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in reply to: Neck and Shoulder Pain #28398
Hi Dr. Corenman,
Another quick update – things have started to settle down quite a bit… for some reason it just seems that it took me a little longer to get the muscles to calm down than most take. I will chalk it up to having severe pain for more than 12 months between the original DDD and then the failed ADRs! Will try to update again in a few months, but right now everything seems to be on the right path.
One question I do have – prior to my ADR surgery, my flex-ex noted about 2 MM of motion between flexion and extension at both c3-4 and c4-5. Post ACDF C5-7, everything looks good and the report notes “Alignment does not change significantly on dynamic lateral radiographs.” Does that mean they are no longer seeing the movement at these levels? Or is this possibly just a difference between one radiologist calling something out and another not finding the movement significant?
Thanks!
Kevinin reply to: Neck and Shoulder Pain #28160Hi Dr. Corenman,
Well, sorry to have to endlessly post questions here, but wanted to get your thoughts on my status. As a review, I initially had some severe gnawing pain at the base of my neck, neck stiffness, and a burning type sensation from the lower neck that would spread out toward the shoulders on both sides, worse on the right and made worse by activity of any kind, impact or exercise. Imaging showed a diffuse bulging disc at c5-6 and annular bulge at c6-7, without foraminal stenosis. Flex-ex showed 2 MM of movement between views at both c3-4 and c4-5. Discs at those two levels both look fine. After 6 months of pain, I had ADR (Mobi-C) in July 2017… initially I was optimistic as the gnawing pain and neck stiffness went away (surgeon said the C5-6 disc was very badly degenerated even though it had not collapsed very much prior to surgery), but I developed some severe facet pain and the burning sensation in the lower neck continued. Medial branch blocks yielded good pain relief, and an RFA on the right side did reduce the severity of the pain considerably. However, since the pain was still significant I had a revision to ACDF in December. I am no longer on any medication post surgery.
While generally pleased with the ACDF revision results, I have noticed I still have quite a bit of what feels like muscular pain near the base of the neck, sometimes extending up into the mid neck region but no longer past the neck area toward the shoulder. The pain is always off center and is on both sides, maybe a bit worse on the right. The severity is reduced from both pre original surgery and ADR, but it is still quite bothersome. Muscle relaxers actually seem to make it worse, and NSAIDS that I am now cleared to take don’t seem to do too much good. It is relieved with rest (lying down) and heat. I continue to work on exercises targeting the deep neck flexors, around the worlds, etc. that the physical therapist recommends.
In your experience, do some people just take quite a lot of time to get the muscular balancing correct again after surgery… there seem to be just an awful lot of wildly varying opinions about why some people still have chronic neck pain after surgery, in the absence of any obvious pain generators… Some articles seem to believe that long term spasms in the back of the neck can lead to very weak / deactivated deep neck flexors that cause chronic overuse of the muscles at the back of the neck. That seems like it matches with my experience, but I’ve been trying to keep working on strengthening those muscles without much impact. Can the facets at the operated levels just take a very long time to completely calm down? I know your experience is that 3 months should be enough time to evaluate pain relief after ACDF, but I’ve also read other articles that say improvement might continue for longer as the neck adjusts to the new mechanics, etc. I recall you joked once in the forum that if you asked 5 spine surgeons a question you’d get 10 opinions, and that certainly rings true for me!
I wonder a little bit about the 2 MM translation at the levels above the fusion, but I would think c3-5 might cause more mid neck / headache issues rather than pain at the base of the neck.
I will have another flex-ex and visit with the surgeon next week so I can post again if that turns up anything of note. At this stage, is there anything else you would recommend? I don’t think a CT is necessary unless the flex-ex shows something worrisome – I don’t feel there is any indications the fusion has failed as the symptoms just never fully resolved. I had expected to just see gradual progress, but unfortunately it seems to have stalled at this point.
Thanks again for your time… hope someday I won’t need to ask anymore questions!
Kevin
in reply to: Neck and Shoulder Pain #27903Hi Dr. Corenman,
Another quick update – now about 3 months post C5-7 ACDF to replace failed ADRs and continuing to feel much better. Wanted to share a couple of observations with your forum for other who may be suffering with neck pain from DDD from my experience as a patient.
