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in reply to: Facet Joints #25965
Good afternoon Dr Corenman,
I have listed every spine surgery in chronological order as requested:
October 2012
ACDF – C4-C5, C5- C6
Diagnosis:herniated disc, nerve root compression, spinal cord compression, cervical radiculopathy, cervical spondylosis
Symptoms : neck pain, arm pain, headaches, dizziness
August 2013 —two procedures
ACDF C3-C4, C6-C7
Bilateral decompressive laminectomy with fusion C3, C4, C5, C6, C7 – right dural tear
Diagnosis : degenerative disc disease, cervical spondylosis, herniated disc, cervical nerve root compression, radiculogpthy
Symptoms : neck pain, arm pain, headaches, dizziness
November 2014
left C6-C7 foraminotomy
Diagnosis: left radiculopathy
Symptoms : neck pain, arm pain, headaches, dizziness
August 2015
ACDF C7-T1-placement of cage
diagnosis cervical radiculathypathy and anterior subluxation
Symptoms : neck pain, arm pain, headaches, dizziness
January 2017
Posterior cervical laminectomy with foraminctomies, medial facetectomies at C5-C6, C6-C7, and C7-T1
posterior segmental instrumentation C5, C6, C7, T1 and T2Diagnosis :evidence of residual foramina stenosis and kyphosis at C7-T1 and psuedoarthrosis C7-T1
symptoms every time I go for walks and sitting causes my pain level at the base of my neck, arms, and shoulder blades to become unbearable, headaches, arm pain, dizziness
Current symptoms :walks and sitting increases my pain level at the base of my neck, arms, and shoulder blades to become unbearable, headaches, fingers tingling both hands, triceps hurt, forearms, numbness /weakness in arms, I also noticed my gait has worsen.
MRI’’s performed July 2017
Cervical reports states:
There is no evidence of frank instrumentation failure or pseudoarthrosis formation.Shallow desiccated annular bulges arise at C2-C3 and C7-T1. These discs mildly efface epidural compartment and thecal sac.
Facet joint and uncinate exhibit some sclerosis.
C3-C4, C4-C5 and C5-C6 right neuroforamina encroachment.
Multilevel anterior-posterior spinal postoperative changes with stabilization and decompression.
No central spinal stenosis produced
Spinal cord well preserved
No gross lesion or collection suspected
Thoracic reports states
There are minimal discogenic endplate irregulateries present.
Small posterior sub ligamentous herniations at T2-T3, T3-T4, T7-T8 and T8-T9.
Small right posterolateral sub ligamentous hernatiated component at T9-T10
These extruded disc exert increased extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.
Shallow annular bulges arising at T4-T5, T5-T6,and T6-T7. Another annular bulge is identified at T11-T12. These disc further efface epidural compartment and thecal sac.
No gross lesion suspected.
I’m due to have an EMG at the end go August and a CT Scan. Let me know if there is anything i can do to help reduce my pain. Thanks as always.
in reply to: Facet Joints #25269Good Morning Dr Corenman,
I really appreciate your feedback. My surgeon did not decompress T1 and T2. He added instrumentation from C5-C2. I have one last question please, my thoracic MRI before cervical surgery indicated the following:
T1/T2, a disc budge is noted deforming the anterior margin of the thecal sac. Right proximal neural foramina extension is suggested. There is no evidence of left neural foramina stenosis.Loss of disc signal is noted with anterior hypertrophic changes and anterior disc extension.
At T2/T3, a disc budge is noted deforming the thecal sac. Left proximal neural foramina extension is suggested. There is no evidence of right neural foramina stenosis.Loss of disc space height and signal is noted with anterior hypertrophic changes and anterior disc extension.
At T4/5, T5/6 and T6/7 disc bulges notes at all three levels deforming the thecal sac. Bilateral paracentral components are noted at T4/5. Right paracentral components are noted at T5/6 and T6/7.
T7/8 and T8/9, paracentral disc herniations are noted at both levels deforming the thecal sac.
