Hello, Dr. Corenman. I cannot thank you enough for the extremely quick response.
Thank you for your thoughts. If you do not mind, I have some more questions:
(1) That is a good point about pseudoarthrosis that I had not considered because my neurosurgeon insisted at the time of the CT that my fusion is rock solid and I took it as the gospel.
The CT that I had was performed 11 months after my ACDF was performed. My neurosurgeon did look at the CT himself and declared the fusion solid. The radiologist’s report does seem ambiguous, as you stated. I did not catch that on my own all this time how the radiologist wrote those comments.
My question is, how likely is it that the fusion was not solid after 11 months? My surgeon used two plastic discs filled with bone material and did not use an autograft or allograft. I did wear an electric bone stimulator for 4 hours a day for 4 months after the surgery.
If the fusion is in doubt and a new CT should be made, do I need to do the CT in conjunction with a myelogram or can it be done without a myelogram?
(2) In regards to the potential facet degenerative changes at C2-3 and C3-4, what would be the diagnostic testing that would be performed on those higher levels to see if that is the problem and what would be the course of treatment if the diagnosis indicated that I have facet degeneration and it is the cause of my pain? I am allergic to all NSAIDs, so if inflammation of those facet joints were the issue, that course of treatment would be a non-starter for me.
(3) Should I try to rule out a shoulder disorder (rotator cuff syndrome) before seeing an experienced spine surgeon and if so, what kind of physician should I see and what kind of imaging would be needed on my shoulder?
(4) Are the upright MRI images worthless because of the weaker magnet that the Fonar machines use? There were some comments in the radiologist’s report that concerned me:
“Spinal canal stenosis is sent at C4-C5 with concentric disc bulge and posterior ligament hypertrophy. The CSF space is erased anteriorly by the bulging disc. Minimal flattening of the cord is also seen at this level”
“Spinal canal stenosis at C4-C5 and C5-C6 levels is seen.
Bilateral foraminal stenosis at C3-C4 and C4-C5 levels is seen.”
(The radiologist’s report is contained in my initial post.)
(5) Would you be willing to look at any of imaging that I have had already done and would it be worth it? If so, I would be happy to electronically transfer them to you and if you do not have that capability I could mail/UPS/FedEx them to you.
Please note that I have had two flexion/extension X-rays, one CT scan post-myelogram and 3 MRIs done in 2012. The details of each of the 3 MRIs is in my original post.
Again, thank you so much for your time.