    Post count: 15

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    CT, NECK, SOFT TISSUE, W/ CONTRAST (#55797341, 08/01/2019 12:00am)

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    AvatarDonald Corenman, MD, DC
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    Post count: 7315

    Had to delete the hyperlinks and your name as this site is anonymous.

    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.
    Avatartrenee
    Participant
    Post count: 15

    Dr sorry for such a delayed response to your questions you had for me about my questions i asked you for advice on and some understanding of what is going on with me.
    I have actually had a total of 3 ACDFs starting in July of 2015. I went to sleep like normal ( July 1st 2015 ). I was totally fine, no pains anywhere. I woke up the next morning and could NOT feel my left leg or foot. The numbness was from my waist down. After about a hour or so the right leg started to feel cold and rather quickly it too was completely numb as well. I was basically paralyzed from my waste down. My husband loaded me into our car and we headed to the hospital. We were in Dallas visiting my kids when this happened and home was in Jonesboro Ar. About an hour into the drive i suddenly lost controlof my bowels and bladder so my husband stopped at the first ER we came to which was Wadley Regional in Texarkana Ar. They took me in right away and started doing all kinda of test on me. A Dr came in about 30 mins or so after arriving and said he was the Neurosurgeon on staff and my tests had indicated to him that i needed EMERGENCY SURG on my neck.. Specifically C5-C6,C7. He said i had extremely large bulging dics and bone spurs that was impinging & compressing my spine. He said those Discs/nerves are the ones that send my brain the signal to breath.
    I didn’t understand how this could just happen to a person while sleeping & he didn’t either he just insisted this was the cause for all my symptoms.
    I had a prior Lumbar Disectomy in 2000. My symptoms were somewhat similar then as i was having but this time was way worse. In 2000 i had woke up in the middle of the night to go pee and when i stepped out of bed i fell face down to the floor! My left left & foot was completly numb! I went to the hospital & a Orthopedic Dr was on call. He explained i had 2 or 3 herniated disc & had to do surgery. He performed a discectomy & i started recovering almost immediately. 4 months into it, all was going well and i had a terrible fall and needless to say they had to do another surgery to fix me. Lol NEVER had another problem ( other than normal pain when i did things i wasnt supposed to do ) UNTIL the morning i described above.
    So i had the ACDF on C5,6,7 like i was told i needed. It did not give me any feeling back in my legs or feet! I found that all i could feel was big time pain in my arms and hands. I couldn’t hold anything without dropping it. I was still having incontinence. I was a mess. The Dr didn’t care to answer my questions. 2 days after the surgrey after my brother felt my left legg, he freaked out because it was ice cold. He told my nurse and they sent me to have a ultra sound on the leg. I had a DVT in my calf AND a pulmonary embolism in both lungs! Still paralyzed.
    93 days in the hospital then to inpatient rehabilitation to try and learn to walk again. I had started getting feeling back in my right leg and foot so that helped in my physical therapy. The left leg & foot was still completely dead. They called my foot prob ” FOOT DROP”. They fitted my foot with a brace (called a AFO? or something like that ) and i ended up having to go home because Medicaid had said there was nothing more PT could do for me so was discharged. Wheelchair bound and incontinent, unable to use my arms to brush my hair! I had home heath care to take care of me when my husband was at work. Never getting Better and still in diapers (4 months after being home). I had called the Surgeon several times trying to get a appt to follow up after my surgery. I could not get this guy to return my calls. I was only seen by my PCP following getting released from the hospital! My pcp was at a loss trying to figure out what was causing all the problems i was having so ended up just giving me medications that didn’t help anything. She actually started being mean to me because she was frustrated that i wasn’t getting better. I told her i needed to have imaging done to at least see how things looked and i needed the damn surgeon to see me. In April of 2017 She decided to have me get a MRI at Wadley and gave me a referral to see Dr Smith ( the Neurosurgeon that did my surgery ). The Mri showed damage to C4. The Mri showed that C4 basically was busted up due to the hardware used in my ACDF . There was a bulge at C3 noted also which was pinching & compressing the spine!!
