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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    First-it is not uncommon for an ACDF fusion with PEEK cages to go on to a lack of fusion. About 1/2 of these pseudoarthoses are stable with a fibers union and create no symptoms. Your comment “I went on to lead a very active life both at and outside of work for several years” indicates that this level was stable for some years.

    The accident at work could have been enough force to injure this fibrous union level or could have injured the levels above or below. Arm pain that radiated to your hand would indicate involvement of the C5-6 or C6-7 level as the nerve root at C4-5 only radiates into the shoulder. I would assume that your shoulder has been cleared of instability or a rotator cuff problem as that is in the differential diagnosis.

    At C5-6, you have cervical isolated disc resorption which can cause your base of neck and bilateral shoulder pain. According to the radiologist, your foramen (the nerve exit zones) are not compressed so the right arm pain is probably not from this level. You do have foraminal stenosis at C4-5 along with cord compression (the radiologist does not note the degree of canal narrowing or stenosis). I assume you do not have myelopathy-look that up on the website.

    I think some diagnostic blocks could be in order. Your neck pain is probably from the C5-6 disc and probably from C4-5 also. Again-make sure the right shoulder does not have pathology.

    The C6-7 level might be able to be left alone but this depends upon the findings of X-ray, CT scan and MRI. This is not something I can comment on without image review. You certainly might need an ACDF at C4-6. Based upon your image readings, you probably would not be a candidate for an artificial disc. I almost never perform an anterior and a posterior cervical fusion at the same time as I find no need for it. Fusion rates are quite high for autograft and relatively high for donor bone (allograft)

    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.
    venkat
    Participant
    Post count: 8

    Hi Dr Corenman, greetings – its been a while. I hope you are doing well.

    My pain and diagnosis journey continues and I was hoping to get your advice based on some new feedback I received. I didn’t want to come back before I got some clear idea of what to look for and some more effort based on our prior discussion.

    I am copying my earlier post below for additional details.

    Symptoms – started when I fell from a bike, had 7 fractures on the left side of my face, implying head was either rotated or I fell on my left side.

    Immediate burning pain in a few days time on my right upper back (traps, levator, rhomboid area), bilateral nerve pain and arm pain + finger weakness (all fingers).

    Have C6-C7 disc bulge and now a minor C4-C5, but several neuros thought it wasn’t a contributor. However, I didn’t get any flex/extension work done – more on that below.

    Was diagnosed with Thoracic Outlet Syndrome by an orthopedist (Dr). Another PT aware person told me I had a serratus weakness on right side. Also my head was rotated to right, indicating neck spasm. Based on this, I tried activating my right serratus anterior muscle and also spoke to some PTs about what my symptoms were being caused by. I was very concerned my repeated trips to neurosurgeons and Drs were not resulting in any clear diagnosis.

    Finally, a hypothesis sort of emerged.

    My symptoms are worse when my neck is propped up. Or when I look down and then up. When I look to the left.

    On my left side of the head/neck, when I lay down or get on my hands and knees (quadraped) and roll my head up and down, raise it up and down (flex/extend) it wobbles to the right. The muscles on the left seem very weak, to the point they appeared very very weak. Head pulls to the right at the top of the movement and near the bottom. The latter especially.

    Plus sports PTs showed a text which showed that my head was rotated similar to a case of torticollis, wherein left SCM was hyperactive (probably to compensate for the deep cervical muscles) and the right scalenes likewise, plus levator (perhaps accounting for the pain on the right). The initial muscle spasm post my accident may have stretched my long thoracic nerve shutting off my serratus. That’s what probably caused/worsened the Thoracic Outlet Syndrome on the right side.

    But by working on the muscle over months I managed to start moving my right arm better again. However, its not completely fixed. My left upper back remains problematic as does the right to some extent. Overall my left side of the body feels much tighter from top to bottom (all the way to my calves). Any extended period of time that I work, makes my upper back burn and the muscles start seizing up and nerve pain in my arms and hands follows. Not just the ulnar but complete distribution. However, tightest sensation (of pulling) in my 3rd finger which seems to imply C6-C7 level involvement?

    My nerve pain in hands arms remains, although some improvement is definitely there. Another PT told me I was rotated with rotated hips – could be postural, but I believe my cervical issues and head rotation is def, worsening things.

