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Updates after C3-C6 ACDF surgery

Posted by birdman518 @birdman518, Mar 20, 2022

I have posted before that my ACDF surgery had not helped my symptoms at all. About a week ago, they seemed to be getting worse! My right hand is more fully numb and my whole arm felt heavy. I also had more shoulder pain.
I reached out to my surgeon and was basically asking: is there anything else I can do in parallel with waiting for my nerves to heal?
He came back and ordered a new CT-scan for my C-spine, and another EMG.
I had the scan on Friday and it is interesting.
Here are a few of the findings:

CLINICAL INDICATION: Radiculopathy, cervical region
ACDF spanning C3-C6. No evidence of hardware complication.
Similar areas of ossification of the posterior longitudinal ligament
at these levels. The cervical spinal canal is diminutive in caliberon a congenital basis.
Likely mild canal stenosis above the fusion at C2-C3 where there is
some disc bulging and ligamentum flavum prominence. There is likely
mild-to-moderate canal stenosis at C3-C4, where there may be some
thickening of the posterior longitudinal ligament. The canal is also
mildly narrowed at C4-C5 and perhaps C5-C6.
Uncovertebral and facet hypertrophy contribute to multilevel
foraminal stenosis, including moderate on the right worse than left
at C4-C5, moderate to advanced bilaterally at C5-C6 and more mild at
a few additional levels..
No acute fracture. No traumatic malalignment.
No prevertebral edema.
IMPRESSION:
1. No evidence of hardware complication or acute findings.
2. Multilevel foraminal stenosis, including moderate to advanced on
the right at C4-C5 and C5-C6.
3. Likely mild-to-moderate canal narrowing as noted above.

I should point out that my previous Lumbar CT-scan showed this:
Lumbar Impression

CONGENITAL NARROWING OF THE LUMBAR SPINAL CANAL IN COMBINATION
WITH DISC BULGES AND FACET AND LIGAMENTOUS HYPERTROPHY CONTRIBUTE TO
SEVERE SPINAL STENOSIS AT L3-L4 AND L4-L5.

SEVERE NEUROFORAMINAL NARROWING AT L4-L5 ON THE RIGHT AND L5-S1
ON THE LEFT.

It seems like this explains why my ACDF surgery has not helped me at all (I am ignoring the Lumbar stuff). My hand and arm problems seem like they are a direct result of the foraminal stenosis noted. I do not doubt BTW that I had disc issues and cleanup for my myelopathy pressing on my spinal cord... but it sure appears that I am not going to get relief from my surgery and will be faced with either another foraminotomy and/or laminectomy.
If anyone else has faced a similar situation I would be glad to hear your story.
Thanks to all on this forum!
Mitch

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Mentor
Jennifer, Volunteer Mentor | @jenniferhunter | Mar 22, 2022

@birdman518 Mitch, I'm glad you got some answers about the cause of your pain. I am wondering why.... I would have expected all of the issues to have been addressed in your surgery unless there was a medical reason it couldn't be done at the same time. Was the foraminal stenosis discussed before your surgery? How does this report compare to the imaging report before your surgery? This also says that your spinal canal is smaller congenitally. I'm sorry you are in this situation. I hope you find a resolution to get your pain under control.

This link explains some of these issues. https://www.spineuniverse.com/conditions/spinal-stenosis

Thanks for checking in.
Jennifer

REPLY
birdman518 | @birdman518 | Mar 23, 2022

Jennifer, thanks for replying. Yes it is a bummer. I went through a complete NCS and EMG before with a separate neurologist, but he did not explain any of his findings to me, just saying "you need to see a neurosurgeon". My overall situation probably looked bad given the several different places (including myelopathy with my spinal cord) that needed fixing. And I have no doubt, based on the 2nd opinion of a different neurosurgeon, that I needed to have my ACDF.
But it now seems like one of those 3 might have been able to say to me "You need this surgery but you have other severe issues that may prevent a complete fix for your pain and numbness".
I definitely do not want to consider *more* surgery if not needed. That is why I phrased my request as "is there anything else I could do in parallel with waiting a year?".
My new followup after the CT-scan and EMG is Apr 23. I will report on what happens....

Mitch

REPLY
birdman518 | @birdman518 | Apr 22, 2022

Yesterday, I saw my neurosurgeon for my 3 mos. post-surgery checkup. My C5 palsy is resolving itself such that I can use my right arm more but the doctor said it could take a full year for the nerve and muscles to completely recover. He is otherwise disappointed that I have not had more progress with my other neurological issues, like the arm pain, numbness in my hands and my "unsteady" gait. My most recent cervical CT Scan does show that there are no issues with the areas that the surgery "cleaned up".

The results of the recent scans and neurological testing show that I have significant damage coming from the C5-C6 nerve root area. He wants to wait one year before looking at other ways to possibly address this (like nerve blocks or further surgery, but from the back). He believes my issues may be congenital, his diagnosis is Myelopathy with cervical radiculopathy and that I may now have "dead" spots on my spinal cord, but that can only be proven through an MRI.

