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in reply to: 2 Years Post 2 Level ACDF With New Type of Pain #8280
Hello Dr. Corenman,
Just wanted to let you know that I did have a phone consult with Eric (sp?) your physician’s assistant about a week ago. It was very helpful and Eric was an exceptional communicator and highly knowledgable. He asked me to send in a write up of his performance, I hope these comments can serve as that. Simply put, he was outstanding.
As part of another second opinion with a neurosurgeon, I did have a new CT scan performed last week. I met with the neurosurgeon yesterday and the CT scan did show that I have pseudoarthrosis at C5-C6. You can see a horizontal line of non-union at that level as clear as day. However, the plate and screws at that level do look to be in excellent shape.
He also had an X-ray taken of my left shoulder to see if anything is going on. I had that done yesterday and am awaiting his comments. I also had X-rays done on my cervical spine in the flexion, extension and neutral positions.
The neurosurgeon suggested that I try to use a bone stimulator for 3 months to see if a fusion to take place. He is also suggesting that I try Botox injections to see if my very tight trapezius muscles will loosen and to see if my headaches and shoulders stop hurting.
Would you be interested in taking a look at the new CT scan and the X-rays of my left shoulder and cervical spine and giving me further opinions?
in reply to: 2 Years Post 2 Level ACDF With New Type of Pain #7947Please disregard the question above, Dr. Corenman. I talked with one of your nurses and resolved the issue.
in reply to: 2 Years Post 2 Level ACDF With New Type of Pain #7943Dr. Corenman, I am getting ready to send all my images to you. Do you require that I fill out the new patient registration and cervical spine history forms and send it with the images?
in reply to: 2 Years Post 2 Level ACDF With New Type of Pain #7931Thank you, Dr. Corenman. I will be sending the images tomorrow. I look forward to hearing your comments once you have the opportunity to look at them.
in reply to: 2 Years Post 2 Level ACDF With New Type of Pain #7920Thank you so much for offering to look at my images. I will send them soon and make sure to note my forum screen name in the package that I send so that we can continue the conversation here, if that is appropriate.
If I were to schedule a visit to see you in the future, generally how long are appointments scheduled out? Also, would you do imaging and diagnostic testing at your location or would I do some of that where I am located? I live in Ohio, so I am curious as to how the logistics would work.
Best regards,
Michaelin reply to: 2 Years Post 2 Level ACDF With New Type of Pain #7915Hello, 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”
and
“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.
Michael
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