    Now I was also told spasmodic torticollis (which seems similar to what I developed post my accident) can be caused by Cranio Cervical Instability, with the SCM muscle in particular on the side of instability getting overactive. This is usually the result of accidents similar to “head on the car dashboard” which would be very similar to how I fell from the bike. Jam the head against the ground.

    I still can’t rotate my head much to the left. On the face of it, this appears to be due to tight muscles. However, when I do attempt to do so, my fingers and arms on both sides hurt. And my upper back starts spasming. Might be a protective mechanism I was thinking.

    While my torticollis is not very visible, I still believe its there since I can feel the contrasting muscle groups firing more than they should. My left SCM and right splenius/Upper Traps in particular.

    Other symptoms are left eye “weeps” more than usual, my left side of the mouth is numb and drools occasionally plus tinnitus on my left side. I was always more worried about my right side (I am a right hander) and its related to my sustenance and the pain and symptoms remain, but I am beginning to think the left is what is provoking the right

    Sir, is there any way I may test myself for cervical instability especially on the left side? I don’t have dizziness (which seems to be a standard issue mentioned by many), but I do feel that my left side is having some kind of impingement or myelopathy (I believe that’s the term? Correct me if I am wrong). But I do have problems with flexion, extension, and rotation. Especially flexion and rotation (especially to the left). I was having an issue wherein if a vehicle moved, I would fall forwards. But then i started doing some neck exercises and surprisingly, that has reduced.

    I think that my disc bulge at C6-C7 actually gets “provoked” or starts getting pinched, or the cord at the level is being messed up whenever I flex or rotate my head as the deep cervical flexors or ligaments which hold the vertebra together are weakened. My neck also crunches when I rotate my head though I can’t exactly say where the issue is.

    I was also told that my fibromyalgia symptoms could be due to “Positional Cord sydrome” which sorta matches what I am thinking above. Weak neck muscles cant hold the neck in a neutral position and the ligament flavum pokes the cord causing the issue. This has been researched by Dr Andrew Holman of Washington who has several papers on this. I was surprised by the concept but it seems to be similar to what has happened to me, as he mentions many of his patients developed fibro etc post a traumatic whiplash injury.

    A Dr on prolotherapy (Dr Ron Hauser) has also written a lot on cranio-cervical instability and how muscles spasm to compensate – in my case the torticollis seems to have been provoked by CCI which would match the reports on how spasmodic torticollis happens – though I hope its not that and its more at a lower level.

    I would post links to all the above but I know your antivirus policy prevents that – but I hope I am making some sort of sense.

    On the plus side, when I do deep cervical neck flexor exercises with a blood pressure cuff, I do see reduction in pain and symptoms.

    Sir, so is there a protocol I may follow to check for cervical instability especially on my left side? Where I think I took the maximum damage. I am praying that I dont have upper cervical spine instability – it seems to be a huge bother even more so than the regular. But can an issue at C6-C7 cause the symptoms I mentioned, wherein I have lost segmental stability, either the nerves themselves from the disc level are getting pinched or the cord at that level or both, and hence it’s causing all my spasms and general fibro?

    I would welcome any advice on how to go about discussing this with my doctors and seeing which tests to do and take. I have been advised flexion, extension X-Rays (wouldn’t rotation be also required) and if I can do them, manually try flexion/extension MRIs.

    Unfortunately, I developed claustrophobia after my accident, so I do MRIs only with sedation, which worries about flexing or extending my neck under such conditions wherein I am not fully aware.

    Any advice or insight would be very welcome. To reiterate, my hypothesis (which may be very flawed) is that I am having direct nerve/cord impingement on the left side as the neck is scrunched up on that side, and on the right side, its TOS (compensatory).

    I am unfortunately having to navigate this issue somewhat on my own, as till date I haven’t found a person who is well versed with trauma induced cervical issues locally. I would welcome any thoughts of yours on the matter,

    Thanks,
    Venkat

    My thinking was that my latest MRI in late 2013 was merely a cervical screening (as versus detailed) so not sufficient.

    Then i realized that my symptoms were already there when i had my 2009 MRI done a year and a half after my symptoms appeared. If so, what that MRI showed would apply (as my main issues already existed moreorless by that time). This would help me crosscheck the validity of what procedures to continue with and what to skip.