My question is can the above be a source of my pain generators? Thanks again
in reply to: Facet Joints #25260Good evening Dr Corenman,
I am currently post op 5 months (6th spine surgery), and fused posterior (C3-T2) and anterior (C3-T1). My surgeon noted cervical radiculopathy from severe foraminal stenosis and pseudoarthrosis (Mobile facet joint at C7-T1). He performed:
1)posterior cervical laminectomy with foraminotomies, medial facetectomies at C5-C6, C6-C7 and C7-T1.
2)Posterior segmental instrumentation from C5-T2.
3)Use of local autograft.
4)Use of morcellized allograft.
I commenced physical therapy two months ago and still having several issues. After surgery my right arm pain went away, however its back. The left bicep never improved. The pain is really bad on both sides of the base of my skull, both traps and at C7/T1 area both sides with a lot of muscle spasms. In addition my headaches in the occipital area has worsened (right side only). I also have pain in both shoulders, dizziness, left elbow pain, all my fingers are tingling at times.
My surgeon also noticed severe muscle spasms gave me a month of muscle relaxants (Valium). After a month of muscle relaxants he performed an evaluation and referred me to pain management. Pain management performed an evaluation gave me a script for Zanaflex, gave me a number of injections. His diagnosis is myofacial tissue damage, fibrosis (trapping nerves), osteoarthritis and muscle atrophy.I was also given a brochure for an implantable spinal cord stimulator that may help, wants me to think about it.
My question now is, how should I proceed in terms of finding out what is the pain generators? My understanding is once your fused, the pain and spasms should not come from facets. Do i start from selective nerve root blocks, and go from there, or do we start from an MRI and or CT Scan, or is it too early to expect pain relief?
Thanks in advance for your help
Hello Dr. Corenman,
Since we last spoke, I’ve been to two additional spine surgeon consults and my pain doctor.
My pain doctor wants me to stay away from any additional surgeries. The main reason is, in his opinion, fusions should be reserved for severe cases, i.e fractured vertebra, deformity) . He would like me to trial an implantable spinal cord stimulation device. We spoke about Discogram, SNRB,Epidural injection, and Facet blocks. He is open to performing an Epidural injection and provided to me a brochure that explains the spinal cord stimulation process.
Spine surgeons had different opinions, the first, agrees with pain doctor, he would also recommend spinal cord stimulation device and avoid additional fusions. He believes there is a musculoskeletal issue due to my laminectomy procedure. The issue is a disfunction, the lamina bones are removed, so the muscles are now tied together, rather then being connected to lamina. He also was concerned with the number of surgeries, (5 cervical, 1 inner ear), all procedures performed within the past 5 years.
The second surgeon agrees with my current surgeon. He noted that anteriorly I am fused from C3 to T1 (solid). He would also extend the posterior fusion to T2 (currently fused from C3-C7–instrumentation removed) and add instrumentation from C5. There are degenerative changes, however more importantly he feels there is instability, that a fusion would address.
Would a flexion/extension X-rays show this instability? Thanks,
in reply to: Neck pain and fusion advice #22911Thank you so much!
in reply to: Neck pain and fusion advice #22904Good evening Dr Corenman,
In the past three ACDF’s were performed covering C3-T1 (C3-C7 – two plates, C7-T1-Peek Cage).
My surgeon would like to re-operate and revisit laminectomy at C5, C6 and C7 (feels laminectomy at C3 & C4 are fine), extend fusion to T2 with instrumentation and perform foraminotomy. I still have pain base of neck, arms(biceps),shoulder blades, shoulders and right side occipital headaches with dizziness.
In terms of pain generators my surgeon feels the above along with herniations, and nerve root impingements below fusion are the root of my pain.
I would like my pain doctor to perform thoracic blocks and see if my pain decreases, and if so perform a radio frequency ablation before going forward with any additional surgeries.
Will RFA address pain associated with disc bulges and nerve impingement? Thanks
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