hohman1118

I absolutely see what you are saying. C 2-3 was not touched. Error on dictation perhaps.
This was the discharge summary in 2013.
PRINCIPAL DIAGNOSIS:
Cervical stenosis.
C3-4 herniated nucleus pulposus.
C5-6 herniated nucleus pulposus.
PROCEDURES PERFORMED AT THIS HOSPITAL DURING CURRENT ADMISSION:
February 14 2013 ACDF at C3-C4 using a Globus Coalition System.
C5-6 cervical diskectomy and arthroplasty

SUMMARY:
Pt is a 43 y/o woman who as a result of a mva had a cervical fracture in 2001.
Pt underwent an ACDF at C4-C5. She did ok post operatively but has had
progressive neck pain which has become intense in 3 years. Pt reports that the
pain is 6/10 currently at worse it is a 10/10. The radiates down posterior of
neck to both shoulder blades. She has numbness up the back of her head and
numbness down the medial aspect of her right arm.

The following is from my physical therapy consult:
SUBJECTIVE
Date of injury: 2/14/13 C/S surgery
Mechanism of injury: 2000 MVA
Pain Scale and Quality: 8/10 currently and is an average pain number
Location of symptoms: headaches daily-global (“all over”), right-sided low back
pain, right UT area
Frequency of symptoms: loss of balance at random (~1x/week but may be d/t
decreased activity and decreased walking), incontinence in bladder increased
over past year (is now daily); headaches and neck pain daily
Aggravating Factors: prolonged sitting, walking, difficulty sleeping (6-hours on
a good night), using the computer.
OBJECTIVE
Imaging: 2-2-15 MRI C/S:
C6-C7 disc herniation to the right is noted with some cord
contact and flattening slightly progressed from the comparison
study. Radiologist recommends CT myelogram.
ASSESSMENT:
Ms. Hohman is a 45 year old female who presents to Physical Therapy today s/p
C3-5 fusion and C5-6 disc replacement in 2000 and 2013. She states her pain is
worse post-operatively than before and she is having difficulty managing it
currently. She has been utilizing taping methods provided by previous PT (this
is helpful) as well as attempting a rowing exercise but states that is painful.
Her activity consists of seated exercises with her 4-year old daughter (“baby
fist”) and 1x/week group water aerobics.
Today, Ms. Hohman presents with limited AROM in all planes of motion. Her
strength is decreased 2/2 decreased use and pain response. She presents holding
her head in her hands (chin in hands) 2/2 difficulty maintaining an upright
posture.

CT MYELOGRAM april 2015:
There is congenital cervical canal stenosis at all levels, with level by level detailed analysis as follows:
Craniocervical junction: Normal
C2-3: Unremarkable. Congenital narrowing..
C3-4: Uncovertebral osteophytosis results in mild left neural foraminal stenosis.Congenital narrowing.
C4-5: Near-total osseous fusion across the disc space without foraminal stenosis. Congenital canal narrowing.
C5-6: Facet arthropathy and uncovertebral osteophytosis results in mild right neural foraminal stenosis. Streak artifact from intervertebral disc device limits evaluation of spinal canal at this level, however, likely mild (congenital) canal stenosis.
C6-7: Right eccentric disc bulge without osseous foraminal narrowing. Congenital canal narrowing.
C7-T1: Unremarkable.

CT MYELOGRAM IMPRESSION:
Impression:
1. Successful lumbar puncture and intrathecal contrast
instillation without apparent complication.
2. Postsurgical changes of ACDF and disc replacements as
described. Multilevel degenerative changes of the cervical spine,
most prominent at C5-6, resulting in moderate to severe spinal
canal stenosis and neural foraminal stenoses as above. This is
superimposed on mild congenital spinal canal narrowing in the
cervical canal.
3. Focal small left paracentral disc protrusion at T1-T2 contacts
the left hemicord and causes associated mild spinal canal
stenosis. No other significant neural stenosis in the thoracic
spine.
I would just like to know in your opinion, what does this myelogram say and why is my neck pain worse especially in the muscle area of my right shoulder blade? I do have weakness, numbness, neck stiffness, sensations of pins and needles and tingling in my arms and hands.
Thank you!!

I finally consented to surgery due to the right arm impairment. But the surgeon is MAD. He said because I had this surgery so long ago, he now has to track down the manufacturer of the plate that’s in my neck so that he knows what type of screwdriver to use. He said the surgery was not ideal because in order to fix my neck, he has to remove the plate just to reposition it and then do another surgery above and below the previous one. Anyway, would I need PT or OT or both? And what kind of recovery as far as driving, lifting, etc? If I need therapy, would I have to stay in the hospital for that? What’s the length of hspital stay with or without therapy. I am getting conflicting feedback from a few folks that have had this type of surgery done. Probably an insurance thing I suppose. I am a vet so I am having this done at the VA in Portland Oregon (the surgeon gave rave reviews about you by the way). I want the best recovery possible. So candid answers would be appreciated. I have not had great luck in getting answers to my questions from the surgeon. Staff have hinted that many returning vets from Iraq and Afghanistan could be part of it as this surgeon only sees vets once weekly. Thanks so much Dr. C. Your intellect has had a bearing on whether or not to forgo surgery!!