    One doctor recently diagnosed me with Thoracic Outlet Syndrome but I have heard that many cervical issues can coexist with TOS & i just wanted to make sure I could address all the possible modalities.

    I am wondering whether my upper/middle trapezius problem on the right side is due to any referred pain from a disc or the like (harder to diagnose? versus a “conventional” issue of std nerve compression at the disc.) so it could coexist with TOS.

    My guess is that its my scalenes which are the cause of the mess post the injury, but your insight counts for 100x. also with your hands on background as a chiropractor + spinal specialist, you’d know far more about how to resolve a possible TOS issue and the differential dx. i fear many of the specialists i have consulted with don’t really “get” soft tissue entrapment etc and TOS is something associated with extra cervical ribs alone.

    Symptoms

    Hi Dr Corenman, is there a way to send you my MRI and other reports? An email address? I a male in his mid 30s, and have chronic pain after an accident a few years back. I fell on my face, left side from the back of a motorcycle. Pain is not reducing / body doesnt seem to be healing, and diagnosis of the whole thing remains unclear. I would appreciate any help as I really don’t seem to have a clear understanding of the issue. Based on your forum posts and other content, I seem to have a mild bulge in my C6-C7 (as was originally diagnosed) and also in C4-C5. I am no expert and would appreciate your thoughts if I could send you the MRIs by mail after getting copies from the hospital.

    My symptoms as per your FAQ -please excuse any typos as I find it hard to type, my upper back – right side of the trapezius/lower neck seizes up on the right.

    What is the quality of the pain?

    Hands:I’d put it as 5 on a scale of 1-10…tolerable, but very irritating. Symptoms worsen if i strain my neck, eg on a pillow on the bed, laying on my back, trying to read a book. Or, at a desk, trying to use a computer.

    Lower neck/upper/mid back -right side – trapezius extending down to shoulder blades: 7…muscle just seizes up on the right side.

    My symptoms become worse i am on te computer or cross my legs when lying down. At night they seem to worsen.

    Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles?

    mostly burning, aching and pins and needles. occasionally sharp.

    in my left and right hands both, all over.
    fingers especially.

    left foot is always vibrating. after i took a medicine, prescribed by a doctor, its reduced…foot vibration/electrical sensation.. its in the background but tolerable, and spikes when i sit on a chair or in the car etc.

    medicine is methylcobalamine, alpa lipoleic acid, biotin, vitam b12 and folic acid.

    big issue is shoulder seizes up, id rate it a 7 in pain, complete spasm, basically trapezius muscle, base of neck on right side to near the shoulder …it just seizes up. medicine doesnt reduce it.

    Does the quality of pain change with activity?

    pain picks up mostly when i am at the computer, or i am lying down on my side or back with a pillow, reduces when there is no pillow and i am flat on my back/neck. sitting has it worse then standing, and standing, my feet hurt or are somewhat sensitive but thats probably because of lack of exercise.

    any slight forward head posture triggers my right side – upper middle/trapezius parasthesias and then burning pain followed by spasm.

    Is the skin hypersensitive to touch?

    Not at all places. But at some spots near my wrist etc, when tapping it, it vibrates/pains and referred signals to my hands.

    Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand.

    my nails appear to be more brittle, and color is more blueish and pale, after myofascial therapy (on traps/levator scapula) have become more pinkish with blue tinge.

    Percentage of Pain by Location

    What is the percentage of pain in the neck vs. shoulder and arm?
    This is important as lateral shoulder region can be typically associated with arm pain or nerve pain while posterior shoulder pain can originate from neck or nerve sources. Don’t forget that the shoulder joint itself can cause pain.

    Is it 80% neck vs. 20% shoulder and arm pain or the reverse? Is it 70/30, 60/40 or 50/50 (equal in both areas). This percentage number is quite valuable to determine what type of pain the disorder is causing. The pain may be all posterior shoulder (100%) or even only 100% in the hand (or both hands).

    the distribution between my neck and shoulder vs my hands is like 50-50% but to be honest the neck hurts when i turn it etc or is stiff, but my hands burn all the time.

    i have grown used to pain and work through it, but the neck/shoulder pain are unstoppable. the muscle seizes up. so fingers hurt all the time, and neck/shoulder hurt when i sit down and attempt to use the computer, extending the hand to mouse or keyboard …seizes up on right side, and i am right handed.

    its my upper back/middle back pain/spasms which are truly disabling.

