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Thanks for your very insightful response.
The posterior is not fused yet, but the anterior is incorporated superiorly and inferiorly with a transverse defect present in the graft at C5-6 and there is bridging bone across these vetebral bodies. At C6-7 the graft is incorporated superiorly and inferiorly with a transverse defect in the midportion. There is a small area of bridging of the graft across these vetebral bodies. Based on prior comparison studies, the anterior seems to be fusing slowly.
I too am baffled as to how I still have severe compression after two surgeries. My guess is that the first surgery (anterior) never got the osteophytes and that the second surgery (posterior) resulted in only indirect compression. If I do fully fuse, could that eliminate the problems I am having, even though I have severe compression?
Is C3-4 typically operated on if there is severe compression there?
How does an osteotomy procedure work?
If I do SNRB’s at C5-7–would it be a mistake to do them at the same time? Thanks.
Hi Dr. Corenman,
I just wanted to gove you an update on my situation. As you may recall, I had ACDF C5-7 surgery last May, followed by a C5-7 posterior laminoforaminotomy with right-sided instrumentation last December.
My recent myelogram shows severe bilateral foraminal compression at C5-7 and my chief complaint is really bad right-sided shoulderblade/scapular pain. The surgeon wants to redo the anterior surgery and also do posterior fusion–a circumferential approach at C5-7.
The surgeon wanted me to do a SNRB at C3-4, due to the myelogram showing severe right sided C3-4 foraminal compression. The SNRB was done with an anesthetic and a steriod. After the SNRB my shoulderblade, arm, and neck pain were 50% better for 3 days, and now are back to the bad level they were at before. Based on the SNRB working for 3 days, the surgeon wants to do a circumferential surgery at C3-C7 (my C4-5 are fine).
I am nervous about such extensive surgery. Based on what I have read the C3-4 does not cause scapular pain, but yet the SNRB there made the pain and numbness 50% better for 3 days. At this point having had two spine surgeries in the last year, I don’t want to go through another without a high degree of certainty that it will work. I also want to make sure that any area that is causing the pain is fixed. What would you recommend? Thanks.
Thanks. I think that the graft is fully intact, but without full fusion in the center. The C4-5 shows as mild disc bulging and minimal osteophyte formation on the left uncovertebral joint with no canal or foraminal stenosis and normal facet joints.
I never had a myelogram before, but the myelogram with CT clearly shows much worse than an MRI or regular CT of around the same time frame. The Myelogram with CT was read by a couple of radiologists as well as the surgeon and they all said that it showed severe bilateral foraminal stenosis at C6-7, and severe right at C5-6.
Since C3-4 showed moderate to severe compression, the surgeon wanted to do a selective nerve root block at that level to rule out that playing a part in my problems–he doubted that such level was playing a role, and thought it had to be C5-7. This surgeon is not the surgeon that did my two surgeries. I am extremely baffled as to how I could still have severe compression after two surgeries by a top surgeon. Have you ever seen this before?
Thanks
Hi Dr. Corenman,
I just wanted to update you on my situation. As you may recall, I had ACDF C5-C7 done last May, followed by a posterior laminoforamintoomy with instrumentation on the right done this past December. After my most recent surgery, my symptoms were all better for a month, only to come back. What came back first was bad shoulderblade pain and numbness on the right, followed by right arm numbness. I had both an MRI and a CT which showed clear improvement post second surgery. I also tried various pain medicine shots (subcutaneous perineural shots offered some relief).
Currently the arm numbness has improved some in that it is not numb all of the time. The shoulderblade pain and numbness are still pretty bad. I had a Myelogram last week and the pertinent part is as follows:
Interbody fusions with cortical bone graft at C5-C6 and C6-C7 with small areas of bridging across the vetebral bodies. Right lateral fusion with instrumentation from C5 to C6 without hardware complication. The fusion does not appear to be united. Right laminotomy is at C5-C7.
C3-C4 Uncovertebral osteophyte formation compressing thecal sac and right C4 nerve root. Moderate right foraminal stenosis.
C5-6 United interbody fusion. The interbody graft is incorporated superiorly and inferiorly with a transverse defect present. There is bridging bone across the vetebral bodies anteriorly. Right posterior lateral fusion not united. Mild posterior ridging. Prominent osteophyte formation at the uncovertebral joints bilaterally. Mild canal stenosis. Compression of the right auxillary sleeve. Severe right and moderate left foraminal stenosis.
C6-7 United interbody fusion. Right posterior lateral fusion is not united. The interbody graft is incorporated superiorly and inferiorly with a transverse defect in the midportion. Small areas of bridging of the graft across the vetebral bodies. Facet joints are not fused. Mild canal stenosis. Compression of the right axillary sleeve. Severe bilateral foraminal stenosis.
The CT Myelogram shows worse results than the regular CT and MRI showed after my second surgery as well as before both of my surgeries. So I’m baffled as to how I could still have severe narrowing after two surgeries. I also don’t know if my posterior instrumentation would make a possible revision ACDF possible without removing the posterior instrumentation. I also wonder if any of my arm/shoulderblade pain and numbness could be coming from the C3-C4 as well. I certainly am not looking forward to a potential third surgery in a year, but also don’t know if I risk damage by waiting.
As always, I’d very much welcome your views. Thanks.
Thanks. I will keep you posted.
I am actually posting something that has nothing to do with the spine. I know that you went to Wayne State for medical school and there was a very interesting article in the NY Times today describing how downtown Detroit is in many instances relying on the Wayne State Police Department. I was not able to include the link within the forum.
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