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in reply to: Facet Joints #30175
Thank you so much!
in reply to: Facet Joints #30170Dr Corenman,
I have an additional question please? If one is diagnose with an ACDF Peek Pseudarthrosis at C7/T1 my understanding is the best treatment option is a 360 degree fusion. If one was to have a posterior fusion (180 degrees) to correct a C7/T1 non union, does a posterior fusion exploration confirm fusion for 360 degrees or just 180 degrees? Thank you
in reply to: Facet Joints #30159Hello Dr Corenman,
My second procedure in 2013, there was a dura leak and it appeared that I had a cord injury.After 10 days in the hospital, was discharged to a sub acute facility for seven weeks, it was during my time there that i developed two large boils on the back of my neck (towards the base). I was transfered back to the hospital for consultation, and no-one knew what it was, some said CSF fluid still leaking, one doctor said it could be an infection. Over time the boils disappeared and I developed this very large dehiscence.
In reference to fusion mass exploration was told I have a solid fusion. My surgeon is scratching his head, the base of neck is tight and when i turn to left and right a few times i can hear crackling and it tightens even further. It’s becomes at times unbearable, and i have radiating pain into shoulders and arms. I also feel at times pain in ring finger and pinky finger left side more than right.
Is it possible to have a non union at that peek cage level (C7/T1) that would not be picked up from a posterior fusion exploration? There has to be something that’s being overlooked. Thanks
in reply to: Facet Joints #30153Good morning Dr Corenman,
A few months ago my surgeon performed removal of C4-T2 posterior segmental instrumented fixation and fusion exploration. Plastic surgeon was consulted due to an open wound of the neck and upper back along with inter operative extensive scar tissue. Excision and debridement of the upper back and neck wound and scar was performed. Reconstruction with right and left trapezius myocutaneous flaps was completed.
The pain at the base of the neck never improved, and i still have left and right bicep, and shoulder pain. To answer your previous question in reference to C4-C5, I’m not sure why the CT scan does not show a fusion at this level? per my surgical notes an ACDF includes this level and Laminectomy/fusion includes this level also.I’m very thankful you pointed this out.
I completed two months of physical therapy and no improvement. Was told by two therapist, that there is significant muscle spasms in my traps, and my pain radiating into the shoulders, arms, and back of head, does not appear “local it’s deeper than that”. After hearing this, I sent a number of my scans and reports to surgical center’s for a free review. A couple reported that a peek implant for ACDF especially below a C3-C7 fusion would be extremely likely to have a failed fusion.
My question is can one have pseudarthrosis at C7/T1 although they have a peek cage acdf and posterior fusion? and second question is if the radiologist is correct and I’m not fused at C4/C5 can that cause base of neck pain, arm and shoulder pain? Thanks again Dr Corenman!
in reply to: Facet Joints #28600Good afternoon Dr,
The doctor did not order an additional CT scan said it was too soon, however I’ve attached one I had done 10 months ago:
Procedure: CT-CERVICAL SPINE WO
CONTRAST
CLINICAL HISTORY: Cervical fusion.PROCEDURE: Contiguous non-contrast axial images were performed through the cervical spine. 2-D sagittal and coronal reformatted images were obtained.
FINDINGS:
There is straightening of the cervical lordosis. There is preservation of vertebral body height. The C2-3 level is unremarkable.
The patient Is status post anterlOr cervical fusion from C3-C4. There is anterior and posterior cervical fusion from CS-Tl. Wide bilateral laminectomles are present from the C3-4 to the CS-Tl level.The C3-4 level there is anterior cervical fusion utilizing a plate and vertebral body screws and intravertebral graft material. There is good alignment of C3 upon C4. There is osseous signal intensity across the disc space consistent with osseous fusion. There is good posterior decompression secondary to wide laminectomy. There is good alignment of C4 upon CS. There is osseous signal intensity noted across the disc space. Intravertebral graft material is
present. There is good posterior decompression of the spinal canal.The CS-6 C6-7 and C7-Tl disc space levels demonstrate osseous signal intensity course the disc spaces consistent with osseous fusion. There is anterior fusion utilizing anterior plate and vertebral body screws there are bilateral pedlcle screws with vertical stabilizing rods from CS-T l. There is wide laminectomies with good posterior decompression of the spinal canal. The neural foramina
are patent.IMPRESSION:
Status post anterior cervical fusion and laminectomy at the C3-4 level. There Is anterior and posterior fusion from CS-T1 with wide laminectomles with good posterior decompression of the spinal canal.
