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I am as confused as you as to your surgeon’s plan. A posterior approach could mean central decompression (laminectomy or laminoplasty), posterior foraminotomy or fusion with or without instrumentation. I do not understand why the surgeon would need to remove bone from the back of the canal at the levels where he performed anterior fusion. There are rare times that an anterior surgery is not effective enough to decompress the spinal cord but that would be an unusual circumstance.

To reply that if your were “younger”, he would have fused all four levels is also confusing. The older a patient is, the more levels they can tolerate with fusion.

Your inability to “sing in tune” could be from injury to your superior laryngeal nerve. This nerve “tightens” the vocal cords to allow different pitches. Ask your surgeon about this.

Have your surgeon explain why he intends to perform surgery and at what levels. Look for understanding of the pathology seen on MRI or CT scan and how surgery will modify this pathology to your benefit.

Dr. Corenman

The core preop symptoms that led me to surgery are all still there. None were severe/sharp even in preop – just chronic and causing me to not live the active life I had been (I have young kids, work out, in late 30s, etc). After 7mo of drugs, PT and 2 epidurals I was ready to try the PF procedure to “get back to normal”.

The preop symptoms jumped around oddly – those that were most disruptive were largely muscle spasms/ dull aches /the feeling of a knot (mostly around medial border of the scapula) – there 70% of the time, in addition fatigue and some dull aches along the upper paraspinals (this is every once in a while) – only 20-25% of the time but most impactful to life when there.

Less disruptive, I also had preop tingling in the thumb tip – 100% of the time , a dull tingling odd sensation in the bottom of my forearm running down to bottom of my wrist – 50% of time (this, and intensity of thumb tingling, was much more intense 7mo ago at the random onset of these issues – but calmed down considerably over the first few weeks). And maybe 10% of the time I’d feel an ache at the front of my shoulder at the tip. All these symptoms (which jumped around/came&went even preop – largely “going” with help of physio massage), I have felt on&off postop (with the medial border of the scapula aches pretty close to 100% of the time) – 4wks post PF.

New sensations POST op (all mild), incl a sensation/feeling of fatigue in my bicep. Also new is a sensation in my tricep – tricep is odd as while I have “severe formaninal stenosis” at C4, C5 & C6 … C7 is ok. I have of course some post surgery pain in neck but pretty mild/understandable.

I now worry re the underlying diagnosis / treatmnet plan … maybe a PF for C6 was not the right path … only 4wks so trying to balance patience(its early) with reality (no improvement after 4wks)

I will connect re a phone/e-consult
Thanks

Rotation and extension of the neck will load the facets in the back of the neck. It is common to hear a “crack” in many individuals as the facets are in a vacuum and will release that vacuum on occasion resulting in a “crack” This is the same sound heard when you “crack” your knuckles. This should be “painless”

Cracks associated with pain are another story. Instability can occur (the abnormal motion of one vertebra on another) which can lead to pain with the unstable motion. Couple that with the sensation of “a zap going through my back” and “my body gives a decent convulsion that is very brief” concerns me about cord compression. Heaviness in the legs could also go along with cord compression leading to myelopathy (see website).

A thorough physical examination will help to reveal if you have the beginnings of myelopathy. You should also ask for an MRI of your cervical spine.

Dr. Corenman

An ADR might work at the C5-6 level but there are some considerations that need to be taken into account. First is that this C5-6 level is very degenerative based upon MRI findings with “moderate to severe loss of disc height”. Reconstructing the C5-6 level to the previous height of the disc (which is what the ADR does for the most part) can increase or create new neck pain.

The second is that the ADR is designed to reduce the stress on the levels above and below to reduce degenerative changes. This device at C6-7 unfortunately did not work for you as C5-6 became very degenerative in spite of this ADR.

If you have developed myelopathy from compression of the cord, this disorder could be the source of of the tingling feeling in your legs. A simple physical examination can reveal if this is the case.

You might be better off with an ACDF but without review of your MRI and X-rays including flexion/extension, this is an unknown.

Dr. Corenman