    In May 2017 i had my 2nd ACDF. Dr Smith was talking to his nurse & was telling her that he didn’t use a bone marrow trasplant (to do the fusion with the first time). He told her that he should have & was going to do it this time.? I also heard him say that the hardware should have been removed a long time ago. It was loose and was banging into the disc above it prob causing to damage C4.
    Then October of 2018… ACDF #3!!
    Still left leg and foot paralyzed
    Still extreme weakness in arms, hands, wrist and fingers. Neck pain mostly on left side , down between shoulder blades. Neck making a crackling noise constantly, loss of coordination, sudden jolt like shocks of electricity in my neck and bottom of my skull. Really cold fingers while thighs and toes were burning hot. Red and hour to the touch. Numbness on the left side of my vagina. Again i would tell him about all this and he again dismissed me. My pcp ordered a MRI. It showed a large broad based disc ( bone spur ) stabbed right between my spine and C3..
    After this surgery, it was way wrong immediately after surgery. I had this lump forming on my left shoulder. I had a stabbing pain on my shoulder that felt like a piece of bone was stuck I there. I noticed a lump on my chest directly under my chin and the left shoulder started getting a lump like the left side. I was choking on ago my food and liquid. Sometimes when i actually was able to swallow i felt it in my right ear and my voice is either hoarse or totally gone.. He told me the lumps were muscle spasms and would go away. The other problems were normal with the surgrey i had..
    Soooo he’s been saying that to me for the past 11 months. He actually did a few xrays and said everything looked great. Then he said he was going to get a MRI of my lower back to make sure there wasn’t a problem. He called a few days later and said i needed a TLIF Procedure done. He said my L5-S4 were blown out and than i had spinal compression down there that was the cause of most of my problems. This was 5 months after the last neck surgrey. Hopefulthat finally having back surgery may give me my left leg and foot back i had him do it.
    So far no leg or foot is back .. Maybe he should have done that 4 years ago idkšŸ˜­ but haven’t had any major post op issues yet with that but…..My neck is bad sir. He stopped taking my call and told my pcp i didn’t need to see him again. I told my pcp that she needs to look at my neck and see for herself what it looked like because i also was sending her message after message in our patient portal telling her all the things wrong and she didn’t seem to care UNTIL the day i walked in and she seen me. She screamed and covered her mouth. She kept saying ” oh no no no”. I started crying, she was crying and my husband to. She told me she was ordering multiple imaging test asap to see wtf was wrong and she did. Colonoscopy, Endoscope, Ultrasound , xrays and a CT Scan. The CT SCAN revealed these results….
    lelf shoulder. Choking when eating or drinking. Neck pain and left facial r..mbnesa. CompenS0n: 8/5/2015 CT cer,ical apine. Spiral Slices we,-e ottained from the sl<ull base tlYough the thoracic inlet following intravenous cortrast The skull base and visualized paranasal sinuses are clear. Nasopharynx and orophar,nx are urvemarkable. Par01id and submandibular glands are normal size and density. The valecua and ~form sil’IU$8$ are reasonatlly symmelric, La,ynx is normal. Thyroid is nOI enlarged a.nd has no dominant maois. Visualized lungs and upper mediastinum are unremarkable. Previous discectomy and fusion at the ~ and CS-7 inle,spaces, -.lh inlei\lal additional discectomy and attemt~ed fusion at the C3-4 and C4-5 int-paces. Alignmett 1& stabilized by a ventral plate and two screws at each level Moderate1,ancy arooo<I the C3 screws and lack of rusion across the disc inters pace. The rigl’lt C3 screw head has partially backed out of the fene8trated plate compered to the left. Shght bone erosion at the anteoor-inlenor margin of C3 vertellral body. The C4-5 level shows complete fusion and no loosening. CIYonic fusion at the C5-6 and C6-7 inte,space;, unchanged. No obVious hardWare failure. A marker placed at the top of left chest indicates and area of swelling or fullness according to the patient No soft tissue mass. edema or obvious lipoma at lhis lellel. IMPRESSION: Previ<lU6 anterior cervical discectomy and fusion at C3-4 through CS-7 intE<Spaces. M<lle recent aurge,y at the upper two levets, with lack or fusion at the C3-4 interspaoe and loosening along the &crew&. The right side screw has backed out ol the plate slightly. other levels show adequale bony fusion. No cervical soil tissue mass or lympl’ladenopathy. This CT exam wa!> pelfooued using one or more of the follCM1ing dose reduction techniques: 1 l Automated expo641’8 control. 2) Adj,..,lment ol thP. mA and kV “””Ā°’ding to body Jl”rf and p,,liP.nt size, and/or 3) Use ol ije,ative reconstruction technique, when available.

