westie California

Good evening Dr. Corenman,

Spoke to my surgeon earlier today in reference to a number of questions I had, however his responses were not what I expected. We spoke in reference to the following:

1)”Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018”, and was told “previous surgeon removed some of spurs, however there were some that remained”.
Bone spurs take time to dissolve. I kindly mentioned, that my ACDF’s were performed in 2012 and 2013, how can they not dissolve after 8 to 9 years? Was told in my case give it a little longer, it takes a very long time. This does not sound right to me.

2)Reviewed my Ct Scan again, not overly concerned with nerve root compressions, being mild to moderate they don’t operate on those compressions. I asked about moderate to severe noted on my CT scan at C3-C4 and was told that the radiologist over stated the degree of compression. This was a bit of a surprise.

3)We spoke about Nuclei ligament that was removed during laminectomy and that one surgeon stated to me that some individuals can have issues with removal because its a cable that stabilizes neck and without it one can run into trouble with pain due to instability and muscle fatigue. He didn’t feel that was the case for me because my kyphosis is not severe. I’m lost on this one also, my thought is, if you have an instrumented fusion, how would one develop severe kyphosis after laminectomy?

4)I asked if he can order an over-read of my CT films for a second opinion to ascertain fusion status on C4-5, C5-6 and C6-7, said a CT Scan will be ordered in approximately 5 months, and they will look at cervical and upper thoracic fusion status.

5)He didn’t address nerve channels during last surgery, because in his opinion the level below my previous fusion T2-T3 should be pain generator. I’m scratching my head on this one also, by no means I’m a spine surgeon, however this is strange for a pre surgical plan to be drafted only to be scraped during surgery.

6)Still thinks after 4 months it’s too early to state surgery was not successful.

6)His plan is to order for my next office visit flexion and extension x rays – next week

7)refer me to pain management for workup

Is there any recommendations on my situation? I’m extremely tired, frustrated and confused. Thanks

I will look for another radiologist. The question’s that I still have is, what will be suggested if one has pseudarthrosis at those levels, would it be revision ACDF’s for those segments? In addition, if a second opinion comes back that there’s a solid fusion, how does that explain “Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018” ?

Is it possible to have some kind of instability/movement that’s not being picked up on a CT scan? When one is in a scanner there’s no load or movement. Is another possibility, that although there’s a fusion due to arthritis, bone integrity is lacking? thanks in advance

Dr. Corenman,

I also attached my CT Scan report performed before my December 2020 surgery. Still not sure if anything here explains why after so many surgeries, I’m still having so much neck pain, severe muscle spasms, headaches, shoulder, bicep pain, dizziness, base of skull and base of neck pain. I’ve also noticed a lot of swelling from mid point of neck on both sides down to where shoulders meets neck. The muscle spasms continue into upper back traps. My surgeon prescribed Methocarbamol 2 months ago and I still don’t see any significant change. Any help with be appreciated.

****CT Scan****

FINDINGS:

Postsurgical Changes: Postsurgical fusion changes, appears to reflect a revision/addition since 5/19/2018, now appears to involve C3-T1 with multilevel postoperative hardware and decompressive laminectomies. Hardware appears intact, appropriately positioned without evidence of failure or loosening. Bony fusion appears solid at C3-4 through C7-T1.

Alignment: Lordotic straightening.

Vertebrae: Normal in height.

Soft Tissues: Expected postoperative changes.

Disc Spaces:

C2-3: Tiny central disc herniation. There is associated minimal mass effect on the anterior thecal sac without significant central canal stenosis No significant change.

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.

Spinal Canal Contents: Limited by CT technique, grossly unremarkable