[Donald Corenman, MD, DC]

#32545

“Recap is that I had ACDF C4 to C7 in Sept 2018. I was pain free for about 7 months, and the left radiculopathy/weakness returned at 11 months”,

“The new surgeon ordered a SNRB on C7 (Yay and thank you for recommending it back in the Fall!). I had that two weeks ago. The pre-procedure pain was a 5. With the Spurling Maneuver, it went up to a 7 before the procedure. Afterwards, pain was a 2 and Spurling maneuver did not increase my pain”.

“CT showed a little more fusion at C6/7 but I was not fully fused and there was still movement across spinous processes (> 4mm). Finally, this surgeon said that since my symptoms have been going on since August, my tricep and hand weaknesses might not fully recover and I might have permanent nerve damage from waiting”.

So to summarize for your neck, you underwent a 3 level fusion of C4-7 and had good relief including arm pain relief for at least 7 months but symptoms returned at 11 months. Suspicion was of a pseudoarthrosis of C6-7 causing return of nerve symptoms. This is a common scenario as a failure of fusion takes between 3-9 months to become symptomatic, The micro motion of the pseudoarthrosis can cause bone spur formation to recur recompressing the nerve root and recreating the arm pain.

The selective nerve root block results does demonstrate that C7 nerve is causing your arm pain. Is it a possibility that you could have chronic radiculopathy? It is possible but since you had relief from the surgery initially, this is less likely. See https://neckandback.com/conditions/chronic-radiculopathy-neck/.

In my opinion, the C6-7 level has declared itself as a pseudoarthrosis and most likely won’t heal, It is not uncommon for a three level fusion to have one level not heal. I can’t guarantee that you will regain strength in your triceps or hand, but with continued root compression due to bone spur formation/ there is a good chance that you will have at least some improvement,

“After my fall at the end of January, I started having low back problems (pain and left leg weakness). At L3/L4 level, the thecal space is less than 6 mm (apparently there is a herniated disc compressing from front, a bone spur, thickened flaval ligament and a gas-filled synovial cyst). I just had a nerve study and it shows that I have L4 compression, which explains the left leg weakness….Unfortunately, I have to wait until late July to have a face-to-face appointment with new surgeon. He mentioned surgery in my telemed visit. He said low back was an easy surgical fix and felt that waiting until August for surgery would not have a detrimental effect on nerve recovery.

I would disagree with this conclusion if you have actual motor weakness and not pain-inhibition weakness. Unfortunately, only physical examination can accurately confirm the differential. See https://neckandback.com/conditions/peripheral-nerve-anatomy/

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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