westie California

Good afternoon Dr. Corenman,

Wanted to give you an update on the following results from testing, Imaging and ask some questions please Dr.:

MRA

“Mild to moderate extrinsic compression of subclavian veins on hyperabduction, without distention or thrombosis in neck veins or cephalic veins”.

EMG

“Evaluation of the Left median sensory nerves showed prolonged distal peak latency (4.0 ms). Needle evaluation of the Left biceps and the Left triceps muscles showed diminished recruitment. The Left mid cervical paraspinal muscle showed moderately increased spontaneous activity. Abnormal study. Electrodiagnostic testing reveals evidence of left C5-6 cervical radiculopathy without distal denervation. There is also evidence of left neuropathy at the wrist without distal denervation.

The graph shows: left biceps C5-C6 abnormal and left triceps C6-7-8 abnormal

The last time we spoke you mentioned “Chronic radiculopathy can cause neck spasms but a multilevel fusion can do that too” and “A multilevel fusion can cause severe spasms, especially if there is malalignment (lack of lordosis)”.

I still have severe pain and muscle spasms with lack of lordosis. My previous CT scan mentioned “Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. Foraminal narrowing, mild on the right at C4-5, and C5-6, mild on the left C6-7.

C3-4 Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 05/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

Any recommendations on what I should do next? I’m not sure if those Spondylitic ridgings and uncovertebral spurrings are contributing to my issues and if so what surgeon would want to go back in and perform revision ACDF’s? also because of my malalignment what part of this condition is the source of pain? The pain in the base and mid neck is much more painful then my biceps. Thanks

Good afternoon Dr. Corenman,

I want to thank you for your continued support before asking my question. The latest is on Thursday, pain management performed an EMG and Nerve conduction and gave results verbally. I’m still waiting for official report and will post upon receipt. The results showed mild left carpal tunnel, and moderate to severe left side C5, C6, C7 and C8 radiculopathy. The doctor told me, I didn’t heal from my surgery in December 2020 and he doesn’t think it’s permanent nerve damage. He became very upset, when I kindly mentioned that my surgery in December 2020 was on T2-T3 level (fusion) and that C5 thru C7 were operated back in 2017, so how can more time be needed to heal?

He said in a stern voice that I can cut 50% of the nerve and strengthen the muscle and you would not be able to tell. I was instructed to report to office next Wednesday and he will administer Botox in the morning, and to return in afternoon to hospital so he can perform injections in front of neck “scalene muscles”.

My questions are:

1. After 4 years is it safe to say this is chronic radiculopathy?

2. Can chronic radiculopathy cause neck muscle spams?

3. I read your article on thoracic outlet and and see arm and shoulder pain, however no neck pain listed as a side effect of TOS?

4. Can one developed some kind of muscle dysfunction after posterior spine fusion’s that would cause severe spams?

Thanks in advance

Hello Dr. Corenman,

1) you mentioned “A new CT is going to be valuable to determine fusion status”. In 2019 a CT scan was performed at a different hospital setting from 2020 Scan, that stated “degenerative osseous fusion” and from your last message “reading indicates that there is a solid facet fusion at those levels”. So it probably safe to say C3-T2 is fused, with T2-T3 pending?

2) My pain management physician states the following:

“Patient presented in office today for evaluation of neck pain and bilateral upper extremity pain. His pain is most likely due to a combination of post laminectomy pain syndrome, cervical radicular pain, facet arthropathy, and myofacial pain.It was discussed in detail regarding patient’s pain management options, including medications, interventional pain procedures, physical therapy, and surgery. Patient is interested in spinal cord stimulation therapy. I explained to patient that he had undergone ten C-spine surgeries. He has extensive scar tissue and altered anatomy in his cervical spine epidural space. The risk of complication outweighs the potential benefit of the SCS. I do not rec this procedure for him”

I’ve had EMG’s that shown abnormal results from chronic radiculopathy at C5, C6, C7 and C8 nerve roots. My Neurosurgeon is reluctant to perform any posterior foraminotomy procedures at these levels due to significant scar tissue encountered during my last hardware removal that required emergency consultation with a plastic surgeon to remove scar tissue, perform an excision and debridement of upper back and neck wound and reconstruction of flaps. My last CT scan shows

C3-4: No significant disc disease. Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

C4-5, C5-6, C6-7, C7-T1: Postsurgical changes. No significant disc disease. Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, mild on the right at C4-5 and C5-6, mild on the left at C6-7. No significant foraminal narrowing at C7-T1. No significant central canal stenosis at any of these levels.

3)If I remember correctly from past questions, if one is fused 360 then facets should not cause pain because one there’s no motion and two those nerves were obliterated during fusion?

4) My last block’s that was performed in 2020 at C3, C5 and C7 bilaterally resulted in a greater improvement at C3 with smaller amount’s at C5 and nothing at C7 (probably not a pain generator). Previous year injections at C4 and C6 resulted in a positive pain reduction. My question is would an RFA be the next course of treatment for these?

5)You state that CT Scan “is stating a solid facet fusion”, if one is fused 360 anterior (ACDF) and posterior(Facets) shouldn’t radiologist comment on fusion status of disc space? How does one know if front is not moving without any reporting on status?

6)Can these “Dorsal epidural soft tissues at all levels from C3-C4 through C7-T1” cause radiculopathy, muscle spasms or pain?

Thanks for your continued support!