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  • Avatarmnjody
    Participant
    Post count: 5

    12/26 I had ACDF surgery, intended to address C5-T1. Follow up CT shows it was a C6-T2 procedure. on 12/30 I had the remaining C5-6 space addressed as well. My question is this – I still have radiating pain from my shoulder blades to my elbow in my left arm. I was told the Post surgical MRI looked good, but when I read it I am not understanding if good means everything is as it should be, or if it is “good enough”. Can you please help me understand?

    IMPRESSION:
    Postsurgical changes. There is been improvement of the areas of stenosis or cord
    impingement since the previous study.
    EXAM: MR CERVICAL SPINE WITHOUT IV CONTRAST
    COMPARISON: November 21, 2019, CT scan of December 29, 2019
    FINDINGS:
    There has been interval surgical change with metallic plate and screws
    transfixing C6, C7, T1 and T2. Interbody fusion devices at C5-6, C6-7, and T1-T2
    are in place.
    Skull base-C2: No MR abnormality is demonstrated.
    C2-3: No MR abnormalities are demonstrated.
    C3-4: No MR abnormalities are demonstrated.
    C4-5: No MR abnormalities are demonstrated.
    C5-6: There is redemonstration of a focal central disc herniation and/or
    osteophyte. This impinges upon and deforms the cord. This is unchanged. Mild
    left neural foraminal narrowing is present.
    C6-7: Mild diffuse disc bulging persists. The focal disc protrusion or
    herniation seen previously has improved. Flattening of the cord persists but has
    improved. Neural foramina are patent on the right and mildly narrowed on the
    left.
    C7-T1: Postsurgical fusion changes are again noted. Epidural foraminal
    narrowing is seen. The focal disc protrusion or herniation seen previously the
    has diminished in size only minimal contact upon the dural sac. Left neural
    foraminal narrowing mild degree is evident.
    The T1-T2: Postsurgical fusion changes are seen. No central canal stenosis is
    evident. Neural foramina are patent.
    Alignment: Normal
    Bone Marrow: Normal
    Extra-spinal Findings: No significant incidental findings

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7262

    I am surprised that you had an anterior procedure with the bottom segment at T1-2 as this is a very low segment for an anterior approach. I assume this level was intentional and that the C5-6 segment “added on” 3 days later went well.

    Your continued complaint “I still have radiating pain from my shoulder blades to my elbow in my left arm” has some differential diagnoses to consider. You still have “mild” foraminal compression at C5-T1 on the left (“C5-6: There is redemonstration of a focal central disc herniation and/or
    osteophyte. This impinges upon and deforms the cord. This is unchanged. Mild
    left neural foraminal narrowing is present…C6-7, Neural foramina are patent on the right and mildly narrowed on the left.,,C7-T1, Left neural foraminal narrowing mild degree is evident”.

    However, residual “mild compression”, especially after an ACDF which hopefully stops motion of the disc space, enlarges the height of the disc space and subsequently enlarges the foramen should have resolved the compression and mechanical deformity of the nerve root.

    Shoulder to elbow pain can be generated by a nerve root that is still compressed or inflamed, a shoulder disorder like rotator cuff syndrome or even cubital tunnel syndrome. See
    https://neckandback.com/conditions/cubital-tunnel-syndrome/
    https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
    https://neckandback.com/conditions/rotator-cuff-syndrome-shoulder-impingement-syndrome/.

    The best way to determine the diagnosis is first with a thorough physical examination and if that is indeterminate, then with diagnostic blocks (shoulder and SNRB- see https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/). If cubital tunnel syndrome is suspected, a neurological consult and EMG should be considered.

    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.
    Avatarmnjody
    Participant
    Post count: 5

    I was as surprised as you with the T1-T2. It was a human error, which is why the second surgery was needed to address the c5-6 disc space. Will having the T1-2 done when it wasn’t needed affect me in anyway? I am still hoping swelling may be the issue in my pain, but now I know where to continue on looking if it doesn’t. Thank you very much.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7262

    The additional T1-2 fusion should not cause any long-term effects.

    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.
    Avatarmnjody
    Participant
    Post count: 5

    Thank you!

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