BACK TO SQUARE ONE...ACTUALLY WORSE...AFTER CERVICAL ACDF

[besharpone]

A short history...I was discovered to have a degenerative disk condition in my entire spine about 15 years ago. From time to time, I have had to see a doctor for neck stiffness and pain and would usually feel better after about a week off work and medication.

Starting in October or November of 2006, I started having additional and more severe symptoms that included severe limitation in range of motion, extreme pain when attempting to move my neck. It was worse when attempting to touch ear to shoulder, where there is almost zero range. There was a bit more range when attempting the other neck movements, but not much more. There was also a cracking or crunching noise when I moved my neck the little that I could.

I also had pain and tingling in my neck shoulders, upper back and "traps", with the most severe pain on the right side. I also had painful cramps in my "traps" and fingers on my right hand. Ocassionally, I would have tingling on the right side of my face.

I ended up being treated with physical therapy with no relief and I also had several epidurals with no relief.

In the course of this time, I had x-rays done as well as an MRI. It was determined that I had very severely degenerated disks at C-5,6 and C-6,7.

After having a nerve block with no relief, I had a diskoscopy done but which came back inconclusive.

The surgeon indicated that although the test was inconclusive, the disks were more than likely the cause of my problem so after advice from him, I decided to have the ACDF With Instrumentation.
done.He did caution me that the results may stay the same, improve or get worse.

I had surgery on May 9th and wore a soft collar for 2 months. I had my second follow up on July 5th and at that time, I explained that I was still having the same symptoms as before surgery. The doctor seemed upset and stated that I should be ready to resume normal activities and return to work with restrictions.

I explained to him that I still could hardly move my neck and after having me attempt to move my neck and saw a lack of range, he stated that I should have more movement then what I had and prescribed a month of physical therapy.

I did the month of therapy with no relief other than regaining the small bit of motion that I had before surgery and which had been restricted by the surgery and collar. This was not much of a gain and was so stated in the therapist's final eval.

When I went to my latest follow up August 16th, I again explained that nothing had changed...that I had the exact same symptoms as prior to the surgery.

The doctor looked at the latest x-rays and said that everything is going fine but never addressed why I was having the same problem accept to say that it may take more time..

He told me that he was sending me back to work with limited lifting restrictions. I explained to him that was fine, but I was more concerned about the pain and lack of range in my neck because my job requires constant bending and twisting of my neck for 8 hours and that I could not do it, especially since that was the reason I sought medical care in the first place.

He basically ignored me and stated that he was just going to go with the limited lifting restrictions and said that I needed to get back to a normal routine.

He never examined my neck, back or shoulders to determine the amount of range, pain or anything else. He also ignored the findings of the therapist. The only thing that he did was give me that standard strength test.

I returned to work on August 27th and since then, my symptoms have gotten worse...due no doubt to the requirement of my job.

I have become very frustrated and untrusting of the doctor so I sought a second opinion. The second doctor looked at my medical records, did the same strength test and that was. He didn't actually check my neck either and made reference to the slight gain in range mentioned by the therapist...totally ignoring the fact that the slight gain was actually what I had gained after having the surgery and wearing the neck brace.

I kept asking him about the worsening of my symptoms and the only thing that he offered was the I had serious surgery and that I couldn't expect it to be better after only 3 months, that it could take up to a year. I asked him if that were the case, then when could I expect some improvement and he stated that I should see some improvement after 6 months and if I didn't, it probably wouldn't get any better.

He seemed very reluctant to offer any opinion contrary to my surgeons and I just felt that he was giving me the run around.

Either I am supposed to be better by now or I should not expect to see any improvement for some time, which is it? Those who I know who have had the same type of surgery talk about how much better they are after 3 months and hav lost almost no range...actually gained almost all of what they may have lost prior to the surgery.

I am very disappointed and frustrated at this point and have no intention of returning for my next follow up since it seems to be useless to do so.

Is there any suggestions on what I can do to get help from another doctor? Someone who is going to be more concerned and caring and who will listen to his patient and run more tests based on his patients complaints?

