[shirley j]

#10677

Have failed acdf c3 to c7. No logical explanation. Disability retirement last 10 yrs. Just referred to as back pain by drs. Last physical med dr accused me of being a liar, asked if I was on public assistance, and gave me 20 pt visits. Rx of more vigorous exercise although at 90 lbs on 5’4″ frame I was clearly emaciated & in distress. Bowel had become irregular. Time able to be upright about 6 1/2 hrs daily with breaks. My left shoulder was rotating backward with left torticollis & gray outs. Low axial back pain with painless left leg limp when fatigued. Thoracic felt weak. Requested brace- refused.

MRI neck showed severe foramen narrowing c6 c7 and mild or moderate on rest of c spine. Lumbar showed spurring @ tip of tailbone, more on right than left. No thoracic testing.

Started physical therapy- all spontaneous bowel mvt ceased. 2 wks later I was injured stretching in supine position, hands behind head, pulling first toward one knee then the other. At first I just felt loose on leaving pt office. 3 to 4 hrs later there was loud cracking/popping of joints below arm pits: ankles, knees, hips, ribs with tingling. Mild burn began in pm. Burning increases over 24 hrs, became unbearable, and I went to ER.

Only PA available. Offered muscle relaxer that I knew I could not take so I declined it. He shrugged left room- didn’t return. Discharge clerk came. I insisted on referral to dr. Was sent to hip specialist who diagnosed hip impingement. Muscles of chest & abdomen tightened & saw pcp. My oxygen had dropped just below 92% from usual 98, I had leukocytis & mild hemoturia. Antibiotics. Had ribs, abdomen & legs wrapped in ace bandages from pain at the time. Forceful spasms in chest & abdomen began- contacted phys med dr & insisted on mri & surgical review. ER again as ribs compressing lungs- oxygen deficit.

MRI of thoracic showed disk buldge @ t8 & formation of multiple smorls nodes. CT scan showed rotation to left. Body xray shows head tilt, right scapular winging, uneven hips.

Saw neurosurgeon & complex spine surgeon & am being sent to 3rd surgeon who wants new neck mri. This is large hmo. Takes weeks to testing & appts. Injury happened last Aug.

Does anyone have any idea what happened to me? I had thoracic scoliosis prior to neck fusion but it was pushed straight by size/weight of fusion. Complex spine dr suggests hardware & implants too large & heavy.

No treatment to date. CTO brace supposedly ordered.

[Donald Corenman, MD, DC]

#10678

I am unclear as to a “failed acdf c3 to c7”. Did every level not fuse? Did the pain the surgery was intended for not recede? Did the fusion form in incorrect alignment? How did the surgery fail?

“Last physical med dr accused me of being a liar, asked if I was on public assistance, and gave me 20 pt visits”. If he thought you “were a liar”, why did he or she give you 20 physical therapy visits and on what basis did he or she not believe you?

“My left shoulder was rotating backward with left torticollis & gray outs. Low axial back pain with painless left leg limp when fatigued. Thoracic felt weak. Requested brace- refused”. These symptoms can be caused by multiple disorders that the origin is not clear by your description.

“Started physical therapy- all spontaneous bowel mvt ceased”. This does not sound like a pure neurological disorder (cauda equina or cord involvement). There other factors that are involved.

Your symptoms are all over the place “My oxygen had dropped just below 92% from usual 98, I had leukocytes & mild hemoturia. Antibiotics. Had ribs, abdomen & legs wrapped in ace bandages from pain at the time”. This is not just a spine disorder but there are many other systems that are involved. Start with a good internist to help ferret out these 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.

[shirley j]

#10686

Thank you for responding quickly. I have been to internist, GI dr & cardiologist. Had lab work & colonoscopy, ekg. Labs are negative for everything but slight hemauria and the leukocytis. Leukocytis resolved. Hematuria is the same. No organic disease. GI dr states lack of motility likely neurological associated with scoliosis.

Original c3 to c7 surgery considered failed due to pain syndrome limiting range of motion to 1/2 to 1 inch in all directions and slightly kyphotic posture. Ashamed to admit I didn’t know enough to get 2nd opinion. Daily 9-10 pain level- heavily medicated & treated for depression.

Two 1/2 years later range of motion increased and pain decreased to 7/8 with some days at 9/10. Sought surgical review & was given ct scan. Told that previously undetected bridging osteophyte between c7 & t1 had broken and that a screw was also protruding into that disk space. Disk was not ruptured but surgeon suggested it could cause spasm. He stated that posterior fusion might be necessary in future but it would likely increase pain level. Sought 2 nd opinion. That surgeon didn’t believe screw causing high pain level but offered no other explanation. I tried everything to recover. Diet. Exercise. Condition remained roughly the same with a few good days followed by bad. At that time I also went to physical therapy and my posture went from slightly kyphotic to slight extension to hold my head up higher.

I was able to reduce pain meds & went off antidepressants. Slightly over 3 yrs ago I noticed the pain pick up & slight backward pull to my shoulder. Meds increased. Just over 1 year ago I asked for surical review from my pcp but was told I had to see physical medicine first for testing.

I believe physical med dr caled me a liar because my lumbar spine looks pretty good. Perhaps degeneration was expected.

[shirley j]

#10687

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I agree that many systems are involved. Cardiologist & GI drs believe scoliosis causing dismotility & shortness of breath. This scoliosis film differs from what I had prior to the acdf.

The thoracic scoliosis from my late teens was small- maybe 4 or 5 vertebrae- and sharp with apex around t7 straightening out by about t10. It increased with collapse of cervical disks & my right shoulder had risen up pretty high just before acdf surgery.

The ct scan I just saw shows a gradual c shaped arc. Interestingly the films after acdf really didn’t show any scoli until now. I also have a protruding rib on left concave side of chest- maybe the 8. I get rib & abdomenal spasms especially at night. Morning stiffness.

I’m not agreeing to any invasive procedures until there is a logical fact based diagnosis. With my digestion & breathing affected, I do not think more pain medication will solve the problem either.

Thank you for your insights. I have no idea why I was sent to physical therapy. I regret it greatly.

[Donald Corenman, MD, DC]

#10688

Certainly you can develop pain some years after a C3-7 fusion. A screw into the disc space is not cause for alarm. This can occasionally cause degeneration of the disc over time however.

I do think that some type of exercise therapy can be helpful. Even small repetitive motions to strengthen without causing increased pain can be helpful. You can even do isometric strengthening (equal forces of muscle contraction to strengthen a joint without motion of the joint). You need to find the right therapist who can be careful but caring.

Your reports do not indicate one structure that is causing pain so be careful as to any further surgical advice unless there is a direct correlation between the pathology and the potential pain relief.

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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