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in reply to: clarification on cervical fusion #11150
As always. Thank you for clarifying doctor Corenman. I was unclear on the necessity of hardware. And i 100% agree with you. We all make mistakes. I gave informed consent. I only regret that he didnt tell me and put a game plan together to revise it. I thought very highly of him and would have let him do the revision as it had to be done anyway. And yes, Dr H is a great doctor…just ask him. He will tell you. Thanks again
Greetings Dr Corenman, Justwanted to tell you after a 5 month ordeal after my acdf at c5-c6, I saw the head neurosurgeon at U.A.B.(university of alabama at birmingham) yesterday. It took him all of 15 minutes to diagnose pseudoarthrosis. A ct later that day confirmed almost no bone growth. I’m on the books next Tuesday for a correction. First thing first. If you review this post, I believe pseudoarthrosis was one of the first diagnosis you made. Unbelieveable. Couple of quick questions…since I don’t smoke, what installation wise could have been done wrong to prevent bone growth…titanium plate with allograft was used…shavings from the bone spurs and portions of the vertebrae were used for the “wadding” so to speak…”the carpenter was the problem” I believe was the vernacular used. Additionally, instead of admitting a problem, I have been referred out for second opinions and radiology done, with pain management without a diagnosis being offered as my only option. Should the radiologist not have the tools to diagnose this? It was the same imaging my new doctor looked at. Can they not use the same Deduction powers he used? The bone was “white”. Fused bone should not be this color. That simple….does the radiologist not have a simple bone density scanner? I’m very concerned that it took 5 months and a new doctor to find what seemed to be a very simple issue to diagnose. If I had not searched out a new doctor and took them for their word, I would be walking around and working(heavy lifting) with the titanium plate with four screws being the only thing holding my neck togethor.if the screws sheared or backed out what kind of troble would I have been in? And lastly, how do they “re-do” the procedure. He is going in anteriorly, and didn’t mention cadaver bone or taking a graft? Where does the bone material come from? You are a brilliant doctor, Dr C and the info supplied on this forum is invaluable. I wish you well and especially a well aligned spine….
Dr Corenman, I will be in contact with your people tomorrow. I am on the verge of having a mental breakdown from the incredible pain I have suffered for the last 11 months. Along with the t spine, I have complete or partial nerve root avulsions in my cervical. I was so desperate I went to the er on Friday, where I was sent home with advil, robaxin, and a flyer on chronic back pain. They wouldn’t even look at my images. If I have to fly to Colorado for help, I would do it in a heartbeat. It appears that in a smaller town like Birmingham, nobody wants to acknowledge any mistakes in the radiology at my physical and neurologic expense. What was predominantly unilateral nerve pain, has now digressed int bilateral arm neuropathy(burning)n and now my feet and toes are starting to burn, along with the unrelenting neuropathy I have experienced in my infra spine upper thoracic area. This appears to be from the compression fracture/fractures in my vertebral column and posterior parts of my vertebrae. Thank you for being so passionate about what you do, and for this forum.
Dr corenman, I assure you its not artifact. This same radiologist missed 3 herniations in my cervical spine, all with cord or thecal sack compression. My injuries oddly enough seem to be from taking severe blunt trauma to my mid back with incredible g forces and velocity being involved, in such a way that from the default angle my t spine looks fairly normal. 2 small herniations. The injuries only reveal themselves from a different angle. The avulsion of the anterior ligament is their. As is multiple compression fractures. My posterior portions of my vertebrae are in pieces, and the column has numerous fractures also. I would be more than happy to send you a copy of the report and the t spine mri. I myself have struggled to understand how or why I was so blatantly disregarded. This misread has steered everybody in the c spine direction. Although c5-c6 was a very focalized herniation, it was a central herniation. The foramina at c4-c5, and c6-c7 look worse than c5-c6 which was fused. I requested additional imaging before fusion surgery, ie ct myelogram, yet I was denied for whatever reason. You can’t even see my heart on the last image of the localizer sequence due to massive edema, and that was 1.25 months after the wreck. I’m ten months plus out and I still have an incredible amount of edema surrounding that area of my back with so many trigger points I lose track. If this is a “case of first impression” I would actually love to send you the mri and attached report.