    Avatartrenee
    Participant
    Post count: 15

    After these results came in my PCP told me i had to follow up with DR SMITH again and see what he says needs to be done ( if any ). She gave me another referral to see him. I DIDN’T WANT TO GO BACK TO HIM!!! She said i had to because he is the one who did the surgrey… I go back and he tells me that the last fusion didn’t work. He said he used screws that were too small . He said the holes in the plate was bigger than the screws and that’s why they are loosing and why 2 on the right were actually backing out. This caused the plate too move and made the it impossible for the fusion to take hold because the plate wasn’t screwed down! He said he had to redo the ACDF @ C3-4. He would remove the HW and use larger screws. He said this would require him to go in thru the back of my neck and the front of my neck. I was speechless. This cant be happening.( I would rather die than let this man touch my neck again! )
    So i pointed to my lumps on my shoulders and chest and said, Will it make these muscle spasms go away too??”.. I said it’s weird that it’s now been a year since the surgery and these muscle spasms are bigger and they never Spasm.
    He looked at me and asked me when my last MRI was. I said about a year ago. He said he wanted me to have one JUST IN CASE there was ANYTHING else that needed fixed so he could do it all at once..
    I had the MRI 2 days later. Here are those results…..

    DATE OF EXAM: 09123/19 TIME OF EXAM: 1500 Report#: 0923-0391 Exam CPT: 72141 MRI cervical spine W11holt contrast HISTORY Cervical pan Pnor surgery COMPARISOO 7/Zl/2015 TECHNIQUE Mulhplanar MRI sequences were performed through the ce,vical sp,ne withou intravenous administrabon of gadol,nium. FINDINGSĀ· Mildlmode<ale roobon artifact ,s pr-nt on some sequences despite repeal attempts A metallic plate and mutiple screws are present extending from C3 through C7 consistert with prior ACDF. There is good algwnent The oord has normal signal. C1-C2: No significant at,, IOI niality. C2-C3: No significant abnonnality. C3-C4: A broad-based diffuse posterior disc-osteophyle complex present. This causes narrowing of the neural foram1na particularly on the nght Mild to Moderate cord nattenlng is present. C4-C5: Mild postenor 061eophyte lormabon is present and causes mild cord attenuabon antEt,or1y C5-C6: No significant at,, IOI mality. C6-C7: No significant abl IOI mality. C7-T1. nosig,ificart abnormality. IMPRFSSION 1 D,sc.ogteophyte cxmplex at the 3-4 ,nterspace as noted above This narrows the neU’al foramina particularly on lhe r’l1!1. 2 Prior SU’ge,y Dictated By:

    The Dr said he would look at the results and call me and let me know if there was any other problems that the MRI showed. I waited 2 days and finally called his office. Got his voice mail and left a message asking what the MRI RESULTS were. I also asked him to post them on the patient portal so i could see them. This was standard practice when ever i had any test such as lab work, or imaging done. They post it normally within 24hrs. NOT THIS TIME. In fact he didn’t ever post it. He did call and tell me that i still needed to have him remove HW, REDO C3-4 ACDF and he still needed to go in posterior as well as anterior in order to make sure the plate is fastened down properly in order to hopefully obtain a successful fusion.
    I still hadn’t seen the MRI results but he clearly didn’t tellme anything about having a broad-based diffuse posterior disc-osteophyle complex present at C3-4 causing narrowing of the neural foramina and Mild to Moderate cord nattenlng at C4-5.
    I got the results from the hospital myself. What do i do Dr?? What are my options? Am i allowed to have another doctor fix me? Can you explain what the CT SCAN and this MRI is saying? If surgery is necessary is it something that needs to be done asap? Is permanent damage a possibility with cord flattening??
    Sorry for the long long dialogue, it’s just so much info and hard to explain . There isn’t a short version I’m afraid. I’ll appreciate ANY input/advice you may have for me. Thank you so much

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