Archives

I had a c5-c6 cervical disc replacement. The doctor feels great about the placement etc. it’s 10 months later and I still have pain aggravation in the back of my neck. It’s not intense pain just sore and like a 3 level all day every day, more so at night.

Recently saw a pain doctor and got a CT scan. Curious of your thoughts? Results below.

Results:
EXAM: CT CERVICAL SPINE WITHOUT CONTRAST
History: 42-year-old male with cervical radiculopathy. History of prior disc replacement.
Technique: Helical volume acquisition utilizing 2 mm multiplanar reformats. DLP : 179 mGycm
Comparison: None.
Findings: Spine is imaged from level of the sella through T2. AP alignment shows slight anterolisthesis at C4-5. There is reversal of cervical lordosis. An artificial disc is seen at C5-6 without evidence of periprosthetic bone reabsorption or malpositioning. No fracture, lytic, or blastic lesion is evident. To the extent visible paraspinal soft tissues appear normal.
Craniocervical junction, C1-2: Minimal osteoarthritic changes are seen at the dens C1 articulation of doubtful clinical relevance. These levels are otherwise unremarkable.
C2-3, C3-4: No significant degenerative changes are present.
C4-5: Slight disc space narrowing is present. This level is otherwise unremarkable.
C5-6: Artificial disc has been placed. There is minimal left posterolateral endplate hypertrophic change and left-sided uncovertebral hypertrophy without significant foraminal stenosis. No neural impingement is suspected.
C6-7: No significant degenerative changes are apparent.
C7-T1: Hypertrophic facet changes are noted resulting in mild to moderate bilateral foraminal stenosis, slightly greater on the left than the right (5/32). No definite C8 root impingement is evident although clinical correlation is needed.
T1-2: There is moderate disc space narrowing present. No disc protrusion is visible. The neural foramina are patent.
IMPRESSION: CT Cervical Spine Without Contrast
1. Status post C5-6 artificial disc placement. Position and appearance are normal with no evidence of loosening.

2. Potentially significant left C8 foraminal stenosis due to facet arthropathy.

3. No other potential neural compromise is identified.

My daughter is a collegiate athlete (19) and chasing answers for a very specific back pain caused by a very specific movement. She was diagnosed with Bertolotti’s, but then told it could not be the cause of her pain because a bone scan did not show inflammation at the place where her L5 was hitting. She has had MRI, CT scan and a bone scan.

So my first question would be is it impossible for that area to be causing pain even if no inflammation shows on a bone scan? Is it unreasonable for us to ask to have the area injected to see if it helps? At this point I don’t see what she has to lose since she is facing retirement due to the pain.

She does not have pain in 95% of what she does including daily life and most her skills. She is a gymnast. She has pain related to extreme extension of her lower back and it’s a very specific sharp pain related to only one specific skill. The moment she does this skill she has a sharp, shooting pain that is so excruciating it takes her breath away. The sharp pain is quick because the motion that creates it is quick and then it throbs for a few minutes and then goes away until she is asked to repeat that skill. It feels distinctly to her as if something is being pinched or hitting.

Complicating matters is that she does have a L5 pars fracture. She has had this injury since she was 10 years old, so nearing a decade. She has successfully trained and competed for 10 years with no pain from this injury doing the same skill that is causing the sharp pain. The injury remains unchanged. When she did have pain from the fracture when she was 10 years old it was not anything like the pain she is experiencing now. All training hurt: pounding, landings, all extension, sitting in the car, bending etc. So to her this feels nothing like that. That was an overall dull ache and soreness with all training and this very sharp and specific.

Because she does have a pars fracture the Dr she is seeing did an injection in that area and told her there was no evidence it could be the Bertolotti’s so he would treat the pars fracture. She had 100% zero relief from the injection.

As I said at this point she is facing retirement since she can’t do skills required of her without excruciating pain. I feel we should look further into the Bertolotti’s syndrome even if her current Dr does not believe it can be the cause. Thoughts?