Would you consider this Mobi-C failed and what would be the next step?

Hello - does this image look like my device has failed at C5 C6. I had an image last year that looked similar but the PA the surgeon had see me said its meant to flex - no big deal. Fast forward a year - radiating pain weakness and numbness in right arm and hand. Ortho doc took xray and said it has failed. Same PA is seeing me as last time.

@rossetti99 Hello and welcome to Connect. I've had a C5/C6 fusion. Your surgeon may suggest a revision to a fusion. I think your orthopedic doctor is right because it looks like the halves of it are offset and don't match up properly like half of it has migrated outward, but I am not medically trained.

I'm sorry you are experiencing this problem. A C5/C6 fusion isn't hard to live with because 5/6 doesn't do much at all for turning your head. The only range of motion that is different from before surgery is that I cannot touch my chin to my chest, but it is pretty close within one finger of space.

Jennifer

Hello @rossetti99, I moved your message and combined it with an existing discussion on Mobi F failure - https://connect.mayoclinic.org/discussion/would-you-consider-this-mobi-c-failed-and-what-would-be-the-next-step/ - so you could meet the members who have discussed a situation similar to yours.

@rossetti99, If your ortho doc has taken an x-ray and has diagnosed it as a failure, will there be an open discussion and those results shared with your PA?

I had a cervical c6 c7 ADR six years ago. About a year ago my neck started locking up at the base and having axial neck pain. Now the pain is worse and I have pain and pressure in my head and severe headaches and loss of spatial awareness. I had an MRI and the report read there is a prominent disc bulge with mild to moderate L and moderate to severe R sided recess and foraminal stenosis at c5 c6. I had a myelogram to look at area of the disc replacement the artifact distorts the image. but c5 c6 read the same as the MRI I had a pyelogram 2 years ago and it showed bilateral mild stenosis. I had osteopenia -2.3 when disc was replaced. I read that was contraindicated so surgeon did a CT and said the bones in my neck were fine. I went back to him and he said my neck looks beautiful and I questioned if he had the right imaging bc that's not even close to what the 2 different radiologist. He said the radiologist is comparing my neck to that of a 16 year old. He says my symptoms don't match the imaging. He can't even see the disc replacement well due to distortion. This is very frustrating. Pain is one thing but the pressure in my neck and head and the dizziness and loss of spatial awareness is scary.

Hi, @arowan65, and welcome to Mayo Clinic Connect. I wanted you to know I moved your post to an existing discussion that is talking about a similar topic as what you mentioned:

- Would you consider this Mobi-C failed and what would be the next step? https://connect.mayoclinic.org/discussion/would-you-consider-this-mobi-c-failed-and-what-would-be-the-next-step/

Hoping that others such as @danylko @rossetti99 @jenniferhunter and others in this discussion are familiar with having pressure in the neck and head, dizziness and loss of spatial awareness at some point following a cervical c6 c7 ADR. Also, hearing that your symptoms do not match the imaging sounds discouraging. I'm hoping they can comment on that, if they have experienced something similar.

What are you thinking of doing next, arowan65? Are you looking at getting a second opinion?

@arowan65 Welcome. I am a cervical spine fusion patient. From experience, I know that spine injuries cause a lot of muscle spasms that start moving the vertebrae around. My C1 and C2 would twist on their own with some sideways shifting as well. All of that causes pain because of all the muscles that connect the skull to the spine when those muscle get stretched by muscle spasms in some of the other muscles. What I might suggest is a good physical therapist. A PT can determine with their hands if your spine is put of alignment and gently tweak it back in place. What has helped me is a PT who also does myofascial release to loosen the overly tight muscle. I had a lot more problems with this prior to the spinal fusion of C5/C6.

I have also had my lower jaw go out of alignment and that has a relationship with C1 and C2 where they influence each other. I have been working with a dentist who does treatment for TMJ issues and who makes oral appliances that are expanding my jaw because it is too narrow. That along with PT has helped my neck stay aligned. It has been 10 years since my spine surgery and my neck is better than before, but I can cause a muscle spasm with overuse of my shoulders that affects my neck. I have learned how to stretch and for the most part can correct muscle spasms and get back into better alignment on my own.

When C1 and C2 were rotated, if I looked upward, it caused vertigo (before spine surgery) and doing that action would likely kink the vertebral artery that runs inside the cervical vertebrae. Rotation would stretch it, and looking up would then bend it. It's not meant to stay like that in a stuck position, but that can happen because of muscle spasms.

It sounds like you may have other levels that developed problems after your disc replacement. With issues described as foraminal stenosis, that is the nerve root which is very predictable where it will cause pain because it is a specific nerve. If you also have some spinal cord pressure of compression, that would be a bit unpredictable as to where symptoms happen, and pain can change location when you move our neck because it can change where the spinal cord may be compressed. The spinal cord needs to glide inside the spinal canal as you change position or bend your neck.

Has your doctor explained structurally how your symptoms are generated by your issues?

@lisalucier Thank you,
I am trying to get a second opinion. There are neurosurgeons in my state but not many do disc replacements. Every time I have imaging someone asks "what is that?" when looking the the area of the disc replacement. Since the disc replacement ,I have developed severe osteoporosis. After Recast for 2 years my hips are almost normal but my lumbar remains the same at -3.6. This is worrisome for me. I think it is a valid concern given my symptoms.

@JustinMcClanahan , thank you
I"m not sure I would classify it as a failure. I hope not. However 2 years I was having more pain than usual down my arms so had a myelogram and it showed bilateral foraminal stenosis. It was mild. I'm hoping it can just be cleaned up and not removed. The area above the disc replacement c5 c6 has deteriorated but I'm not sure all of my symptoms are coming from that area. I had a steroid injection at c5 c6 and it helped about 40% but has worn off. I am on an oral course of steroids which has resolved some of my symptoms like loss of spatial awareness and dizziness and decreased the pain to a tolerable level. Steroids are not a long term solution as I already have severe osteoporosis. I also have seropositive RA.

@jenniferhunter Wow Thank you for sharing your story. the doctor who replied my disc I have seen a total of 4 times in 6 years. I am seeking a second opinion. I had an appointment with the Dr who replaced my disc 6 years ago end of May When we were walking out the door my spouse said it seemed like all he did was admire his work. He didn't explain anything to me. He said it's too much for one appointment. I think he is about ready to retire so just getting in as many office visits as possible.

My physical therapist does myofacial release my neck starts to stiffen later in the day. My spouse works on my neck and upper back as well. I have been in off an on for 2 years. I also have a gym routine and my PT owns the gym I attend wrote up my routine.
I had a steroid injection 2 months ago at c5 c6 and it gave me about 40% relief . The effects have worn off so I started an oral course of steroids which have helped with dizziness, loss of spatial awareness and brought pain back down. Steroids are not a long term solution.
I have RA and severe osteoporosis . After 4 years of bisphosphinates my hips are almost normal but my spine is the same -3.6. I had my 3rd dose of Recast last March. So, osteoporosis with a disc replacement is of concern to me as well.
Two years ago I had a myelogram and it showed bilateral foraminal stenosis at the level of the disc replacement c6 c7 and the other levels were fine. Now, the latest myelogram in May report says there is too much artifact to see the disc replacement but did show a prominent disc bulge and severe recess and foraminal stenosis on the right and moderate on left. I"m not sure if Mayo has better ways to image the disc replacement but that is who I am trying to get in a second opinion from.