failedACDF

Hi Dr. Corenman,

I had an MRI with and without contrast and the findings are similar to those of the CT scan. Relevant portions state:

Moderate right C5-6 and mild right C6-7 neural foraminal narrowing. So this is clearly much better than prior to my surgeries. Pre-ACDF (nine months ago), both levels were severe narrowing. Pre-laminoforaminotomy (three months ago) both levels were also severe.

Interestingly, my left on those levels is moderate/severe on one level and severe on the other, yet I have no problems on the left.

I currently still have bad right shoulder blade and right arm pain and numbness. My surgeon would like to give it some more time to possibly resolve. I am on 1200mg a day of Neurontin.

My questions are as follows:

Could moderate and minor narrowing cause so much pain and numbness?

Being that the posterior procedure based on the scans seems to have helped open up the foramina, could I heal with time? I was all better for three weeks after the second procedure, until the pain and numbness came back.

The MRI also notes “ill-defined enhancement is seen in the soft tissue posterior to the C5-7 levels without associated fluid collection. related to postsurgical scarring.” I assume this is related to the swelling that I have there.

Thanks

Thanks.

Do you think an MRI would make sense for me now, or is the CT scan sufficient?

If I fuse fully, do you think that would help the shoulder blade pain?

I know that you had said that an ACDF redo is harder if the front fully fuses. However, does the fact that I have instrumentation (rod and screws in the back on the right) in the back now, make a possible ACDF redo harder or easier or have no impact. What I mean is if the back is fused, would that make an ACDF redo easier or harder?

Lastly, is it unusual to have such a lengthy recovery from posterior surgery (I’ve been out from work 10 weeks)? Would your advice be to give it more time to see how this progresses (especially since the CT looks better) or do a third surgery this year in the form of a revision ACDF?

Hopefully, my case has proven interesting to you. Your advice has been extremely helpful.

Hi Dr. Corenman,

I just wanted to update you. As you may recall I had ACDF at C5-7 on May 12th, 2014, and a posterior laminoforamintomy on December 9th, 2014, with right-sided instrumentation.

I was completely better for three weeks after the December 9th surgery, and then my right arm became numb again, followed by very bad shoulder blade pain.

On the left side of my neck where the hemovac drain was, I developed signifcant swelling (that I still have) about the time that the surgery stopped working and an ultrsound didn’t show anything of significance there.

I was on a dose of oral prednisone (370mg over 9 days) 7 weeks after surgery. This helped for about a week and then stopped working.

A CT was performed ten days ago and notes the following:

C5-C6:Uncovertebral joint hypertrophy with moderate right and mild left foraminal stenosis (the pre-foraminotomy CT report showed severe right and moderate left–so I am baffled as to how the left could improve when only the right was operated on.).

C6-C7: Uncovertebral joint hypertrophy with moderate left and mild right foraminal stenosis (the pre-foraminotomy CT report showed moderate to severe left and severe right).

So according to the post-right sided laminoforaminotomy CT report, the operated on portions are certainly improved, however the non-operated on portions improved as well, which could mean that someone just read the report differently. My surgeon looked at the images and said that the operated portions are definitely improved, and I seem him again this week.

The recent CT report also states that “there is minimal fusion anteriorly across the C6-C7 disc space which is new from the October CT and the fusion across the C5-C6 disc space appears increased.”

So here I am almost three months post the second surgery, with very bad shoulder blade pain and arm numbness. I had never been sick a day in my life, but have not been able to go back to work yet, but have started doing some work from home. The shoulder blade pain gets much worse when I move my neck or sit up. It is in the area of the supraspinatus, infraspinatus, deltoid, and teres major.

Based on a “Tender Points in Cervical Radiculopathy” chart by Letchuman that I looked at, these points all coincide with C6. Additionally, prior to my second surgery, the numbness was in my middle finger and now it is in my thumb. Accordingly, my C7 radiculopathy (as confirmed on an EMG/NCS) prior to my second surgery now seems to be a C6 radiculopathy.

So at this point I am not sure what the next step should be, but I am very frustrated and don’t want to keep giving it more time or go for further surgery right now. I would greatly appreciate your advice, as always.

Thanks