VRTs 3-D reformatted images of the bony structures demonstrate good alignment of the cervical vertebral bodies and good positioning of the hardware.
Page 2 of 2Addendum 1
Addendum: 8/28/17.
Reporting
Date: 8/28/2017A previous MRI of the cervical spine dating 7/16/17 is now available for comparison.
At the C3-4 level the patient is status post anterior cervical discectomy and fusion. A plate, vertebral body screws and intravertebral graft material is in place. There is osseous attenuation across the disc space level consistent with good osseous fusion. There is a wide bilateral laminectomy with good posterior decompression of spinal canal. The neural foramina are patent.
At the C4- 5 level there is good alignment of C4 upon CS. There is a wide laminectomy with good posterior decompression of spinal canal.
The patient is status post posterior fusion utilizing pedicle screws and vertical stabilizing rods from the C5-T2. There is anterior fusion with an anterior plate and from the C6 -Tl level. At the CS-6 level there is good posterior decompression of spinal canal. There is osseous attenuation across the disc space level consistent bony osseous fusion. The CS-6 neural foramina are patent.
At the C6-7 level there is good posterior decompression of spinal canal. There is osseous attenuation across the disc space level consistent with fusion. The C6-7 neural foramina are patent. There is good alignment of C6 upon C7 with osseous attenuation across the disc space level.
There is good alignment of Tl upon T2 and Tl-2 neural foramina are widely patent.
Signed by:
Signing Date: 8/31/2017In reference to the muscles, the physician mentioned there is a problem with the wound and requires a wound revision. After my posterior spine surgery, the trapezius muscles from C5 to T2 appears disfigured and are extremely painful. There is also a large indentation at approximately C7/T1. thanks
in reply to: Facet Joints #28576Happy Father’s Day Dr Corenman!
I have some additional questions please, after having my standard MRI’s, flexion/extension X-rays, CT scan and EMG/Nerve conduction. My results were:
Thoracic Spine
T1/T2 disc space level, postsurgical changes are noted. Posterior stabilization rod is noted with paired transpedicular fixation screws transversing the T1 and T2 vertebral bodies. No evidence of herniated disc or sideline thecal sac deformity . Loss of disc signal is noted with preservation of disc space height.
T2/3, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T3/4, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T4/5, left paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T5/6, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T6/7, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T7/8, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T8/9, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T9/10, right paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T11/12, disc bulge is noted deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
These extruded disc exert extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.
Central canal integrity is partially compromised. Persistent thoracic multilevel discopathy noted
Cervical spine
C2/3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central spinal stenosis in conjunction with posterior ligamentous hypertrophy. 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 C3/4, C4/C5, C5/C6 and C6/C7 disc space level. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/C4 mild left neural foraminal narrowing is noted in conjunction with facet and ucinate hypertrophic changes.
At C7/T1 disc buldge is noted deforming the thecal sac.Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration.
Cervical spine straightening is noted
Ct Scan – Per doctor noted straightening and solid fusion
Flexion/extension Xray – no instability
EMG/Nerve Conduction states abnormal study:
1.Mild left carpal tunnel syndrome
2.Chronic lower cervical radiculopathy bilaterally at C5, C6, C7, and C8 nerve roots
3. Acute findings affecting the cervical paraspinals/dorsal roots.
My surgeon would like to perform a two step procedure, first remove posterior instrumentation since he feels this is likely causing nerve irritation, and second have a plastic surgeon work on trapezius muscles his opinion is there is displacement of the muscles.
I’m really hesitant on having a seventh spine surgery and was told this surgery may improve my symptoms. As you know, i’m still having great amount of pain at the base of the neck, shoulder’s pain, occipital headaches on right side with dizziness, both biceps pain, fingers tingling, etc.
My pain doctor told me he can’t inject C5, C6 and C7 because there is no joints and he does not perform SNRB in the neck area.
Can you give me any recomendations? Thanks
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