    Rate each area that you have pain. If the neck has 4-6 VAS, the shoulder has 0-2 VAS, and the arm has 8-10 VAS, make sure that is noted.

    i dont know the VAS method but if a rank of 0-10 is employed,
    i’d say neck has around 4, shoulder/upperback around 8 and hands around 4-5 too. neck becomes stiff and aches along with feet if i sit for more than 15 mins and lower neck/upperback/right side of trapezius portion just seizes up. hands left and right keep burning 24/7. sometimes both, sometimes one. since my back is seized up (upper) i cant do many exercises. fingers and feet hurt if i walk too fast or attempt to jog.

    Is there weakness associated with the pain?

    Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is

    weak because the signal from the brain is interrupted due to a pinched nerve)?

    Is there now an inability to lift the arm due to pain or to weakness?

    Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle?

    i would say i have become weaker in terms of pulling and lifting things.. but it could be due to lack of exercise.. apart from walking my exercise regimen is non existent and even walking is occasional. my arms hurt if i lift them above my head and if i extend my arms at the shoulder and keep them akimbo, my back hurts (muscles)

    i cannot raise my arm (right especially) above the shoulder without being fatigued.

    both hands become numb and burn if raised above shoulders.

    Incoordination and Numbness

    Are there now some noticeable problems with coordination and walking?

    Do you find yourself unbalanced when you walk?

    Do you “misstep” unintentionally much more than you use to do?

    Do you have trouble keeping your balance in a pitch black room?

    Has your handwriting changed?

    Do you now have trouble picking up a dime off a counter, zipping a zipper or buttoning a button?

    Do you find lightening type electrical charges down your spine if you tilt your head backwards?

    Have your bowel and bladder function substantially changed in association with any of the above symptoms..

    Noticed handwriting, i find it hurts if i attempt to write for long periods, then again, it could be that i am fully a computer person now and havent written anything for around 8 years.

    but i am definitely weaker in picking up things and more butterfingered.

    hands are numb many times, begins with fingers.

    i tried the tennis in the sky method a few days back from the mckenzie neck exercises, basically tuck chin in, look towards the roof and move head sideways…when i moved head from side to side, i got severe dizziness and loss of movement control. went away though.

    Onset and Length of Time Symptoms Have Been Present

    How did the pain start?

    Was it a gradual onset over years or was there one specific activity or injury that caused it?

    When did that injury occur?

    Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?

    How long have the symptoms been present and have they changed in quality or intensity?

    For example, did you lift something one year ago that caused neck pain and in the last month you have developed severe

    arm pain that radiates down to the hand?

    Six years now since the issue became apparent.

    Fell down from the back of a motorcycle, face down on the road, injuring the left side of my face, too fast for me to stop,
    i was too tired/sleepy to even prevent it, and was trying to catch a bag that was falling off. the bike was going around 30 mph. i had some fractures around my left eye (plastic surgeon said around 5-7 fractures), and deep cuts which required stitches. i then developed a problem sleeping, and that night itself could not sleep due to neck pain. after chronic discomfort for around a year, istarted seeing doctors, and was told the disc bulge at c6-c7 was a probable cause but not a clear answer. after i started making notes and the pain became constant, and i went back to spinal specialists, one diagnosed it as possible whiplash, another said probably due to the minor bulge at c6-c7 in MRI.

    as things stand, its become worse since the past 3 years ?(been five years since the accident) as my sedentary lifestyle, thanks to this issue and high stress computer work, probably worsened my posture and also i have been unable to get proper diagnosis on the issue. a doctor told me i have significant anterior postural issue. as i type this, my left hand is burning and right shoulder/upper back are seizing up.

    since i hurt my back down a staircase recently, i got another MRI done and CAT scan showed probable hairline fractures to transverse process at L1-L2. so i went back to doctor and on mentioning my issues with burning was prescribed medicines and isometrics.

    upon taking the pill, within 1-2 hrs, my left foot’s intense tingling (basically buzzing vibration) reduces to a tolerable level. but my hand burning remains, upper back muscle seizing up remains.

