Need input on MRI after ACDF surgery
 

Hello all! It's been a few months since I posted and would like some help with a new MRI I just had done a few days ago. I had the C4-5 and C6-7 levels done with cadaver bones and hardware on September 5. When I woke up, the pain, tingling on the left side were gone, and eventually the numbness subsided. The C5-6 disc was bulging but not ruptured, so the surgeon did not remove it. Of course, I had the mid-back pain from shoulder to shoulder for quite some time. About 5 or six weeks after the surgery, I started experiencing some major pain on the right side. There is no numbness or tingling involved and the pain is different from what I experienced before my surgery. It's not constant and I have brief intervals without pain throughout the day. The pain involves my right shoulder blade, shoulder and my arm. The pain ranges from mild to severe. The doctor ordered another mri. I'm going to type the whole thing out. I understand the fused levels are good, but I need some input on the interpretation of C5-6.

At C4-5 there has been interval fusion. There has been significant decrease in the size of the disc osteophyte complex. Only mild canal narrowing is currently evident.

At C5-6, there is a post-fusion change. There is a diffuse disc osteophyte complex which causes mild to moderate central canal and right foraminal narrowing. The degree of central and right foraminal is unchanged from the preoperative study.

At C6-7, there are post-fusion changes. Previously seen right paracentral disc osteophyte complex is no longer evident. There is no significant canal or foraminal narrowing seen.

Impression:

Status post anterior plate and screw fusion from C-4 through C-7. The appearances of of C4-5 and C6-7 have improved. At C-5-6, there is persistent central canal narrowing with right foraminal narrowing unchanged from the pre-op study.

The reason I am asking for an explanation is because I do not see my doctor again for almost two months! He won't be in the office. Do you think I would have to have surgery again or is there some other alternative treatment that would help with the pain? I appreciate any insight from the group.

Beckel

At C5-6, there is a post-fusion change. There is a diffuse disc osteophyte complex which causes mild to moderate central canal and right foraminal narrowing. The degree of central and right foraminal is unchanged from the preoperative study.

Well I am as confused here as you possibly!?!?!

You stated that the doctor left C5-6 alone....the study says post op changes, then it ends with these are unchanged from pre op studies.....

Yes, I am slightly confused. I have the original MRI and it states:

C5-6, there is posterior disc osteophyte complex. There is mild canal stenosis. there is moderate bilateral neural forminal stenosis secondary to posterior osteophyte. The only difference I see is in the word "diffuse" added to the disc osteophyte complex and the word "moderate" added to narrowing. So it looks like the osteophte complex has spread out and the narrowing is getting worse. I asked him if he was going to remove the C5-6 disc before surgery and he said no. I am wondering if he had fused it, would I be having all this pain now?

well it is hard to answer. If the disc was healthy then it was probably in your best interest to leave it. The osteophyte or bone spurring, could have gotten worse for sure. Usually when they clip the osteophyte they do so from the anterior when the disc is removed. In order for them to get to that w/o removal of the disc is posterior.

It could most certainly be the source of pain btw. I can explain what I was told as I am C4-7 Myself, and it took two tries lol. The body senses trauma to the bone and sends signals to repair itself and then the bone starts to grow, this is how fusion is achieved. Now if there are bone spurs already present it can make them larger. Hope that helps a bit :)

Just to note I also experience this same type pain. Never had it like that prior to surgery. They did an MRI of my right shoulder and found out I had a torn rotator cuff....there was some etiology present as well to cause that kind of pain and I am also told that this is a normal type complaint from this kind of surgery.

Thanks Gator and it does make a lot of sense about the bone spurs getting larger. So if it actually came to the point of another surgery, they would go in from the back, correct? I didn't have this pain before surgery and if the conditions were present then, I wonder why? Maybe because they have gotten larger. You say you've had two surgeries, were they both ACDF?

