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  • mvenkata
    Member
    Post count: 3

    Hi Doc,
    Thank you for taking your time reading through this. I am 36 yrs. old and in Dec 2010, I had two surgeries within 2 days to alleviate severe cervical stenosis. ACDF 2 levels from C3-C5 and PCDF from C3-C5.
    I had a severe radiating pain running through my shoulder to my left arm with severe head pain before my surgery which had lead me to the doctor’s office visit.
    There have been many ups and downs since then and now almost 21 months from my surgeries, I am often experiencing these symptoms which I had also discussed (MRIs and x-rays) with my doctor three times and I was told that the surgery has alleviated the pressure from the nerves and these symptoms might be related to something else. I can also see that the severe myelopathy (stenosis) is taken care off and the nerve shoots have good room to branch. I also tried physical therapy and it made my pain worse and caused more knots on my neck muscles.

    My Symptoms: Numbness in my right hand from time to time in the ulnar area. Stiffness/Neck pain and upper back pain on my right shoulder and Torticollis on the right side of the body.

    I have also noticed that this happens if I stressed myself a little more the previous day. Also whenever I experience these symptoms, the torticollis seems much more prominent which also leads me to think that my sleeping position or the torticollis is pinching some nerve and causing the pain.
    I did have one shoulder above the other since I remember, but my neck was always straight. Now after the surgery, it looks tilted and only if I keep my shoulder straight then the neck aligns straight.
    I want to get my life back and start exercising but given this above symptoms, I feel that I will cause more damage without knowing the reason for the stress and fixing the same in the first place.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Cervical stenosis (narrowing of the central canal which compresses the spinal cord) causes a condition called myelopathy. Myelopathy does not include neck pain as a symptom by itself as the spinal cord does not have any pain nerve ending in its substance.

    Neck pain is normally generated by the discs, facets and nerves but not by compression of the cord. You report “head pain” which I think you mean back of the skull headaches. If that is the case, this type of pain is typically generated by the facets at C2-3 and C3-4 (rarely by the C1-2 facets). If you have had a fusion of the C3-4 level and it is solid (lack of fusion can also cause these symptoms), then the base of skull pain could be from C2-3. Facet blocks (see website) can help to diagnose this condition.

    Shoulder pain radiating into the left arm sound to be a radiculopathy (see website- compression of a nerve root). If the pain radiates down below your elbow, that could originate from the C6 or C7 nerves. If the pain does not radiate below the elbow, then the C5 nerve could be involved as well as C6 or C7.

    Torticollis, I assume you to mean that you have neck pain that stiffens your neck. If this is the case, this neck pain can originate from degenerative disc disease or facet disease in the lower portion of your neck (assuming that your fusion of C3-5 is solid). A new MRI and physical examination can go a long way to help sort out your disorder.

    Dr. Corenman

    mvenkata
    Member
    Post count: 3

    Hello Doc,

    Thanks for replying to my post. I might not have come across correctly in the original post. My symptoms prior the surgery are not there anymore.
    I have a recent MRI and many x-rays after the surgery and all shows good fusion and no myelopathy or stenosis. C3 to C5 are completely fused.

    What i experience now is numbness in my right hand from time to time in the ulnar area. Stiffness/Neck pain and upper back pain on my right shoulder(which is mostly muscle knots as i can feel them too) and Torticollis on the right side of the body(The left shoulder goes much higher, but my neck looks short on the right side).

    My doctor has mentioned that this is musculoskeletal and not nerve related but also cautioned me to against adjustments(worrying that it might reverse the work from surgery) from a chiropractor. He told me that i might get some relief from massages. I have been in physical therapy last year , but the pain and numbness did not go till i stopped. Once I stress, they return back. I have also had a discussion with a chiropractor who feels that he can alleviate the pain and do corrections. He has done this to his mother-in-law after her ACDF.

    Doctor, I know that you have also practiced both studies and can better relate to my question on the safeness on visiting a chiropractor.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    I do not have any issues with my patients having chiropractic adjustments after a neck fusion that has become solid (as long as there are no other areas that demonstrate instability).

    Numbness in the ulnar side of the hand could originate from new or residual cervical radiculopathy, thoracic outlet syndrome, ulnar nerve compression at the cubital tunnel (elbow) or compression at the tunnel of Guyon (wrist). A physical examination and occasionally an EMG test can determine this source of numbness.

    Malalignment of the neck (torticollis) can be caused by scoliosis in the thoracic spine, antalgia (painful posturing), asymmetric degeneration of the cervical discs or malalignment from surgery. An X-ray and a physical examination will uncover the source of this problem.

    Pain in the neck can be caused by the discs, facets and occasionally nerves. Many of my patients can get adjustments after ACDF surgery but that is determined on a case by case basis and it also depends upon the skill of the chiropractor.

    Dr. Corenman

    mvenkata
    Member
    Post count: 3

    Thanks a lot for the reply. I really appreciate your insight.I live in Denver-DTC and I would definitely like to visit you in person to get evaluated. I will call your office on Monday to schedule an appointment. I will get all the MRI’s CTs and x-ray which i also have in discs during the visit. Thanks again for taking your time in replying to my questions.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    A pleasure. Please call the office directly at (970) 476-1100.

    Dr. Corenman

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