    I would appreciate any answers, insights on how to get you my MRI pics, whether they are sufficient and if my above symptoms show any evidence that its actually from nerve root compression at C5-C6 or C6-C7, or it could be any other issue. this issue has badly affected my life and forced me to curtail my activities. not being able to work on the computer or undertake any activities is another serious issue.

    2009 MRI

    History: Neck pain since 1yr 6 month
    Technique: Multiplanar, Multisequence MRI imaging

    Findings MRI:

    Vertabrae:
    Cervical spine shows normal alignment with morphology
    Facetal joints: No significant facetal hypetrophic changes noted
    CV Junction: Normal. No marrow pathology
    Spinal canal:No bony canal stenosis

    Intervertebral discs:
    C6-C7: Diffuse disc bulge with mild impression on thecal sac. No focal root compressions. No extension into the foramina
    Other discs: No significant disc herniations (2013 MRI shows mild bulge at C4-C5)
    Cord: Shows normal signal morphology
    Pre and para vertabral soft tissues appear normal

    Impression:
    Diffuse disc bulge at c6-c7 level with mild impression on thecal sac

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660
    #19926 In reply to: Poor MRI Images |

    Sorry but I had to delete your personal references as this is an anonymous site.

    Looking at two selected images will not be diagnostic as information is missing. You have CNS or “crappy neck syndrome”. Multiple discs are degenerative. You have what appears to be cervical central stenosis at C4-5 or C5-6. You definitely have cervical foraminal stenosis (see website) at the cross sectional level (unidentified level) you added.

    This means you could have neck pain from cervical degenerative disc disease, shoulder and arm pain from foraminal stenosis and/or myelopathy from central stenosis.

    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.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    There is a lot to cover and some of your questions cannot be answered without an examination and evaluation of your films. We will start with your original pathology that required surgery in the first place.

    “Sizable disc protrusions deforming the spinal cord more on the right,a slight signal change immediately at and below the c5/6 level and a reversal of lordosis at c4/5 c5/6 c6/7 with degree of sub laxation”.

    You had spinal stenosis with some cord injury “slight signal change immediately at and below the c5/6 level”. This means some cord dysfunction and probable myelopathy (see myelopathy on the website). If this is the case, this would explain your continued symptoms; “I have balance issues and muscle memory problems in my legs and arms. Subtle but there. My right foot aches and tingles. My hands are weak. Worse on the right. My thumb and index finger spasm and pull towards each other, my middle finger goes numb, Worse on the right”.

    You bladder symptom “I have urinary urgency: certainly could be explained by the myelopathy. Your symptoms of “I also had GI bleeding and hemorrhoids. When I called to discuss it, the surgeons PA told me urgency isn’t from my condition” is not from the spinal cord. The PA was correct. Now stress and certain medications can cause some of these symptoms but not the cord.

    “The pain in my neck concerns me because I didn’t really have much neck pain before and it is now 6 months post op and the pain takes my breath away still. I awake in pain and many times I need to lay down to take the pressure off my neck. I don’t sleep well at all. Every time I move my neck, it hurts, even on medication”. Pain in the cervical spine after neck surgery could have certain causes. You could have a pseudoarthrosis (lack of fusion) which can be noted on a CT scan. You could have pain generation from the levels above or below the fusion. This is diagnosed with either selective nerve root blocks, facet blocks or discograms (see all of these on the website).

    “Can the pain be from bony spurring that was left there at the time of surgery now hurt worse, because the surgeon corrected the lordosis and there is more pressure at that level now”? The answer is yes-see above.

    “Can these fasciculations be caused by spinal cord compression?? Or damage”? The answer is yes but faciculations can be from cord injury, nerve injury or from metabolic reasons (your electrolytes are out of whack). “Isn’t it true that they are an indication of lower motor neuron issue”? Yes in general. Can a large disc protrusion cause damage to the anterior horn, without much indication of cord signal change? Yes but normally the injury is to the nerve root, not the anterior horn which is an upper motor neuron injury.

    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.
    lila
    Participant
    Post count: 9

    Hello,

    I will try to sum up my situation as briefly as possible. As I’m sure you understand, it’s hard to do sometimes.