1) You should feel considerably better by at least 6-8 weeks after surgery.. in my case I still had severe pain after the ADRs at that stage, but my surgeon told me I needed to give it more time. Said the same thing at 3 months. At 4 months I insisted the ADRs had failed and scheduled a revision to ACDF (after facet injections / RFA failed to fully relieve the intense facet pain that was made worse by the ADRs).
2) If most of your pain is in the neck itself, you do have to be patient during the recovery process. You should feel quite a bit better at 6-8 weeks, but even at 3 months I still have some nagging muscular pain in the back of my neck, particularly in the morning. It is improving with time, and is much better that pre-surgery. Unfortunately, from what I understand, it is not uncommon to have muscular imbalances develop when you have severe muscle spasm from DDD in the muscles at the back of the neck. Physical therapy is important to help correct this – so follow your surgeons instructions on exercise and PT! From what my PT indicates, the deep neck flexors toward the front of the neck often become very weak / inactive after months of neck pain as the spasms in the back of the neck tend to inhibit these muscles from working normally. They are important to the overall stability of the neck, and take time and work to get back to normal. While that process is ongoing, he says it is not atypical to still have some muscle pain from overworked muscles in the back of the neck.. For Dr. Corenman – curious how often you see this kind of pattern with your neck pain patients?
Thanks again for all your help!
Kevin
in reply to: Looking for advice for upcoming cervical ADR #27339Hi Slou92,
I’m sure Dr. Corenman will give you some solid advice shortly, but I wanted to share my experience with you. The full saga is under the topic Neck and Shoulder pain on this forum. Bottom line I had a two level ADR back in July. Initially, despite some severe axial pain afterward, I was pretty optimistic that it worked since it eliminated my disc pain. As time went on thought it was clear I had facet syndrome and that proved resistant to conservative measures, so I had a revision to ACDF in December. Very satisfied with the results.
Long story shorter, I would really quiz your spine surgeon about the potential for facet issues, whether he is confident your pain is not facet related, etc. I used a top surgeon at a highly ranked facility, but my surgeon was confident that in the absence of radiologically apparent facet damage that ADR would work. It did not work at all for me and was a miserable experience.
Wish you all the best and hope you get some relief soon.
Kevin
in reply to: Neck and Shoulder Pain #27338Hi Dr. Corenman,
Quick update – 5 weeks out and I am extremely satisfied with the results of my ACDF (c5-7) – this was a revision of failed ADRs at those levels.
Range of motion is great, and the only remaining issue is a little bit of muscular strain late in the day, particularly on the right side where my facet syndrome was the worst. My guess is the muscles need some strengthening / rebalancing after a year of muscle spasms and disfunction from DDD first and then the failed ADR.
Will update again after my X-rays but everything is going great!
Kevin
in reply to: Neck and Shoulder Pain #27184Hi Dr. Corenman,
16 days out from my ACDF and the posterior neck pain is really starting to improve now. I already feel better than I did on my best day of the 5 months I had the ADRs installed. I can also tell from the simple yes / no exercises and stretching that my doctor indicated I should do that the ROM difference will not be noticeable after the C5-7 ACDF.
Will update again in a few weeks. Again just wanted to note for others who may be in the same boat with serious neck pain from DDD / minimal arm pain that need surgery – really recommend taking Dr. Corenman’s advice and going with an ACDF. The potential benefits of the ADR, in at least this one patient’s opinion, are not worth the risk of facet pain after the ADR. I can’t really tell the difference between the ADR and the ACDF in terms of the way my neck moves, etc post surgery. My experience was really quite terrible, and if I had changed my surgery to an ACDF instead of going ahead with the ADR installation I could have avoided 5 extra months of pain and a second operation.
The other obervation I would make now, after the fact, is that a disc degenerative enough to cause 6+ months of serious neck pain non-responsive to PT / injections / medications, is probably degenerative enough to cause facet damage. It certainly was in my case. My damage was not very apparent on imaging, but the ADR installation was diagnostic in a big way!!!
Thanks again for all you do Dr. Corenman – I’ve received great benefit from both your website and your responses to my questions – I really appreciate it!
Best,
Kevin -
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