[chadry]

By any chance are these doctors from Workmen's Comp?

[mike1105]

im sure i sound like a broken record to many readers, but your problem may have nothing to do with your spine at all--especially since you had decompression and you are unchanged. Going to PT and DOING PT are totally different. there are postural exercises and stretches for your problem (tight traps and shoulder pain) that patients need to do many times DAILY for months before their efficacy can be judged. Going to PT for an hour even 2 or 3 times a week for a month just does not cut it most of the time. If the problem is postural or related to muscle spasm and tightness-- well, muscles are a lot more stubborn thna that-- muscle memory is a huge component. IF this interests you at all then let me know and I will try to direct you more. I've been where you arw and I am pain free now--fixed it myself.

if your initial symptoms were stiffness and pain in the neck------that is muscular usually. nerve impingements usually cause numbness, weakness, symptoms into the hand and/or arm.

[besharpone]

I appreciate what you are saying but the fact is, I do know that what you say  is not related to the spine in fact is. I have done enough research to know that my symptoms are symptoms of a spinal condition.

Maybe you missed the part where I stated that I am having tingling in my neck, upper back and right hand as well, which is nerve related. Also the pain in my neck definitely is spinal related, with crunching and cracking and increased tingling on movement of my neck. Yes, there is some muscle issues involved, which would usually be the case.

I would also think that if it were something other than spinal related, the surgeon would indicate as much. He isn't telling me anything, especially whether or not he feels that it is unrelated to the spine.

Also, the physical therapist indicated that the only thing that would cause such tingling is a nerve related problem.

As for the muscles, that very well may be, but aren't the neck and shoulder muscles controlled by the nerves from the cervical spine?

[besharpone]

From the sound of it, you would think that it is a Workers Comp doctor but it isn't.

They have been quite unfriendly since my 2nd follow up visit when I mentioned that my symptoms had not changed at all.

As I have said, he has never examined my neck to see what might be going on. All he does is look at the x-rays and say that everything is looking good. He doesn't even respond to my complaints about my symptoms.

He just acts as if I never said anything.

Just last week, I asked his secretary if I could get a letter to send to VA so that I could show that I had surgery for a condition that I had while in the military and the dates that I was off recuperating and she basically said that the doctor will not do it.

The bottom line is that there is absolutely no interaction between the doctor and myself. It is as if he is trying to hide something.

He is not telling me why I don't feel any relief or anything and as I mentioned to the other poster, if it were something other than spine related, I am sure that he would say so just to get it off the issue of the surgery.

Also, before I had surgery I asked him if there could be other causes for my problem and he insisted that it was spine related.

I would hate to have to deal with a Worker Comp doctor is he is any worse than my own doctor.

[mike1105]

firstly, certain nerves from the brachial plexus run through and around the scalene muscles in the neck. these finger sized muscles take major punishment and go into spasm and get rock hard when there is chronic forward head posture as in computer users or people with desk jobs. these muscles can compress nerves. I only posted becaue you had the surgery and did not get better--- logic may tell you that the compression may be taking place outside the spine. tight neck musculature can easily cause the crackling sounds--- the muscles are so tight they pull the vertebrae together and cause them to rub on each other. My neck MRI reads horribly--herniations, stenosis, cord flattening etc etc. i had the crackling sounds all the time. After a few months of correcting my posture and working out the tightness in my scalenes, upper traps, SCMs , I can turn my head noiselessly like an owl. After a few hours on the computer-- i sound like rice krispies again and I have to go work on the muscles in my neck.

surgeons do surgery-- they are not really well read on things like crossed syndrome and muscle imbalance. Mention Upper Crossed syndrome to a surgeon and he will look at you crosseyed !!!!

Just food for thought for you, that's all. I agree your symptom are nerve related... the question is where is the compression???  the difficult part is that MRI findings do not always translate into the source of pain. Mot MRI finding are harmless and cause no symptoms, as bad a they may sound.