    I am a 35 yo female. I did heavy manual labor as an emergency gas technician. I am 5’4″ and 125 lbs. In good physical shape other than these issues. Have 3 children. Now age 3, 4 and 13.

    In 2011 I had a SLAP tear to my right shoulder during a pulling/fall accident at work. Had surgery but had to wait because we found out we were expecting our third child during preop testing, so I stayed in PT through the pregnancy and surgery was postponed until after delivery in Feb 2012. I returned to work 7 months later to full duty, but still had burning under my shoulder blade that never went away.

    June 2013 was disassembling a large meter at work and heard/felt a pop in my neck or shoulder, not sure which, when the 36′ pipe wrench I was using, slipped off the pipe.
     I thought it was my shoulder because my arm felt tired and heavy and my hand was weak. After 3 days it never went away and I requested to see the doctor.
    My orthopedic surgeon that did my shoulder surgery, had imaging done and found my shoulder and anchors ok. He felt it was a nerve problem.

    I started having wide spread muscle fasciculations around 4 weeks after I first hurt myself and was very fatigued. I decided to see my GP as well, to get his opinion. 
     I had episodes of dots in my vision and dizziness. My physician was concerned and I was referred to a neurologist. By the time I saw him, I also seemed to have a hard time regulating my temperature. It was summer and I was cold to the touch. Especially my hands.
    Trying to describe all these things proved difficult. I felt very strange for the first 2 months. I kept saying I felt weak. I could barely walk into my back yard without needing to sit down. I felt overall sick.

    An MRI of my brain and cervical spine was done as well as emg and blood work. The Dr was concerned about ALS but those tests were normal. Although I did have an abnormal emg suggestive of nerve dysfunction in my right arm.

    Eventually the neurologist concluded,  I had a stretch injury to my braxial plexus. I was also diagnosed with benign fasciculations syndrome. That explained the fatigue and fasciculations. It seemed strange that all the symptoms had started around the same time, but I was told stress could bring on benign fasciculations syndrome. However I didn’t feel overly stressed when the started. It just didn’t seem to add up.
    All he said about my cervical spine,  was that there was some degenerative changes and unless I wanted injections, he didn’t think it was significant, because my neck pain wasn’t bad. Just really stiff and loss in range of motion. I certainly didn’t know how to read the MRI, but sure wish I had done my own research instead of relying on the Dr. to explain it. 

    Over a year went by and I was still out of work. Eventually the dizziness and vision issues subsided. I tried PT but the first day I went, the therapist did a bunch of bending and stretching of my neck and the following day I could barely move it and my symptoms were escalated. My neurologist advised me not to do any more PT for the time. He prescribed rest and muscle relaxers, that I didn’t like to take and didn’t stay on them. 

    I requested massage therapy at that point. My fingertips were tingling, I had stabbing pain under the shoulder blade still, a lot of muscle fatigue and tension, tingling/crawling in my right foot, my hands were cramping and my arms would posture when I was at rest. The fasciculations were pretty constant.
     The neurologist prescribed hand splints to keep my hands and wrists straight while I was sleeping. I felt tight all over. I kept thinking that in time they would eventually diagnose me with some sort of neurological disease that was presenting in a slow or strange fashion…

    I was told by the Dr at the wellness clinic handling my massage and deep tissue therapy,  to get a 2nd opinion from a different specialist, after he looked at my MRI for me. This was a year after the injury now.
    I saw an orthopedic spine Dr who referred me to a neurosurgical consult, on the first visit I saw him. He was very concerned about my neck.
    I saw the neurosurgeon, whom is well respected and the chief of neurosurgery at a main hospital in Buffalo, shortly after that and he looked at my images and testing and immediately proposed an acdf surgery to stabilize my spine.

    Apparently I had issues in my neck. I hadn’t fully understood. 

    The neurosurgeon states this under review of imaging:

    Sizable disc protrusions deforming the spinal cord more on the right, 
     a slight signal change immediately at and below the c5/6 level and a reversal of lordosis at c4/5 c5/6 c6/7 with degree of sublaxation.

    I also had other tests to rule out disease and he felt the complaints were definitely related to my neck.

    The surgeon requested an updated MRI and then suggested a 3 level due to a worsening of condition. The discs and ligament were calcified etc. Third disc had gotten worse and he felt it was necessary.

