Still having issues 4 months post op ACDF C4-C6

@jenniferhunter do you have any thoughts on what I posted? THANKS!

@amywood20 I'm sorry you are having issues. I understand your concern with that image. The screws do seem kind of long like they could be breaking through to the spinal canal. What I am not sure about is what kind of artifacts could be caused by the hardware itself on the imaging, so I don't know if the screw is pushing into the spinal canal or right up to it. If you don't get a satisfactory answer from your doctors, you may want to see a neurologist for another opinion who is not associated with the medical centers of your current doctors. If a doctor misses something, others associated with that facility don't want to challenge the current opinion. I had run into that myself before I had surgery when the various surgeons who evaluated me didn't understand my symptoms. I had found the answer myself in medical literature and asked for help in bringing that to the attention of the surgeon, and none of the doctors would help with that even though I had been their patients for several years before I saw the spine surgeon. The only thing they would say is to get another opinion, and I did at Mayo which is where I did get help.

If you see a neurologist who specializes in spine issues or thoracic outlet syndrome, that would be best. You could have thoracic outlet syndrome in addition to the other issues you mentioned and it causes arm and hand pain, and TOS is more common with spine injury patients. You also have surgical scar tissue in an adjacent area if you had a frontal approach in your surgery. I do have TOS in addition to my spine issue which was at C5/C6, and after my ACDF, my TOS got worse and everything tightened up, and doing myofascial release helped me loosen that up. I do have extra tightness on one side of my neck and shoulder that pulls into my rib cage. I keep working on this with myofascial release which I was also doing for several years before my spine surgery. I think it helped surgery go easier because the tissues were looser which made it easier to retract. You might want to look at our MFR discussion for information. Mostly, this is hands on stretching by the therapist while you lie on the table. I have not been seeing my PT because of COVID-19, but I continue on my own as best I can.

You are also at 4 months spine surgery post op and when I was at that stage, that is when my muscles really tightened up. I had no hardware and had to be really careful not to do anything until I fused, but it was at the 4 month mark that I was beginning to fuse and was cleared to begin PT and myofascial release again. MFR might be able to help you even if you don't exactly know the source of the pain. If your PT is not trained in MFR, there is a provider finder on the MFR website. If you do have TOS, it causes compression of nerves in the brachial plexus and blood vessels where they pass between the ribs and collar bone. It is usually missed and misunderstood by doctors, so look for a neurologist at a facility that treats TOS as a condition. I have had some shoulder issues too, a SLAP tear in the capsule in one, and a frozen shoulder in the other caused by the contrast that they injected during an MRI for shoulder instability. Neither of the shoulder issues was the source of my ongoing pain, it was caused by my spine (cervical stenosis) and TOS. My spine has been corrected, and I'm still working on the TOS and making progress.

https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
https://trainingandrehabilitation.com/how-truly-treat-thoracic-outlet-syndrome/

@jenniferhunter thanks for your insight. My physical therapist started doing manual work on Thursday instead of the ASTYM she was doing on my arm. She is now working the pec area and the arm. I don't know if it's technically MFR though. If I don't get satisfactory answers with the neurosurgeon I am either going to go back to the shoulder doc ("if" the surgeon thinks it's a shoulder issue) or make an appointment with Mayo. I did the bouncing back and forth between these two specialists prior to surgery and don't want to do it again. Both of them, along with two physical therapists, said my issues were cervical spine which is why I had surgery. I tend to think that is what I have going on again. Even the hubby said I might just need to go to Mayo. We'll see how Monday goes. Thanks again for your response!

Hi this is lilypaws Did you have a fusion on your neck? Sounds like you need to see a surgeon again if you neck is not better. My neck is bad too, but so far PT had helped. But, my low back is a mess. I have to have a fusion from T10 to my pelvis it is a big surgery. They do my front first then I rest a day and have my back done. Then I only have 2 days left in the hospital. I won't be able to bend forward or sideways, which will be hard, but it will help my spine to heal. It's going to be tough at home, but at least I will have pain pills.
Take care Jenniferhunter.

@lilypaws yep, I had an ACDF. It was from C4-C6 with two spacers and a plate with six screws.

So your fusion was in your cervical. I don't know what ACDF means. Hope you are doing ok.

@lilypaws ACDF is anterior (frontal approach) cervical discectomy (disc removal) and fusion

@amywood20 When Mayo is open again for appointments, I think that would be a good decision to go there. What you should do is get together copies of all of your imaging before and after your spine surgery. You can contact Mayo with that and they will review the imaging. After that, a decision is made based on if they can offer medical help, and if that is yes, they will contact you about an appointment. You can probably do all of this now. I don't know if anything (other that waiting until COVID-19 urgency has passed) has changed.

When I contacted Mayo 4 years ago, I wrote to a specific surgeon and asked that he review my imaging because I read papers he co-authored and thought his area on interest would be a good match for what I needed. I had been turned down 5 times by local surgeons who didn't understand my symptoms and none would help me, but I knew that this Mayo surgeon would understand because of reading about a similar symptom of leg pain that was caused by cervical stenosis. There was terminology in that paper that I looked up and in doing that, I found medical literature with cases like mine that were described as a rare presentation.

