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  • westie California
    Participant
    Post count: 138

    Good evening Dr Corenman,

    Just received my results from CT Cervical Spine with the following findings:

    Comparison: Outside MRI Cervical Spine 5/19/2018.

    Findings: Postsurgical changes:Postsurgical fusion changes, appears to reflect a revision / addition since 5/19/2018, now appears to involve C3-T1 with multilevel postoperative hardware and decompressive laminectomies. Hardware appears intact, appropriately positioned without evidence of failure or loosening. Bony fusion appears solid at C3-4 through C7-T1.

    Alignment: Lordotic straightening.

    Vertebrae : Normal in height

    Soft Tissues: Expected postoperative changes.

    Disc Spaces:

    C2-3: Central disc herniation. There is associated minimal mass effect on the anterior thecal sac without significant central canal stenosis. No significant change.

    C3-C4: No significant disc disease. Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

    C4-5, C5-C6, C6-7, C7-T1: Postsurgical changes. No significant disc disease. Spondylitic ridging and uncovertebral spuring at C4-5, C5-6, and C6-C-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, Mild on the right at C4-5 and C5-6, mild on the left at C6-7. No significant foraminal narrowing at C7-T1. No significant central canal stenosis at any of these levels.

    My understanding is that bone spur’s from the uncovertebral joint’s causing foraminal stenosis can’t be addressed with a posterior foraminotomy, would an anterior approach be the correct procedure to address the above stenosis? Thanks in advance for any information you can provide.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    I assume you are talking about the C3-4 level where there is “Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing”.

    One of the questions is whether this level is causing you pain. The way to determine if this is a pain generator (and I am also assuming that you have neck and trap pain) is with a selective nerve root block. If you gain temporary relief, the you are a candidate for either an ACDF or a posterior foraminotomy. It really depends upon how large the prior posterior decompression was, and if the large compressive spur was generated more from the back (foraminotomy) or from the front (ACDF).

    See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

    Dr. Corenman

    westie California
    Participant
    Post count: 138

    I really appreciate your feedback and have additional questions please:

    Lets say this level is the pain generator, I already had an ACDF at C3-C4 w/plate and Laminectomy covering this segment. Does a CT scan show “if the large compressive spur was generated more from the back (foraminotomy) or from the front (ACDF)”? And if spur is generated from the front, will the previous ACDF need to be redone or would this be an anterior cervical foraminotomy? Thanks again

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    If you have a solid ACDF at C3-4 and you wanted to go from the front, then you would need an osteotomy at that level which is more surgery than you need. A posterior foraminotomy in the face of an anterior fusion is a good surgery as the surgeon can remove more facet to decompress the root without worry of instability.

    Dr. Corenman

    westie California
    Participant
    Post count: 138

    Thank you so much Dr Corenman, can’t thank you enough! Wishing you continued health and a great weekend.
    bye for now.

    westie California
    Participant
    Post count: 138

    Good Evening,

    I did forget to ask you a question, sorry about that. How does the above play out with Post- laminectomy cervical kyphosis? is the procedure still posterior foraminotomy or would a pedicle subtraction osteotomy be warranted?

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