[Egggravy]

#8952

Hello, will you please read my reports following my surgery. I am 16 moths post-op and have not been under the Care of a surgeon since 5 months post-op. History: Surgery 02-03-12 level 2 at C5-C6, C6-C7, corpectomy, ACDF, Fusion with donor bone. Pre-op diagnosis of severe advanced disk degeneration, foraminal Stenosis and cervical myleothopy, broad based disk herninations at levels C4-C5, C5-C6, C6-C7 with one osteophyte at each level. Myleothopy was greater on right foramen at levels C4-C5, C6-C7 and at level C5-C6 disk hernination was milder than other levels. EMG/Nerve conduction study conducted because of severe pain in hands, fingers and arms. I was diagnosed with carpal tunnel that was greater in right hand.

When my surgeon first planned my surgery I was under the impression all three levels would be operated on. This did not happen and my plate is attached from C4 to C-7. I had both cervical and carpal tunnel release done at the same time. My surgeon only ordered one X-ray two weeks post-op and stopped providing me post-op care just a few months after surgery. The following reports were ordered by my regular physicians so there has not been any interpretation other than the report itself.

Current and Previous symptoms:

Symptoms I had prior to surgery reappeared almost immediately following surgery and have progressed, with the exception of approx. two weeks at 9 weeks post-op in which I felt like things were getting better. Soon after, I just continued to deteriorate. In addition to the old symptoms, I have had an onset of new symptoms never experienced prior to surgery. Starting in the hospital, I began losing control of my bowels and urine. I have no feeling to know it’s coming. This continued on a daily basis for several months after surgery. It still occurs, however, happens less often now. I have some numbness in my tailbone and vaginal area and my tailbone hurts to the touch or sitting like its badly bruised this feeling began seven months post-op. Horrible constant pain in cervical area at same levels of surgery and is very painful to the touch. My husband and I felt what appeared to be something large and jagged in the cervical area at C5-C6 at about 12 weeks post-op. This area began having really intense pain to the touch and deep inside. It was a dull achy throbbing pain. At around 14-15 weeks, I felt something in same area literally shift and had a grinding sound with a deep pop or snapping that caused an immense amount of intense shooting burning throbbing shock like pain that traveled down my spine.

My pain is worse on right side of neck and goes down into shoulders , down my spine, into the middle and lower portions of my back and radiates into my buttocks, tailbone, hips, down the backs of my thighs and into leg. While I did have some low back pain prior to surgery, it was not unbearable as it is now. My ipain radiates from my neck through my shoulders, into arms and down to fingers. I wake up all throughout the night because the pain is so intense in my sleep. I cannot sleep flat or propped low. I have to sleep sitting up or propped really high. I cannot sleep more than two hours before awakening from this pain. I have numbness in both hands, fingers and now my numbness in my feet, although it’s not extreme like my hands. This pain can often last for just a few minutes, several hours or up to several days at a time and has even lasted for months with zero letting up. Both hands are affected but worse on Right, Numbness in my hands and fingers with extreme pins and needles pain and electrical like pain almost always. My feet and toes also go numb and with pins and needles. On my left hand in middle and ring finger I have pretty intense numbness, pain and pins and needles.

I can no longer write more than a sentence and even that is painful to do. I scribble my name to sign and cannot grip a pen without intense pain, numbness, pins and needles. I can barely type and typically only with only able to use index finger on a good day, so now I use surrey to dictate for me. I cannot turn my head to the right without getting dizzy and fuzzy in my head with almost a faint feeling come on. It is painful to put my head back or down. I can turn my neck side to side quite far but it is more restricted when turning to left and again I cannot turn to the right without the sudden dizzy faint feelings. I often have extreme headaches at the base of my neck and back of head and along both sides of my neck that travels into my head. The pain is often nauseating. When I move my head in any direction I hear and feel a grinding and crackle sound. I have electrical like pains shooting down my spine from neck to low back. The pain is also a very deep throbbing and burning like pain. Its hard to explain what I mean by deep but it feels like its deep inside my bones. Last July, I began having difficulties walking and really had to think about each step. I can walk better now but not without pain, stiffness and my right foot is now turned outward to the right. My hands at times will be on fire with burning pain and swell. My hands at times will be red and I always have purple hew to my right hand. It was thought for years I had Raynaurds but I do not agree with this and neither does my physician. He continues to go back to RSD/CRPS. While I’ll agree that I have many of the symptoms I keep coming back to my neck as the culprit because almost always when there’s severe pain in my neck my hands go into spasms. The spasms my hands have are not typical of Raynaurds but more similar to RSD.