    Everything was happening so quickly then and I had been out of work for 18 months. I was really needing to get back to work for financial reasons.
    I was told surgery was being requested as “urgent” and I was risking permanent injury if I waited. 
    I had thought I had an arm injury and some neurological disease. It was rather overwhelming. I didn’t want to wait, due to the tone and urgency expressed by the Drs and also it was a work injury, and I didn’t want to do something against doctors recommendations and risk complicating my case further with my employer.

    I also started to experience urinary urgency but didn’t understand it at the time. Didn’t associate it and nobody ever really discussed it or questioned me in detail.
    I was diagnosed with cervical myelopathy and underwent a 3 level acdf with hardware and fusion for c4-c7 and correction of lordosis and sublaxation Nov 25 2014. The calcified disc and ligament was dissected. The surgeon said everything went well.
    My hospital stay was bad. I was unassisted ringing the bell for over an hour vomiting in a hard collar the day of surgery. I had a bad reaction to the meds and nobody seemed to listen to me regarding my sensitivity. I opted to leave the following day.

    I was heavily medicated for the first 2 weeks. My husband helped me keep track of doses and times.
     I was prescribed cyclobenzaprine, oxycodon, lyrica etc. I don’t like pharmaceuticals though and don’t do well on them. I seem sensitive to most. So I normally avoid them if possible.

    At first the symptoms seem to feel better. I came of the oxy at 2 weeks. Didn’t bother with cyclo because it didn’t help much. Stayed on a low dose of lyrica for 3 months. I was also kept in a hard collar for 3 months and the surgeon has said “a lot of work was done”. Still had pain in the shoulder blade. I had a shelf or lump in my throat, and still do. I was told it’s the nerves which make sense.
    New and worse pain in my neck though. A stabbing, awful, deep spine pain. Every time I turn or strain or move it. It’s constant.

    The fasciculations returned after I came off the medication to assess my symptoms and start PT at 3 months. I was discouraged and my therapist said we had months of work to do after assessing my mechanics. He kept me optimistic though. I enjoyed feeling my muscles doing work outs again. But it’s different than reconditioning. 

     I have balance issues and muscle memory problems in my legs and arms. Subtle but there. My right foot aches and tingles.  My hands are weak. Worse on the right. My thumb and index finger spasm and pull towards each other, my middle finger goes numb, Worse on the right.

     I still have an overwhelming fatigue that I don’t associate with deconditioning. There’s more to it. I worked out for years and also spent months in pt. I know the difference. This is muscle fatigue from overuse. Even though I’m not exercising other than light PT and walking.
    I have urinary urgency. I also had GI bleeding and hemorrhoids. When I called to discuss it, the surgeons PA told me urgency isn’t from my condition. Which confused me. Apparently she wrote in my notes, she told me it was probably a UTI, although she never did. This is not a UTI I’m describing. I had a few of those in my younger days. I know the difference.

     I believe I have a subtle degree of spasticity and test positive for Hoffman’s and babinski in all extremities and have hyperactive reflexes still as well.
     I seem to have increased muscle tone in my arms. The doctors always comment that I have good strength, although I feel completely weak. Or fatigued.  I do have confirmed weakness of the hand and foot muscles though. Slight gait abnormalities.

    I’ve lost some weight and am not sure how. I look like I am working out even though I have done NO real exercise in almost 2 years now. It seems my muscles are always firing. I’m toned for no reason.

    My surgeon seems very dismissive and I’ve only seen him personally 2x since surgery. Once in the hospital, again at my 2 week follow up and once last week for my 6 month follow up. I’ve heard this is normal, although I’m not exactly comfortable with it. With as many questions and concerns as I have, I wish I was actually speaking to him more.

    He only spent 20/25 minutes with me this last time and I was still asking questions as I was being ushered out of the exam room. I didn’t have a chance to ask him much and he said I will come back in August. He gave me a release to work part time, although we never discussed my limitations or complications, which caused a lot of confusion because the neurologist I just started seeing, my orthopedic spine Dr, my primary and my physical therapist all tell me I should not attempt to work right now. I don’t have control of my pain, sleep or fatigue and am barely maintaining daily living for my family.