When I came to Mayo for my workup, first I saw a neurologist from the spine center who ordered tests based on his exam and those were blood tests, nerve conduction EMG, MRI so we had complete imaging of the entire spine to rule out any non-cervical problems, testing in the Doppler lab for thoracic outlet syndrome which they confirmed by testing and the neurology exam, and a follow up with a thoracic surgeon about the TOS, and the exam with the neurosurgeon where he discussed my MRI imaging with me and told me his recommendation. The thoracic surgeon had to decide if he thought my biggest symptoms where coming from my cervical spine or the compression of nerves because of TOS which he discussed with me, and he consulted with the neurosurgeon about this, actually in a phone call while I was at the appointment with the neurosurgeon. I had a choice of fusion or artificial disc, but I wasn't a great candidate for the artificial disc because of 2mm of instability at C5/C6. Choosing a fusion let me avoid hardware and I agreed to stay in a neck brace until fused which was at 3 to 4 months. I didn't want possible hardware complications and I knew my body didn't like metals because of reactions I had with pierced earrings. I also knew that my range of motion would be nearly the same with a fusion at C5/C6 because it isn't very involved with head turning. My range of motion is normal except that I cannot touch my chin to my chest when I tuck my head, but it is darn close.

I did a lot of myofascial release before my surgery because I was doing this to treat the TOS, and that helped the neurosurgeon during spine surgery because my muscle was easier to retract. I have continued with MFR since spine surgery which helped me recover from that, and make more progress on TOS. I had to stop seeing my PT because of social distancing now, and I'm doing what I can at home to maintain my progress. I also work and stretch pec minor because that is a compression point for TOS, and have found some tools I can use to press and stretch it as I roll onto it with my body weight. The more I open that up and release the tightness, the better my arm feels and I breathe better too. TOS affects my breathing by making the muscles on one side of my chest too tight, so it doesn't expand well enough, and it pulls up on the first ribs, so they don't relax downward during an exhalation.

Mayo is very thorough in examining all the issues a patient has in a multidisciplinary approach and it is a team effort where the doctors do consult each other and right away, so they are very efficient. My testing and consults were completed in a few days, and I had an answer and an offer of help. I would highly recommend Mayo and my neurosurgeon, Dr. Jeremy Fogelson. I received excellent compassionate care and have great results. Here is my patient story.

In reply to @jenniferhunter. Wow, that was a big surgery too. How are you getting along now. As I told you before I have a bad neck too, but PT seems to help, but my back is a mess.

@lindyflock Thank you for asking. I feel great. I don't have pain. I do have some tigthness in my neck, but I have had that for years because of Thoracic Outlet Syndrome. If I do something that stresses my neck, like lifting something heavy, I tend to cheat and use my neck muscles to help, then I will get a neck spasm. I know how to take my hands and work the knots out. I asked my surgeon what I could do that would lessen my chances of needing his services again, and he told me to build core strength. Core strength in the entire spine supports everything in the body including the neck.

The best way I have found to do that is horseback riding. I do a lot of trail riding just at a walk, and I have to compensate for every step the horse takes with my back, and I do that with good posture and balance. The more I do that, the less fatigued I get after some miles of riding, and then everything is easier, even walking and climbing stairs because I built the hip, leg and back strength by using all those muscles. This is also how I rehabbed after my spine surgery beginning at 7 months post op with my doctor's permission, but also with the understanding that there is risk with horses. I wear a helmet and make sure I ride in control, or I get off if the horse's mind is somewhere else. You have to think about safety with everything you do with a horse and make sure that the horse trusts and respects you. On Sunday, I rode about 20 miles on hilly terrain and was really exhausted after that because of not riding for months during winter, but now, I feel much stronger.

I can get sciatic pain because of my pelvis alignment shifting and do stretches for that, but after this last ride, it feels fine. I don't feel like I had spine surgery, and I feel much younger than when I was living with the pain from the spine problem. I still have to maintain posture and spine alignment or my TOS will get worse, and I work on my PT exercises at home because I can't go to appointments because of social distancing. As long as I stretch out what gets tight, I feel great and I have to remember not to slouch and stick my neck out. That is bad for spine and shoulder alignment and I want to prevent any future problems that could be caused by wear and tear with poor ergonomics. I have to also say that the physical therapy and myofascial release I did before spine surgery prepared me well for a great recovery, and I had an excellent surgeon. I have normal range of movement of my head, except that I can't touch my chin to my chest, but it is very close. My fusion is at C5/C6 and it doesn't do much at all for head range of motion. Most of head turning is done by C1 & C2, with a little bit of movement from C3 & C4. I do know that I have a bulging lumbar disc that cracks on rotation, and I have less issues with that because of core strength. I think it keeps it aligned instead of allowing it to rotate and shift at that point. I know without cervical spine surgery, my quality of life would have suffered a lot, but I got my life back and I can do most anything I want to do and have no pain except for normal muscle aches because I just rode 20 miles on a horse. That was the 3rd ride in a week and both other rides were about 6 miles each.

I prepared myself mentally for a great surgical recovery and worked a lot on deprogramming my fears and it all worked. I didn't even take any pain medication at home after my surgery because it was tolerable and I just rested and took my time in healing. I knew the pain was temporary healing pain, and for awhile, I was tired because my muscles had atrophied, but gradually muscle came back because I was using it. I didn't get all the muscle back in my arms and shoulders yet, but there should be some more tomorrow since I just scrubbed my horse's winter blankets outside. I do know that what you believe makes a big difference, so don't think that your back is a mess. PT, and myofascial release can help a lot, and when there is a structural problem to correct, look for the best surgeon you can find because that helps you have a successful procedure and recovery.