Lisa1979

Hi Dr.Corenman-That is great. I Spoke with Lori and I sent my information to you in the mail early this week and look forward to hearing from you.
You have been tremendously helpful in this process.
Lisa

I talked with you this fall. Thank you for your help.
Quick recap: healthy 38 year old female Registered Nurse. 120 pounds. No other health problems. Active, non smoker, no drinker, H/o headaches, otherwise benign health history. Successful C6/7 acdf in 2013 – fused at 6 weeks.
Fast forward: 2015 – 2 MVAs 90 days apart required surgery c5/6 acdf oct, 2016- now a pseudoarthrosis at that level

I have a failed c5/6 neck fusion I’m trying to get fixed. 16 months out now. Bilateral arm pain sharp and burning pain. No numbess tingling, or weakness. Burning Pain, sharp and heavy arm are pain symptoms. Bone scan shows c5/6 inflammation, EMG is negative. In search for a cause for arm pain and nerve involvement, did a CT Myleogram. Results- Obvious pseudoarthrosis at c5/6, but also There’s a moderate sized herniation at C7/T1. No foraminal stenosis. No nerve compression showing on scan.
For another opinion, I went to the other side of the state and the surgeon there says the C7/T1 is the cause of the arm pain. The surgeon here (that did the surgery) says it’s not. He says the pain is from micro motion from the c5/6 pseudoarthrosis.
I was ready to schedule a repeat c5/6 ACDF and then when they threw in this other level as a possibility I don’t know what to think. Questions for you:
1) How does this arm pain get diagnosed? C7/T1 Epidural injection? Or nerve block. (Tried c5/6 nerve block already with nothing noticeable)
2) can this failed union be turned into an artificial disc?
3) can a hybrid surgery be done? C5/6 fusion and c7/T1 artificial disc?
4) would it be best And move forward with a repeat ACDF at c 5/6 and just see if the arm pain resolves?

I can’t see doing a fusion on both of those levels c5/6 and c7/T1 Because then I would have all three levels of fused at 38 years old. I am healthy, active, and really want to be pain-free and active again. With 3 levels fused I think the otter levels would go so quickly! What’s the best route for outcome and relief of arm pain in your opinion. Thank you!

Thank you so much Dr. Corenman!!

Would it be in my best interest to repeat the c 5/6 nerve block, or is there another study that would be part of the ‘work up’ prior to a posterior revision, to ensure the posterior was the best approach?

If I chose anterior and used my own bone this time, what are the chances (in your experience) of another non union? (last time was a cadaver bone, with also NSAID use beginning at week 6) No one knows for sure why I didn’t fuse.

in your opinion, Overall is this just a big gamble? what would you recommend your patients to do, anterior or posterior?

Thank you so much for your time.

Lisa