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  • hohman1118
    Participant
    Post count: 8

    Hello Dr. C.,
    I am reposting because I am really unsure what I should do or what my options might be. Can you assist me? 11 years ago I was involved in a near fatal MVA. Since my ACDF, I have had progressive pain (mostly in the last couple of years) in my neck and increasing numbness to my right inner arm and 4th and fifth fingers including palm. I have had some numbness and tingling to my left as well but not as much. Weakness accompanies the above symptoms and also coldness. I have also noticed numbness in my abdomen (weird I know). I have tried everything over the years mostly on my own. Initially I tried TENS, PT, hot/cold packs, Steroids, injections, NSAIDS, Muscle relaxers( highly allergic to those though). Wish not to take narcotics due to their limited help and also I have young children. I am a healthy 42 year old female that is active in youth sports. I am not over weight or engage in any risky behavior or habits. My doctor finally talked me into the MRI although I have been reluctant because I am quite sure I need another surgery. I have come to terms with the need to be more aggressive in treatment but I was wondering what you think so that I can be more aware of options. Thank you in advance!!
    MRI Findings:
    alignment of spine normal. There is anterior cervical discectomy and fusion c4-5. mild bone marrow edema is present at superior endplate of c7. there is a cord signal abnormality at c7 level consistent with degeneration. Otherwise the cord demonstrates normal signal without mass or syrinx.
    There is multilevel degenerative disc disease as detailed below:
    c1-2: normal
    c2-3: posterior ligamentous hypertrophy with mild canal stenosis.
    c3-4: annular disc bulging and posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate neural foramina narrowing.
    c4-5: discectomy with fusion. no canal stenosis or neural foramina narrowing.
    c5-6: annular disc bulging posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate to severeneural foramina narrowing.
    c6-7: right paracentral disc protrusion resulting in right neural foramina narrowing. posterior ligament and hypertrophy.
    c7-t1: normal.
    Impression: c4-c5 ACDF. multilevel degenerative disc disease as described above worst at c3-c4 and c5-c6 with canal stenosis and mass effect on the cord.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    You apparently had an ACDF at C4-5 after your severe accident 11 years ago. Most likely, you also had some milder, non-surgical injuries to some other neck structures. Over the years with normal wear and tear, these levels might now be problematic.

    Neck pain can originate from many structures including the disc, nerve and facet. Arm numbness and pain generally can originate from compression of the nerves in the neck or compression of the nerves in the shoulder or arm.

    Inner arm pain with numbness into the 4th and 5th fingers is normally the domain of the C8 nerve (occasionally C7), thoracic outlet syndrome or cubital tunnel syndrome. If you feel the pain radiating from the neck, normally compression of the C8 nerve in the neck is the culprit.

    Your MRI notes C3-4 “annular disc bulging and posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate neural foramina narrowing”. This could cause some pain radiating only into the tops of the shoulders and chest wall.

    “C5-6: annular disc bulging posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate to severe neural foramina narrowing” can cause pain to radiate into the shoulders and down the arm to the thumb side of the hand.

    “C6-7: right paracentral disc protrusion resulting in right neural foramina narrowing. posterior ligament and hypertrophy” can cause the symptoms you are experiencing. “Mild bone marrow edema is present at superior endplate of c7” could also indicate one of the causes of neck pain.

    “There is a cord signal abnormality at c7 level consistent with degeneration” is a confusing reading. Cord signal change could indicate a cord injury or the beginnings of myelopathy (see website for description). Cord signal change is not consistent with “degeneration”. Also, the radiologist notes canal stenosis (narrowing) “multilevel degenerative disc disease as described above worst at c3-c4 and c5-c6 with canal stenosis and mass effect on the cord” but he indicates that the signal abnormality is at C7 when the worst narrowing is at C3-4 and C5-6. This must be a misdictation on his part.

    To summarize, it seems that your compressed nerve at C7 could be causing your arm pain. The cord compression is not clear as to the level involved or the symptoms generated. If we ignore the cord compression and signal change in the cord for now, a selective nerve root block (SNRB) of the right C7 nerve should give you excellent temporary relief of your arm pain (see pain diary on website) which will diagnose and possibly treat this pain.

    If you have cord signal change at a level that compresses the cord, you need to think strongly about having surgery at this level. A consult with a spine surgeon is important at this point.

    Dr. Corenman

    hohman1118
    Participant
    Post count: 8

    I finally consented to surgery due to the right arm impairment. But the surgeon is MAD. He said because I had this surgery so long ago, he now has to track down the manufacturer of the plate that’s in my neck so that he knows what type of screwdriver to use. He said the surgery was not ideal because in order to fix my neck, he has to remove the plate just to reposition it and then do another surgery above and below the previous one. Anyway, would I need PT or OT or both? And what kind of recovery as far as driving, lifting, etc? If I need therapy, would I have to stay in the hospital for that? What’s the length of hspital stay with or without therapy. I am getting conflicting feedback from a few folks that have had this type of surgery done. Probably an insurance thing I suppose. I am a vet so I am having this done at the VA in Portland Oregon (the surgeon gave rave reviews about you by the way). I want the best recovery possible. So candid answers would be appreciated. I have not had great luck in getting answers to my questions from the surgeon. Staff have hinted that many returning vets from Iraq and Afghanistan could be part of it as this surgeon only sees vets once weekly. Thanks so much Dr. C. Your intellect has had a bearing on whether or not to forgo surgery!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    I don’t understand why your surgeon is upset. You might have misunderstood him. It is very common to have to remove unidentified hardware if you do revision surgeries and there are “removal sets” that have instruments to fit most any hardware.

    I assume he is operating on the level above and below now. The recovery depends upon the graft or spacer used in the surgical construct. See the section under “Recovery information by surgery/ACDF” to understand what a standard recovery protocol is.

    Dr. Corenman

    hohman1118
    Participant
    Post count: 8

    I reviewed what you instructed me to do. It’s standard and doesn’t say anything regarding triple ACDF and it’s recovery. Is it the same as a single? The surgeon told my husband and I that it would be a lengthy surgery like 8 to 10 hours…is that common? I do as much research as possible before consulting with you including reviewing your informative site. I still see nothing about doing a triple. Again, Thank You!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    An ACDF performed above and below a prior solid ACDF with removal of the previously placed plate takes about three hours, give or take 30 minutes depending upon the graft used for fusion. I think you must have misunderstood your surgeon unless he also intends to perform surgery on the back of your neck too (a front and back procedure or a “360”).

    Having a three level cervical fusion is generally tolerated well by most patients. You might not be at olympic level sports after this procedure but generally can participate in many day to day activities.

    Dr. Corenman

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