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  • RSSMITH
    Participant
    Post count: 23

    Good Morning Sir-
    I am 2 years post-op from C3-C5 anterior fusion with C-4 corpectomy using expandable cage as well as left c6/7 posterior formainotomy. Continued symptoms of bilateral trapezius & deltoid pain, radiculipathy down left arm into 2nd and 3rd digits with pain and numbness, tricep weakness and spasms.

    Diagnosis of pseudoarthorsis (C4/5) and C7 radiculopathy due to disc osteophyte complex. There is 3.5 mm motion between the lamina in flexion and extension at C4-5, bone scan showed increase uptake in cervical spine and CT showed no evidence of solid fusion.

    Initial plan is to do C5/6 and C6/7 anterior fusion with zero profile devices and then possibly C-3-5 posterior fusion at a later date to address the pseudoatrhosis. I asked if while we we doing the anterior if we could not go ahead and just do a revision on the corpectomy and avoid the posterior fusion. Doctor advised as long as there was not a lot of scar tissue that could be possible but if too much tissue it would require too much “chisling” and prove difficult. I am also concerned about what additional load the zero profile devices would put on the non-fused segments above it.

    Any suggestions would be appreciated or do you feel we are on the right path?

    As always-thank you for your service on this forum!

    Kindest regards sir!

    RSSMITH
    Participant
    Post count: 23

    Sorry-I forgot to mention that MRI shows severe bilateral stenosis at C4/5 that is new/increased since the corpectomy surgery.

    Good Morning Sir-
    I am 2 years post-op from C3-C5 anterior fusion with C-4 corpectomy using expandable cage as well as left c6/7 posterior formainotomy. Continued symptoms of bilateral trapezius & deltoid pain, radiculipathy down left arm into 2nd and 3rd digits with pain and numbness, tricep weakness and spasms.

    Diagnosis of pseudoarthorsis (C4/5) and C7 radiculopathy due to disc osteophyte complex. There is 3.5 mm motion between the lamina in flexion and extension at C4-5, bone scan showed increase uptake in cervical spine and CT showed no evidence of solid fusion.

    Initial plan is to do C5/6 and C6/7 anterior fusion with zero profile devices and then possibly C-3-5 posterior fusion at a later date to address the pseudoatrhosis. I asked if while we we doing the anterior if we could not go ahead and just do a revision on the corpectomy and avoid the posterior fusion. Doctor advised as long as there was not a lot of scar tissue that could be possible but if too much tissue it would require too much “chisling” and prove difficult. I am also concerned about what additional load the zero profile devices would put on the non-fused segments above it.

    Any suggestions would be appreciated or do you feel we are on the right path?

    As always-thank you for your service on this forum!

    Kindest regards sir!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Generally, corpectomy surgeries have a much more difficult time healing that standard ACDFs. It seems to be what you are experiencing now. The lowest level of the corpectomy is not solid and the motion is causing bone spur formation exemplified by (“severe bilateral stenosis at C4/5 that is new/increased since the corpectomy surgery”).

    I think you need to find out which nerve is causing your current arm pain to the fingers. It could be the C6 or the C7 nerves. A selective nerve root block would be helpful to diagnose this particular nerve. The shoulder pain could also be caused by the C5 nerve as you now have severe bilateral stenosis at C4/5 (the exit of the C5 nerves).

    You already have failures of C3-4 and C4-5 as well as C6-7. You don’t mention the current status of the C5-6 level. You could consider leaving this level out if healthy but when sandwiched between fused levels above and below, it will probably wear out eventually.

    If the C4-5 level is very degenerative due to the pseudoarthrosis, a posterior fusion of C3-5 may not give you relief of the C5 nerve compression as foraminal narrowing does not respond well to a posterior decompression.

    See:
    https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/
    https://neckandback.com/treatments/posterior-cervical-foramenotomy/

    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 the helpful response. The C5 level shows broad based disc bulge with moderate bilateral foraminal stenosis. We did a series of SNRBs and I had the greatest releif at the C7 level.

    I am hoping they can do an anterior revision on the corpectomy as I too am concerned about any releif from a posterior approach. Their concern is how much work it would take if the cage is embedded. I definitely want to go anterorily for everything. They just advise they won’t know until we get in there.

    Again thank you so much for sharing your valuable insights. Have a good day sir!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I can see no reason why you could not go anteriorly as the X-rays and the CT scan should allow the surgeon to plan for any problems. Even if the cage is somewhat embedded, the films will demonstrate how much ingrowth is present at the top of the construct and what would need to be done for a revision.

    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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