Approx. February this year my legs began to go numb when I sit after a couple of min. After the numbness when sitting began approx. May 2013 from my cervical spine down to middle of back moving over to the right side under my arm goes completely numb and stays numb for long periods of time. It began here and there but is becoming more persistent. Also in May of this year my right elbow had what felt like a lump. It got very large and felt hard but a few days later went down but a small marble like knot remained. My elbow continues to swell with I’m assuming fluid and after a few days disappears. It only hurts on the inside of my elbow down my arm not the lump itself. I feel very tight in neck, back and shoulders as if I’m having constant muscle spasms and have multiple knots in same areas of all my complaints and knots in my shoulders, on each side of my neck and on right side I have a couple of knots under my arm on my right side. On the right side next to spine I have another knot just under shoulder blades. Like if you drew an L from my neck to my right side. I also have a very large hard solid knot at the end of my low back close to buttocks. These are all very painful to touch and send a constant stream of pain, except for the one in my low back the one in my low back does not hurt but I have immense pain in my low back. I have received multiple injections into knots and painful areas in cervical spine. I obtain slight relief but its more like the peak of my pain gets tapered off with sporadic bouts of more relief on some days. I have pretty extreme pain so I notice the slightest improvements very easily and with less pain I can take less meds. Within 1-3 weeks after receiving shots the intensity of my pain returns.

In July of 2012 my right thumb and middle finger began to deform crookedly and a new pain at the base of my joints came. Suddenly the pain was worse and I have even more swelling of both hands and my right middle finger and thumb drew into the palm of my hand. This continued to get worse and now my thumb is deformed and same with my middle finger but now middle finger on most days neither I nor anyone else can get my middle finger to unbend. Recently I’ve noticed it is spreading to the furst three fingers on each hand. In addition to having almost same exact problems on both hands my left pinky and ring finger drop down in a stuck position as if I have a Charlie horse. This also happens to my left knee. It gets stuck and is extremely painful to move. Medicine definitely helps relieve some of the intensity but there is never enough relief to be free of this severe pain to function like I used to. The pain is deep, throbbing, burning intense pain that often shoots electrical like shocks of pain down my spine, into hands, legs and fingers. Since surgery I been diagnosed with Hyperthyroidism and Vitamin D deficiency, I did not have a thyroid or vitamin deficiencies before. Not sure if its even related but worth noting. I am also losing weight. Approx 4-7lbs per mo. for several months and recently last couple of months it’s only been approx. 2-5lbs per month. I am already a very thin person with no weight problems. I honestly just don’t have much of an appetite and the pain is often so intense it’s nauseating. I have really wonderful doctors that do their best for me but they are not Neuro surgeons which is what we all agree I need to fix this for me. I want my life back.

I apologize for the lengthy list of symptoms but after reading your responses to other posts it appears you really need more info in reading ones reports. Thank you in advance for any time you give to reading my post and reports and responding.

MRI CERVICAL SPINE, WITH AND WITHOUT IV CONTRAST

INDICATION: Cervicalgia, postop surgery from February 2012, bilateral
neck and arm pain

FINDINGS: The patient was given 10 mL of Omniscan IV with the enhanced portion of this study. Comparison is made with a CT cervical spine from 9/7/2012. Metallic signal loss artifacts noted due to anterior fixation
plates and screws extending from lower C4 down to C7. The C-spine is straightened with loss of the lordotic curvature. The C1-C2 and C2-C3 levels are unremarkable in appearance. At C3-C4 there is no canal or foraminal compromise. At C4-C5 mild bulging disc causes moderate
effacement of the ventral thecal sac and perhaps slight ventral cord
flattening. The foramina appear patent.

At C5-C6 bilateral osteophytic
foraminal encroachment is noted, left greater than right. There is also
moderate osteophytic ridging of the ventral thecal sac and mild ventral
cord flattening. At the C6-C7 level there is minimal bilateral
osteophytic foraminal encroachment but no cord deformity or significant
effacement of the ventral thecal sac. At C7-T1 there is no canal or
foraminal compromise. At T1-T2 also no canal or foraminal compromise.
The cord shows normal signal characteristic at all levels.
Impression
IMPRESSION:
1. Metallic fixation plate and screws extend from lower C4 through
C7.
2. Broad disc bulging with osteophytes cause moderate effacement of
the ventral thecal sac and slight ventral cord flattening at C4-C5.
3. Osteophytic ridging of the ventral thecal sac at C5-C6 is noted.
There is also slight ventral cord flattening at this level and bilateral
osteophytic encroachment, left greater than right.
4. There is mild bilateral osteophytic foraminal encroachment at
C6-C7.

