JBoz

Dr. Corenman, it’s been awhile. I have been meaning to get back to you on my surgery. Surgery went well, but I have been having severe pain in only the bottom right on my surgery site. This is about 1/2 inch to the right of the bottom of the incision. I can feel the typical neck pain my surgeon told me I would probably have the rest of my life. This one spot has been very problematic, and is severe compared to the mild pain along the shoulders and remainder of my neck. I had 3 sets of trigger point done, and 30 sessions of therapy to try and see if the muscle was knotted up.

I don’t know what this 6 month post operative neck pain might be at this point, we have tried everything. Another disappointment was the remaining severe chest pain, in which I have been to three specialists to try to figure out. Angiogram, Bravo Endoscopy, multiple chest X-rays, three years of unknown severe chest pain. I was really hoping for this to be resolved.

I do believe the C3 C4 will finally fuse, as well the step off at C4 C5 in time. I don’t have any clue on the stabbing type pain in the spot I mentioned above. This pain is as bad as the pain I had prior to surgery, just in one spot.

That is the surgery update, and perhaps you might know the reason for the one location of severe pain at the bottom right of the posterior incision. It feels deep to me, the therapy works for awhile, but it comes right back. Dry trigger point needling was even performed, with no real improvement.

Any idea’s would be wonderful. I hope it’s not hardware related.

My pain doctor ordered a MRI of my thoracic spine, to see if there could be a connection to the even worse chest pain. This is what they found on the MRI.

The spinal cord has normal signal characteristics. Negative for intradural or extradural masses.

Vertebral height is anatomic. Vertebral height is maintained at all levels. Negative for compression fractures. Vertebral marrow is negative for infiltrating processes and osseous destruction. Benign hemangioma in T7 vertebral body. Paraspinal soft tissues are within normal limits.

T3 T4: Very small left paracentral disc protrusion, not clinically significant.

T4 T5 small central disc protrusion causes ventral thecal sac compression with localized cord effacement. No spinal cord edema.

Remaining intervertebral discs demonstrate age- appropriate mild desiccation, but are otherwise normal. Central canal and foramina are patent at all levels. Mild facet arthropathy at lower thoracic levels.

Benign hemangioma in T7, not sure how they know the tumor is benign. It is a circle size, from one end of the bone to the other.

Impression: T4 T5 central disc protrusion with spinal cord effacement, but no cord edema.

My concern is traditional methods, epidurals, and perhaps nerve burning have all failed on me in the past. I have also read about T4 syndrome, and the chest pain symptoms all seem on the mark. I guess I hope this is the answer to my chest pain. I truly love your website, and the time you put in to help others. Your knowledge has been spot on so far.

I must say I had a very good surgeon, and I pray this new finding is the cause of my chest pain. I would do anything to have this chest pain taken off my shoulders. Perhaps this could be the answer. I just can’t live with this pain the balance of my life, as a single father of 49 years of age.

I appreciate your time Dr. Corenman, sorry to have taken so long on my surgery follow up.

John

PS, You have a very interesting video of the thoracic spine as well. I have told my surgeon of the MRI, he will be reviewing the report and images.

Dr. Corenman thank you again. It’s good to know that the posterior approach will help with the step off, if I’m understanding your last response correctly. You made mention that the step off will not be corrected with the posterior fusion previously. I’m hoping this will be the last neck surgery I will ever need. You have been a great source of information.

John

Hello Dr. Corenman,

I’ve had my visit with my new neurosurgeon. The plan is a 2 level fusion at C3 C4 and C4 C5. They will not be doing any removal of any type of bone or disc. The 2012 fusion failed as you guessed, and the C4 C5 is a problem as well. I’m in tremendous hands, with whom I believe to be one of the best neurosurgeons in Arizona. They are coming in from the back of the neck, and using two plates with four screws each. This will secure the unstable fusion I believe, and allow for the fusion to take place. They are leaving the old hardware in place.

I always fail to ask some type of question. I never got his thought on what was causing all my pain. I’m assuming a failed fusion is the cause for my pain since my last surgery, there never was a time of relief.

Do you know if my failed fusion would be the cause for severe pain?
Is a two level fusion recovery any longer than a single level?

I guess the C4 C5 retrolisthesis will be corrected by the fusion.

I also wanted to ask if the new decompression at level C3 C4 my old fusion site, will be relieved by the new fusion?

Again, thank you for your time. Very nice to be able to get solid advice online. You were spot on about the failed fusion. I will keep you posted on the progress.

John