Yes both ACDF. I had a mal/non union of C5-6, and C6-7 went bad so they had to go back in and redo C5-6 and then do C6-7. I too had an osteophytic bar that grew on C5-6 and it was spearing the nerve root so that was removed during the second surgery. They would ONLY go through the back if they wanted to leave that disc. That is IF they even consider it surgical at the moment. :)

Yes, Gator I am in no hurry for any more surgery at this time. I am just wondering what the alternative treatment would be for the osteophytic bar. At this time, I use heat alot, pain medication when it gets really bad and Biofreeze, a topical pain relief gel. I also take Robaxin on a daily basis. The pain woke me up at 4 a.m. this morning and I felt like I was being stabbed in the arm and shoulder. Just curious if it is something I am going to have to live with. One other thing I have noticed is that my right arm is becoming progressively weaker. I cannot lift anything very heavy at all and I have a lot of trouble with my hand grip. As far as the canal stenosis, it is moderate right now. What alternative non-invasive treatment would be used for that? Is the stenosis contributing to the pain I am having or is it strictly related to the bone spurs? I really appreciate you taking the time to answer my questions.

Well, no one pushes for surgery, but when they do it isn't for resolution of pain. It is for cord preservation and mechanical function and it seems as if both of those areas are being hindered. Listen to YOUR body. I would also suggest going out of network to get a second opinion. I was told I was good, it was in my head only to find out I had a broken neck for two years.... They can try injections as an alternative, medrol dose pack (oral steroids). PT is NOT going to improve this condition. In fact it could make it worse as there is possible erosion to the cord and nerve root from that bone spur. If it were soft tissue then PT would be a viable option. Give Naproxen a try if you have not already. I tried all of the anti inflammatory and I just had an amazing breakthrough in condition with mine with a drug called diclofenac sodium. The two popular names for it are Cataflam and Voltaren.

Gator, I am already in the process of obtaining an appointment with Cleveland Clinic, which is a five hour drive from me. It is just unreal to wait 7 weeks after having an mri before you can see the doctor for the results. I am not happy with my care here in my hometown, and the surgery was a nightmare! To make a long story short, my surgery was delayed almost five hours because he told me he had one "short" procedure to do before he did mine. My surgery wasn't finished until one a.m. in the morning and I was actually sent home from the recovery room less than seven hours after the surgery! I was never admitted to a room because they said they didn't have one! I almost developed pneumonia because I didn't receive a spirometer or any other things you normally receive when coming home from surgery. I have vowed that if I ever have to have surgery again, it won't be at the same medical facility. I agree with you totally about the physical therapy. I woke up one morning in April, and I had an ache under my left shoulder blade. I thought I had just slept wrong, but the pain worsened until I couldn't ignore it any more. I waited two months, and I saw my primary care doc. They did an x-ray, which of course, doesn't show much and sent me straight to physical therapy. My insurance company wouldn't pay for an mri until I had completed six weeks of therapy. Four weeks into therapy, the therapist, who performed terribly painful manipulations on my neck, ruptured another disc, the C6-7. I started out with the C4-5 ruptured but at the time I didn't know that. When she hurt me so badly that day, the pain immediately started down my arm and extended through my fingers. Then the tingling started and my thumb and two fingers went completely dead. The "electrical" shocks that went down my arm felt like I was sticking my fingers into an electric socket. So my insurance company gave in and let me have the mri, it showed exactly what I was dealing with, ruptured discs at level C4-5 and C6-7 that were in the process of damaging my spinal cord. I had to wait a month to get in with a neurosurgeon and I didn't know how much longer I could live with the horrific pain. He immediately told me there was no alternative, that nothing could be done except the surgery. And so it was done and again I am suffering pretty badly. As far as the Naproxen, it used to be my drug of choice because I have severe osteoarthritis in both knees and my feet. However, I was diagnosed with Crohn's disease about 7 years ago and I am unable to take any NSAIDS. I can only take narcotic pain meds at this time. I cannot believe you actually had a broken neck for two years! But actually, I can. It seems as if a lot of people in the medical profession just don't give a darn. I've found you have to be really pro-active in order to get anything done. I really appreciate your taking the time to answer my posts. I should hear back from CC tomorrow about my appointment, which they said they would schedule in three to five days after I faxed them my medical reports. In the town I live in, it takes 2 or 3 months or longer to get in to see a neurosurgeon. It's just down right ridiculous!