Dr Corenman, I hope this finds you well and your spine well aligned. I have continued to struggle with the same infraspine/scapular pain since c5/c6 acdf. As stated in previous posts, most problems started post wreck, of which the kinetics aren’t your typical rearend/frontend collision. Their were rotational forces along with being broadsided on the passenger side mid rotation, throwing me backwards and sideways where my upper back took some heavy blunt trauma from the drivers seat as I struck the side of the seat. Speeds from my vehicle and other vehicle were in the 50-60 mph range. The first mri I was given was a thoracic approx 1 month 1 week post wreck. The findings were incidental, being mild degenerative changes at t8-9, and t9-10. At this point the thoracic issue was laid aside and never readdressed.It occurred to me recently that the same radiologist that missed key points including a focal herniation with cord impingement at c5-c6, was the same radiologist that read my thoracic and I decided to put my own eyes on it. Frankly, I was dumbfounded by what I saw. The localizer view showed what appears to be a large area of edema in the vicinity of where my back took the blow. The anterior longitudinal ligament appears to be avulsed from t5-t10, with a large pocket of fluid(edema) between it and my vertebrae, coinciding with the localizer view. Their appears to be a couple of places where their are fractures at the rib joints, 1 at t3. Also, what appears to be a compression/wedge fracture at t4-t5, starting a cascade of vertebral problems including other fractures down to around t10, with vertebra touching vertebrae in numerous places. The other concerning aspect of the imaging is the axial view shows what appears to be almost every posterior part of the vertebrae on the image whether I’m looking at the lamina or spinous process shoved forward from the blunt trauma as the vertebal column was compressed, breaking the posterior parts of the vertbrae that hug my cord off, or splintering them…in some places broken off and touching the cord, or damaging the white material as they were shoved forward, taking gouges out of it before being stopped by compression or going back into place by the recoil. Is this a naturally built in mechanism to prevent the bones from cutting my cord? It appears that it missed my cord in places by mm. Their also appear to be numerous facet joints that are missing or broken? Not to be redundant, but I’m not a radiologist and that’s just some of the stuff that sticks out to me. I know for sure that parts of my posterior vertebrae are touching the white matter of my cord, within mm of the cord itself. What’s perplexing is why none of this is noted? The only thing I can surmise is that when the images come up the default image from the saggital view looks fairly good. I can see why mild degenerative changes are noted. Its not until you rotate to the other side that the damage becomes apparent. Could the radiologist have biased himself from even looking through all the images if 1 side looks good? Especially it being the thoracic which is so muscled and reinforced? Seeing so many precautionary mri’s that don’t show problems, could mine just have received a cursory glance? My myelopathic symptoms persist post acdf, including constant urinary frequency and urgency, tinnitus, dropping things, weird musical hallucinations if I “unfocus my eyes” while looking at something, e.d. dysfunction at times. My left arm still hurts post acdf with persisting and digressing bicep weakness and pain, cold hypersensitivity, tingling in all fingers at different times with the worst now being pinkie and ring. Odd twitches in all parts of my body. The list goes on and on, with the focal spot of pain and burning(neuropathy) being left interspine, medial/lower scapula area. Their appears to be a direct correlation between length of time on my feet daily and the intensity of pain in my upper back,along with bending, twisting, sitting in the “thinking position”(possibly from facet damage). As stated, I am pain free for the most part if I lay down. Is it possible that my thoracic spine took that kind of beating and having that degree of spinal stenosis, while still being able to walk around and function(although albeit a struggle). Why can’t I get anybody to seriously re-evaluate my thoracic? I think my neurosurgeon thinks either I’m crying wolf due to either a) expecting results of acdf to resolve scapular pain quicker than usual, b) more pain medication(which I can’t get by without right now),c)because he doesn’t make mistakes and I’m just a regular person who knows nothing about neuroogy,d)liability(which I have chalked acdf to being necessary due to associated myelopathy whether it was really the pain generator or not, or e) all of the above. I know the reference lines on mri show 33 reference lines , including numerous that stop mid vertebrae, 2 of which have very odd angles <. It appears on multiple images that I'm looking through endplate disc, endplate. Or disc, end of posterior endplate from adjacent plane. I'm to the point that I'm about to walk into the e.r. and tell them I have upper thoracic pain and let them take it from there. Any insight would be appreciated?
Dr Corenman, thanks for your responses. Afyer your initial response, you validated my opinion that their was a nerve damage issue. I went back to the drawing board and poured over the mri. It Now appears that their is a stretch injury at the c5 nerve root with demyelination and partial avulsion. I guess its Brachial Plexopathy all along. I’m not sure if any medical advances have been made that can address that. If its permanency, I’m ok with that. Just wanted finality on the “pain generator”. I’m not asking for a comment on my radiologist, but in general, is it acceptable for a radiologist failing to note a herniation at c5-c6 with cord compression, and a partial nerve root avulsion at c4-c5? How does this happen?
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