westie California

Good morning Dr. Corenman,

Thanks for information. I do have fixed kyphosis at C7-T1 (cervical-thoracic). I was operated on back in December to address pseudarthrosis at this level, however when they went in a solid fusion was noted at this segment. The surgeon noted what they found was T2-T3 facet joint was significantly unstable and spondylotic, so they instrumented and fused T1-T3. Pedicle screws were placed at T1, T2 and T3 bilaterally.

My question is, in your opinion, would adding back hardware up to C5 alleviate neck muscle fatigue caused by fixed kyphosis and instability? My understanding is after the nuchal ligament is removed the spine can weaken causing neck muscles to fatigue due to increased instability. Thanks in advance

Hello Dr. Corenmen,

My first laminectomy was performed in 2013 (C3-C7), however it was determined that a revision procedure was required due to “defects”. So in 2017 a revision surgery cervical laminectomy with foraminotomies, medial facetectomies C5-C7 and segmental instrumentation C4-T2 was performed. In 2018 removal of hardware C4-T2, excision, debridement of upper back and neck wound, and reconstruction of right and left trapezius myocutaneous flaps was performed.

In 2018, I also developed cervical thoracic kyphosis. I recently spoke to a surgeon who mentioned that close to 40% of patients who undergo cervical laminectomy develop post laminectomy kyphosis due to nuchal ligament removal. The head tilts downward and causes pain, neck muscle fatigue, etc. My question is, would adding back hardware alleviate neck muscle fatigue by avoiding head from tilting downward?

Good evening Dr. Corenman,

So I wanted to give you an update, last week my surgeon performed surgery. The pre operative plan was to perform a T1-T2 revision surgery to address pseudarthrosis at this level using iliac crest bone graft and to open up nerve channels that were tight.

My surgeon informed me the next morning after surgery, that the procedure went well however, there was no pseudarthrosis at T1-T2, and the level below was significantly degenerative, so he performed a fusion to T3. He added rods and screws from T1 to T3 with bone morphogenic protein. In reference to nerve channels, it was decided that procedure wasn’t required because all the nerves channels were open.

This did not sit well with me. I’ve gone to several surgeons, including pain management, and even my CT Scan and MRI scan reported foraminal stenosis. So now, I’m really concerned, nervous and anxious to know if my base of neck, arms and shoulder blades pain will improve? I did tell him during my office visit’s that SNRB blocks especially at C3, C5 and C7 did help and were pain generators. I showed him CT scan report again stating stenosis and all he said was, ” When I looked they were open”. So now all I can do is pray that my symptoms improve.

I do have questions in that:

1. Is this normal to have a surgeon and neuro radiologists disagree?

2.Is the likelihood of a T2-T3 degeneration causing my issue higher than foraminal stenosis? My CT performed 5 months ago report: C3-4 Bilateral uncovertebral spurring and bilateral facet arthropathy, 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. How long of a period after fusion is usually warranted to know if this fixed my problems?

Thanks in advance Dr. Corenman