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  • C-spine issues months after ACDF- advice needed

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    Old 06-08-2014, 08:50 PM   #1
    kmmom
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    C-spine issues months after ACDF- advice needed

    I'd appreciate any advice about my current cervical spine issues. Are there other options besides a multi-level fusion? I see my neurosurgeon again on 6/17, & hope to have educated questions to ask him. History: At age 49 I woke with a stiff neck, found I had 60% spinal cord compression by a herniated disc, and 7/2013 had c5-c6 ACDF surgery & a Medtronic Peek implant. Other discs were not in great shape, but we hoped any future surgery would be years later, not months. I've been participating in my neurosurgeon's recommended Pilates/PT & continue to do so to strengthen core. All was well until 8 months later, March 2014, when I began experiencing stabbing pain, aching, & muscle spasms in my trapezius/shoulder area, and down into my left elbow. Acupuncture, massage, muscle relaxant, & Celebrex have not worked. The current MRI shows:
    Straightening & slight kyphosis at C3 unchanged from pre ACDF surgery.
    Cervical spinal cord has normal signal.
    Degenerative signal developing within each cervical disc w/ mild C3-4 & moderate C4-5 disc space narrowing.
    C2-3: no central or foraminal stenosis despite mild uncinate & facet hypertrophy.
    C3-4: asymmetric left severe uncinate hypertrophy causing severe left foraminal stenosis. Disc spur complex causing mild to moderate stenosis w/ trace effacement of anterior left cord. Right foraminal stenosis minimal.
    C4-5: uncinate & facet hypertrophy causing severe left & moderate right foraminal stenosis. Disc spur complex w/ minimal broad-based disc bulge causing moderate central stenosis & mild effacement of left cord.
    C5-6: no residual central or foraminal stenosis post ACDF & fusion.(7/2014 surgery)
    C6-7: uncinate & facet hypertrophy causing mild bilateral foraminal stenosis. Disc spur complex causing mild to moderate central stenosis. 2mm broad based disc bulge present.
    C7-t1: no central or foraminal stenosis.(yeah!)

    Any input, suggestions about future procedures, advice would be greatly appreciated. Thank you in advance, Sue

     
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    Old 06-09-2014, 12:03 AM   #2
    ChuckStr
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    Re: C-spine issues months after ACDF- advice needed

    I'm not a doctor but I do have some observations based on having some of these issues as well, and talking with myriad neurologists, and spine surgeons. As long as you don't seem to be suffering from more central cord compression symptoms (and from the symptoms you list you don't appear to be), then your problems seem to be coming from the left foraminal stenosis at c3-c5.

    Radiculopathy (referred pain to your trap/elbow etc) is often treated with multi-modal PT, cervical traction and other non-surgical modalities with great success (some studies suggest 90%).

    Failure of conservative therapy or emergence of cord compression symptoms (gait abnormalities, incoordination of hands, various long tract signs etc) would favor surgery.

    Of course, one of the hazards of surgery, as you are finding out, is that adjacent segments to those fused often develop arthritis more quickly (studies suggest about 26% within a 4 - 8 year period). There are now alternatives to fusion which may or may not be appropriate if the need for surgery does arise.

    You should definitely have a good conversation with your spine surgeon and make sure to get multiple opinions, especially if surgery is recommended in this case, as you may get differing opinions and access to less invasive surgical options as well. BTW, some of these options such as disk replacement are generally only performed on one level so you may want to get the nerve root causing your problems isolated through EMG, or selective nerve block, unless the consensus is both levels will require attention.

    Good Luck

     
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