TD – by JC on 11/2/2012 at 10:39
TE – by dc on 11/2/2012 at 12:07

Ct Scan 9-8-2012

CT CERVICAL SPINE WITHOUT CONTRAST

INDICATION: Cervicalgia, status post ACDF

TECHNIQUE: MDCT axial imaging was performed, and this was followed by reformatted sagittal and coronal imaging.

FINDINGS: The patient has had an anterior cervical and interbody fusion procedure at C5-C6 and C6-C7. The bone grafts are quite large at both levels, and it is probable the patient has had partial corpectomy at
both levels. Vertebral alignment is normal. There is straightening of
the C-spine suggesting muscle spasm. There are small bony ridges
posteriorly at C5-C6 and C6-C7, but this does not result in significant
spinal stenosis. There is neural foraminal stenosis on the left at
C5-C6. There is no mass effect within the spinal canal.
Impression
IMPRESSION:
1. Status post anterior plate and interbody fusion at C5-C6 and
C6-C7. The bone grafts are large at both levels, and it is probable
that the patient has had a partial corpectomy.

Recommend correlation
with operative findings.
2. Straightening of the C-spine.
3. Mild neural foraminal stenosis of the left at C5-C6.

TD JS on 09/08/12 at 1145
TE db on 09/08/12 at 1219

LATERAL C-SPINE X-RAY

Views are compared to the preoperative study of December 29, 2006. A screw and plate transfixes the C5, C6, and C7 levels. Vertebral body
alignment is normal. There is mild straightening of the cervical
lordosis again noted. Facet alignment is normal. The metallic devices are grossly intact. There is mild residual pre-vertebral soft tissue
swelling.

IMPRESSION:
1. Postop change of C5-C7 ACF.

[Donald Corenman, MD, DC]

#8958

Your report has some inconsistencies that I am unclear. You report an ACDF procedure at C5-7. You however have a plate on the anterior cervical spine from C4-C7 according to the CT reading but the X-ray reading notes a plate from C5-C7.

The CT/myelogram notes some spinal stenosis at C4-5 but this is not noted on the MRI. What is interesting is that there is no comment regarding fusion status of C5-7. Did these levels fuse or not?

Your symptoms could be related to myelopathy (injury to the cord due to compression) but this is not reflected by the MRI findings (normal cord signal at all levels). You could also have continued symptoms due to unresolved carpel tunnel syndrome in your hand.

I think you need a new set of eyes to take a careful look at you, your post-operative imaging and come to a conclusion regarding the cause of your current symptoms.

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.

[Egggravy]

#8975

Good morning Dr. Corenman and thank you very much for your prompt reply. I do not know if those levels have fused. I have never been told and have no reports stating they have fused. The only imaging ordered by my surgeon was the two week post op X-ray that I also included in my post. The other imaging (CT and MRI) were ordered by my GP and pain management doctor and they have not reviewed the CD’s only read my reports and they don’t really know what to do for me, however, they both agree I need a surgeon to review the actual images.

I am just as confused as you are because originally I was told all three levels would be operated on, however, my medical records from the hospital only show two levels and that the plate was attached from C4 to C7. That never made sense to me because pre-op MRI showed broad based disk herniation, myleothopy, foraminal/spinal stenosis and osteophytes at c4-c5.

I was able to look at the MRI from 11/2012 on my computer and to me the area doesn’t appear to look very good or like the examples of successful fusions I have found online to compare to.

The MRI report you read was performed at nine months post-op and I have not had any further imaging since, however, my pm doctor wants to order an new MRI, so I could easily request specific types of imaging if only I knew what to ask him to order.

Is it possible the areas the radiologist points out as being “very large” means there’s empty space, where there should be fusion?

Is there a particular type of imaging or positional views that would be better suited to tell us exactly what is going on or more specific in order to provide a more concise report so that these questions could be answered?

What type of imaging would you recommend? Would you be willing to be the second pair of eyes I need?

Thank you again so much. You have no idea how grateful I am.

[Donald Corenman, MD, DC]

#8977

The CT scan is the gold standard for investigation of fusion but an X-ray with flexion/extension views can be helpful.

The MRI is used for understanding canal and nerve foramen (see website) size although the CT scan can also be used for this with less detail and resolution. A CT myelogram can be more helpful than a CT scan but requires a spinal injection of dye.

The radiologist’s comment of “very large” spaces most likely means a comment on the graft sizes. Normal graft sizes are 7-9mm but with a corpectomy (removal of some or all of the vertebral body), the graft sizes can increase to 20mm.

you can contact my office for information allowing my review of your images.

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.

[Egggravy]

#8980

I will get the new views asap and forward them on to your office. The information you have provided has been very educational and helpful and I have appreciated such an informative site. Thank you for your time and all you do on behalf of educating the public.

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