He said he supports the idea of me getting an MRI compatible pacemaker when it is replaced this year and is willing to talk to the cardiologist and insurance company, if needed.

So really it is still "wait and see". I feel fortunate that I still have mostly the use of my right hand, although numb and sometimes painful.
I have some difficulty managing my thumb and index finger, and have to be careful picking things up. I cannot button my shirts.
But things could be worse.

REPLY
2 replies
lebanon100 | @lebanon100 | Apr 22, 2022
In reply to @birdman518 "Yesterday, I saw my neurosurgeon for my 3 mos. post-surgery checkup. My C5 palsy is resolving..." + (show)
@birdman518

Yesterday, I saw my neurosurgeon for my 3 mos. post-surgery checkup. My C5 palsy is resolving itself such that I can use my right arm more but the doctor said it could take a full year for the nerve and muscles to completely recover. He is otherwise disappointed that I have not had more progress with my other neurological issues, like the arm pain, numbness in my hands and my "unsteady" gait. My most recent cervical CT Scan does show that there are no issues with the areas that the surgery "cleaned up".

The results of the recent scans and neurological testing show that I have significant damage coming from the C5-C6 nerve root area. He wants to wait one year before looking at other ways to possibly address this (like nerve blocks or further surgery, but from the back). He believes my issues may be congenital, his diagnosis is Myelopathy with cervical radiculopathy and that I may now have "dead" spots on my spinal cord, but that can only be proven through an MRI.

He said he supports the idea of me getting an MRI compatible pacemaker when it is replaced this year and is willing to talk to the cardiologist and insurance company, if needed.

So really it is still "wait and see". I feel fortunate that I still have mostly the use of my right hand, although numb and sometimes painful.
I have some difficulty managing my thumb and index finger, and have to be careful picking things up. I cannot button my shirts.
But things could be worse.

Jump to this post

Blessings to you for more and more healing.

REPLY
Mentor
Jennifer, Volunteer Mentor | @jenniferhunter | Apr 22, 2022
In reply to @birdman518 "Yesterday, I saw my neurosurgeon for my 3 mos. post-surgery checkup. My C5 palsy is resolving..." + (show)
@birdman518

Yesterday, I saw my neurosurgeon for my 3 mos. post-surgery checkup. My C5 palsy is resolving itself such that I can use my right arm more but the doctor said it could take a full year for the nerve and muscles to completely recover. He is otherwise disappointed that I have not had more progress with my other neurological issues, like the arm pain, numbness in my hands and my "unsteady" gait. My most recent cervical CT Scan does show that there are no issues with the areas that the surgery "cleaned up".

The results of the recent scans and neurological testing show that I have significant damage coming from the C5-C6 nerve root area. He wants to wait one year before looking at other ways to possibly address this (like nerve blocks or further surgery, but from the back). He believes my issues may be congenital, his diagnosis is Myelopathy with cervical radiculopathy and that I may now have "dead" spots on my spinal cord, but that can only be proven through an MRI.

He said he supports the idea of me getting an MRI compatible pacemaker when it is replaced this year and is willing to talk to the cardiologist and insurance company, if needed.

So really it is still "wait and see". I feel fortunate that I still have mostly the use of my right hand, although numb and sometimes painful.
I have some difficulty managing my thumb and index finger, and have to be careful picking things up. I cannot button my shirts.
But things could be worse.

Jump to this post

@birdman518 Thanks for the update, Mitch. On an MRI, if there is permanent damage to the spinal cord, it shows up as a whitish somewhat diffuse area within the cord. I hope you don't need further surgery. I'm glad you can stay positive. Healing can take a very long time.

REPLY
1 reply
birdman518 | @birdman518 | Apr 22, 2022
In reply to @jenniferhunter "@birdman518 Thanks for the update, Mitch. On an MRI, if there is permanent damage to the..." + (show)
@jenniferhunter

@birdman518 Thanks for the update, Mitch. On an MRI, if there is permanent damage to the spinal cord, it shows up as a whitish somewhat diffuse area within the cord. I hope you don't need further surgery. I'm glad you can stay positive. Healing can take a very long time.

Jump to this post

I have a pacemaker that is going to be 7 years old this summer, so it will be due at some point for a new battery. I am going to approach my cardiologist to see if (with the help of my neurosurgeon) I could get an MRI compatible pacemaker installed. Of course that is a bigger deal than just replacing the battery, but given my spine problems, I need to be able to have an MRI.

REPLY
Mentor
Jennifer, Volunteer Mentor | @jenniferhunter | Apr 22, 2022

@birdman518 Mitch, I agree. That sounds important. I was curious, so I searched for some info about MRI compatible pacemakers. If you are on Medicare, it may take a lot of paperwork from your specialist to get it done and that may take awhile.

https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/new-protocols-allow-for-mri-in-selected-pacemaker-patients/mac-20430571
https://www.health.harvard.edu/heart-health/mri-is-safe-for-most-people-with-pacemakers-and-defibrillators

REPLY
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