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  • RSSMITH
    Participant
    Post count: 23

    October 2016 I had a C-3-C-5 disectomy with C-4 corpectomy with expandable cage and plating. Pain and weakness bilaterally in neck, upper traps and deltoids. Doing well after surgery, while in PT blew out c6/7 disc and had posterior foraminotomy March 2017. Now I have had return of pre October surgery symptoms along with muscle twitching in traps and SCM and diffuse swelling over both clavicles. CT/Myelogram performed May 30, Doctor said “all good”, report states at least moderate right side formainal stenosis C4 and C-5 due to hypertrophy and end plate spurring. 3 of the 4 plate screws are well seated, Left C-3 screw tip enters the ventral cortex. Top of plate not flush. No screw retraction noted. I asked Dr. about fusion he said on XRAY it looks like fusion has occurred (did not do flex/ext Xrays). No mention of fusion on CT/Myelogram. They are saying my problems are muscle related and referring to PT for dry needling. Could this all be muscle related or possibly something else? Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I have some concern about your fusion status. First, the CT scan is the gold standard for fusion so why your surgeon commented on your fusion status by observing an X-ray not even having flexion and extension views and did not comment on fusion status using your CT myelogram is unusual. There will be a radiological report read by a radiologist that you have a legal right to read and you might find some information there.

    You might have symptoms from a lack of fusion (pseudoarthrosis) at C3-5, continued compression of a nerve root, new degenerative changes (C5-6) causing root compression or facet disease. Ask to have your surgeon go image by image over your CT myelogram with you so you can understand what is going on.

    I worry about corcectomies with expandable cages as the fusion rate of these devices can be problematic.

    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.
    RSSMITH
    Participant
    Post count: 23

    Thank you so much for your quick response. Meeting with the surgeon will be problematic as he moved to a practice across state 30 days ago with no notice to patients. We are given option to see another neurosurgeon in practice but they are booked out 6-8 weeks. I do have the CT/Myelo report:

    Stable straightened cervical alignment status post C-4 corpectomy with C3-C-5 anterior cervical fusion with expandable interbody cage in place. C5 screws are well seated. Tip of left C3 screw extends to ventral cortex. No screw tract loosening identified.

    C2-C3 no disc herniation or significant spinal stenosis.

    C-3-C4 Status post C4 corpectomy with resection previous left parasagittal osteophyte and resolution of previous mass effect upon the left cord. Progressive interval enlargement of right unicate spur producing at least moderate right foraminal stenosis which has increased since prior. Correlate for potential right C4 radiculopathy.

    C4-C5 Progressive right formainal stenosis from enlarging right unicate spur with marginal disc bulge effacing the proximal right foramen and exiting C5 nerve root. Moderate right bony stenosis.

    C5-C6 No disc herniation or significat central stenosis. Mild right foraminal narrowing from unicate spur.

    C6-C7 Interval left formainotomy with resection previous left formainal disc herniation. No recurrent disc herniation or central stenosis. Unicate spurring without significant foraminal stenosis

    C7-T1 no disc herniation or spinal stenonis

    Impression:
    Stable ACCF C3-C5
    Interval left foraminotomy at C6-C7
    No new disc herniation
    Multilevel bony foraminal stenosis

    No mention of fusion status. I also do not understand how I can have moderate formainal stenosis with disc herniation at C-4 and C-5 when that was suppossedly removed during the diseectomy/corpectomy. As stated my NS said this CT/Myelo was “all good”. I dont know if I am comfortable seeing another NS in this practice. We have one orthopedic spine surgeon in town and a University Medical Center about an hour away. I am thinking I need to get a second set of eyes on this scan and reports, do you agree?

    Thanks again for your tremendous help!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    This surgeon’s move to another location far away from his old practice without notice is a major red flag as to the quality of his care. You definitely need a second opinion to shed light on your current symptoms. It is alway difficult to recommend who to see. It depends upon the age, experience, meticulousness and thoughtfulness of the new physician. This is why I generally don’t make referral recommendations here.

    You will note the radiologist does not comment on the fusion “Stable ACCF C3-C5”. This just states it appears as before but does not comment on fusion status. The CT/myelogram is what you need reviewed.

    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.
    RSSMITH
    Participant
    Post count: 23

    Thank you so much for your assistance, it has helped confirm that “nagging” feeling that I need to get a second opinion, but was reluctant because I always want to trust my surgeon but I just did not feel good about what I was being told with my symptoms. I really appreciate your assistance!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Please keep in touch to let the forum know how you progress.

    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.
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