    The worst part of it has been the extreme pain in my neck. The surgeon has not been of much help explaining it. I have asked about it every time I see them. They just say a lot of work was done and it may take time to heal. 
    The pain in my neck concerns me because I didn’t really have much neck pain before and it is now 6 months post op and the pain takes my breath away still. I awake in pain and many times I need to lay down to take the pressure off my neck. I don’t sleep well at all. Every time I move my neck, it hurts, even on medication.
    I’ve been in PT for 12 weeks now. I feel plateued and have a sensation of exercise intolerance. The PA at my surgeons office, just said therapy can be hard work… 
     Although my therapist had faxed them a report explaining all my limitations and a request for extension of visits.
    The surgeon did regular xrays too and says it looks good, but that’s it. 
    It looks good.
    They seem to disregard my other complaints or concerns. I’m not even sure if I’m fusing because nobody has looked at the images with me.

    I sought a neurologist to try and help me with the pain and fasciculations. I got the feeling my surgeon was not meant to address these problems.
     I have only seen him 2x so far and he seems a tad overwhelmed with my file. Although willing to spend time with me. The first appointment he spent over 2 hours with me. He is only beginning to understand my situation though. He mentioned I have a peripheral neuropathy… ?? Isn’t that different than cervical myelopathy?? He thinks medication is the way to go right now and that the surgery can cause neck pain worse than before, but surgeons don’t usually tell you much about that.
    He did start me on a high dose of lyrica again to try and shock my system to think a lower dose is easier to handle and requested a new MRI. 

    The latest MRI report states:

    Vertebral bodies appear normal in height and alignment. Metallic artifact consistent with anterior plate and screws c4-c5 through c6-c7. Slightly eccentric. Marrow signal otherwise unremarkable. Cord normal in caliber. Craniovertabral junction unremarkable.
     There is generalized disc dissection. Left foraminal narrowing c3-c4 due to bony spurring.

    Impression
    Anterior fusion c4/5/6/7 with no stenosis identified.
     Left foraminal narrowing c3/4 due to bony spurring.

    My neurosurgeon didn’t read it with me though. I didn’t have that report yet when I asked him if he had looked at the MRI. All he said was that yes he saw it, and it looked good.

    The neurologist did look at it with me, and seemed hopeful that it looked ok, but he seemed to think there was some slight bulging at c3/4 but nothing serious.
     He also didn’t mention the bony spurring.

    My question is this….

    Can the pain be from bony spurring that was left there at the time of surgery now hurt worse,  because the surgeon corrected the lordosis and there is more pressure at that level now?
    Do bone spurs cause pain?

    There has always been debate regarding the muscle twitches. They are widespread from the neck down and have no discernable pattern, other than the one in my right tricep that is usually frequent.

    Can these fasciculations be caused by spinal cord compression?? 
    Or damage?
     Some doctors say yes, some say no.
    Isn’t it true that they are an indication of lower motor neuron issue? Can a large disc protrusion cause damage to the anterior horn, without much indication of cord signal change? 

    And if so, do you think the symptoms are permanent? 

    What could be the cause of the sharp, deep pain in my neck? 

    Is it normal for a surgeon to be dismissive after surgery? 
    Why is nobody talking to me about all of it?? I am not feeling listened to by them and wonder If I would benefit from trying to find a surgeon to take over? Will any surgeon be willing to take me 6 months postoperative?? The surgeon I had is well respected within the medical community here and I worry that may influence another surgeons decision to take my case.

    I am at a loss as to what I should do and all I really want is for the pain to go away and start feeling better… And for someone besides my therapist to see the big picture and treat me as a whole person instead of just a number.

    I apologize for the length of this and if it sounds like I’m complaining. I just want help and to feel better.

    I truly appreciate any suggestions. 
     Thank you in advance!!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Headaches can typically originate from C2-3 and C3-4 facets (and occasionally discs). Balance issues can originate from cervical myelopathy due to stenosis (“bulging herniated impinging discs at c2_7”).

    Visual disturbances are generally not associated with cervical pathology unless vascular problems exist (very rare).

    I do not know why your doc wants to perform rhizotomies at C5-T1 or not block C2-4. There is greater precision necessary at higher levels but most interventionists will inject the upper levels.

    Maybe a discussion with your present doc or a new consultation by another physician might be helpful.

    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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