westie California

I really appreciate your feedback and have additional questions please:

Lets say this level is the pain generator, I already had an ACDF at C3-C4 w/plate and Laminectomy covering this segment. Does a CT scan show “if the large compressive spur was generated more from the back (foraminotomy) or from the front (ACDF)”? And if spur is generated from the front, will the previous ACDF need to be redone or would this be an anterior cervical foraminotomy? Thanks again

Good Morning Dr Corenman,

I appreciate your feedback and will dictate my operative note from August 18, 2015:

DATE OF OPERATION: August 18, 2015.

PREOPERATIVE DIAGNOSIS: Herniated disc and spondylolisthesis C7-Tl.

POSTOPERATIVE DIAGNOSIS: Herniated disc and spondylolisthesis C7-Tl.
OPERATIONS:
• Anterior cervical decompression at C7-Tl and fusion at C7-Tl.
• Placement of cage biomechanical device in disc space at C7-Tl.
• Anterior instrumentation C7-Tl.
• Use of local bone graft.
• Fluoroscopy.

ANESTHESIA: General endotracheal.
INDICATIONS: This is a XX year old with a history of multiple previous spine surgeries who has been having progressively increasing neck pain and kyphosis. Imaging studies showed an anterior subluxation of C7 and Tl and therefore surgery is recommended after risks, benefits and complications were explained.

INTRAOPERATIVE FINDINGS:Narrowing of the disk space at C7-Tl. Good restoration of disc height at the end.

PROCEDURE IN DETAIL: The patient was brought to the operating room and placed in supine position. After the appropriate monitoring lines were placed, the patient underwent general endotracheal anesthesia.The patient was positioned supine and the anterior part of the neck was prepped and draped in the usual sterile fashion.Once this was done, a transverse skin incision was made. Dissection continued through the soft tissues. The prevertebral fascia was identified. The trachea and esophagus were retracted medially. Carotid sheath was identified and retracted laterally.Longus colli muscles were elevated. The previous plate was then identified thereby localizing the correct level the bottom of the plate. Once this was done, a distraction pin was placed in Tl and #11 blade was used to incise the annulus.Curettes were then used to remove the disk material down to the level of the PLL. The distraction was then applied and the decompression completed all the way down to the uncovertebral joints. The endplates were prepared for fusion.After decompression was completed and a 6 mm PEEK off the cage was impacted into the centered of the disk space. Once this was done, the screws were then affixed to the spine using 16 mm screws were placed in Tl and 14 mm in C7 and the locking caps were placed. Once this was done, hemostasis was obtained.Final fluoroscopy showed satisfactory positioning of the instrumentation.Wound was copiously irrigated with antibiotic irrigation. A JP drain was left in place and tunneled through a separate incision. The wound was closed in layers using 3-0 Vicryl for the platysma and deep dermis and 4-0 Monocryl for the skin. Clean sterile dressing applied to wound.The patient turned off the operating table, extubated in operating room and transferred to recovery in stable condition. No apparent complications. SSEP and motor evoked stable throughout the procedure.

My MRI’s are very confusing since it keeps referring to a disc. Per procedure above, I have a peek cage.

What Xray or MRI should I request from my doctor to check for displacement of cage? From what I see online, it appears measurements should be taken before and after surgery and something about distance between cage posterior marker and posterior margin of the vertebra should be greater than 2mm to provide reassurance that the cage is not invading the spinal canal?

Thanks again Dr Corenman, any help would be appreciated.

Good morning Dr Corenman,

That is correct, pain doctor is stating cage is displaced and projecting into the canal. The surgery was performed in 2015. My spine surgeon stated that I have at c7/t1 kyphosis(not sure if this information helps). The radiologic report performed May 2018 states the following:

“At C7/T1, disc bulge is noted deforming the thecal sac. There is no evidence of neural foraminal stenosis. Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration”.

Additional Information on this report:

At the C2/C3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central stenosis in conjunction with posterior ligamentous hypertrophy. There is no evidence of neural foraminal stenosis. Loss of disc signal is noted with preservation of disc space height.

C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Graft placement associated with discectomy and fusion procedures are noted at the C3/C4, C4/5, C5/6 and C6/7 disc space levels. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/4 mild left neural foraminal narrowing is noted in conjunction with facet and uncinate hypertrophic changes. There is no evidence of right neural foraminal stenosis at C3/4. Neural foraminal stenosis is not suggested at C4/5, C5/6 or C6/7 currently. Cervical spine straightening is noted which meets criteria for muscle spasm.

The Previous MRI dated July 2017 by a different radiologist states:

“Shallow desiccated annular bulges arise at C2-C3 and C7-T1. These disc mildly efface epidural compartment and thecal sac”. Facet joints and uncinate processes exhibit sclerosis. C3-C4, C4-C5 and C5-C6 right neuroforamina appear contracted.

I hope this information can explain why I’m still having headaches, base of skull, base of neck, shoulder’s, and bicep’s pain, that at times run into my pinky and ring fingers. The base of neck pain worsens standing, turning my head left, right and up (the worst), looking down, and left and right causes base of skull pain to worsen. Thanks again Dr Corenman.