[bev62]

I had a two level ACDF(C5-C7) in Nov of 2006 due to herniated disk after a fall at work. It has been over 10 months now and I still have not returned to work.  My pain is worse than before surgery. The only thing it helped was the arm pain. My neck and right shoulder aches and burns all time time.  I have a terrible headache everyday.  I still don't drive because my range of motion is so bad. I am taking muscle relaxers and Demeral every 4 hours for the pain.

My doctor has done every test to be thought of and he says everything looks great.  He finally decided that I may have injuried the ulner nerve in my elbow when I fell and that my be causing my shoulder pain.  Even though the EMG was good he wanted to do surgery on my elbow.  During surgery he found a lot of scare tissue on the nerve and he thought that the surgery would really help me.

It has been 4 weeks since my surgery and my shoulder pain has not improved.  Now my ring finger, pinky and all the way up to my elbow is totally numb and I have a nine inch incision on my arm.   I know some of the feeling will come back as it heals, but I'm beginning to think that I'm stuck with the pain in my neck and shoulder for the rest of my life.  

I am 45 and husband and I waited late in life to have children, they are ages 7 and 4.  I feel like I have cheated them because it is very hard for me to care for them.  I know how frustrating it is to feel helpless.  My doctor has really tried to find out what is causing my pain, but I don't know what his next step will be.

It sounds like you my even want to get another opinion.  Sometimes doctors egos keep them from admitting they didn't do everything that they could.  Good luck.

[besharpone]

Ok, I see what you are saying. It makes much more sense now that you explain it this way.

Maybe that is why the doctor is so silent when I ask him what could be causing my problem...and that is all that I ask...at least tell me something, even if it is I have no idea.

I will definitely keep your advice in mind. BTW...you sound like a doctor...one who knows what he is talking about...:-).

Thanks

[besharpone]

Thanks, bev62...

All of this is so crazy. Not only am I not better but I feel so abandoned by the doctor. As I said, there is absolutely no interaction between us. I voice my concerns and problems and the only response that I get is that everything looks good...LOL.

mike1105 has some good information but the only problem is getting a doctor to listen. You would think that if you were to discribe the symptoms, he would be able to figure out that it could be related to what mike1105 mentioned.

Meanwhile, I am in agony everyday while at work. The pain is almost unbearable. It isn't as bad when I am at home but the work that I do evidently aggravates it.

If I wouldn't be so embarrassed as a grown man, I would probably cry from the pain...:-(.

I did try the second opinion route and that doctor basically blew me off. He seemed to not want to step on the doctor's toes and say something contrary.

[G_Luv]

I'm new to this and no one understands how I feel.  I read these conversations and I see me.  Yes, I'm on the computer in so much pain.  Let me give you a little history on myself.  I'm 40 female I've been injured since March 6, 2006 or I should say when I went out, but I think it is longer.  I have c5-6 disc extrusion wich central spinal stenosis, c6-7 4mm disc protrusion and borderline central stenosis caliber.  Bone spur in c3-4 w/o stenosis, and a disc bulge in at c4-5.  I've had a EMG test done in March they found something in my right elbow, and carpal tunnel in my right hand in 3 places.  I haven't had surgery yet due to worker com claim had to do the steps.  That has really drained me.  My company has terminated my employment as November 06 when I was out on disability I feel my life is over.  I don't what to do from one day to the next.  I'm emotionally drained from all of this.  I finally found a outlet where people who have suffered the same injury understand me.  I don't know what to expect from this surgery I just know I'm scared to death.

[G_Luv]

I underdand you to I just haven't had the length of time as you.  10 years they found tension my neck from EMG and that I had tennis elbow.  I didn't think nothing of it.  When I hear say the cracking & crunching in my neck hear it in my sleep when I'm sitting down.  It sounds horrible I hate it.  I hope someone can help you with this because you sound like and I haven't had any surgery.  I'm just scared I want my life back at least 75% actually I'll take what I can get right about now.

[mike1105]

mds are clueless about this stuff... iwent to the mayo clinic 2x-- best facility in the world perhaps.. no help

[bev62]

What kind of surgery are they planning?  I know what you mean with workers comp, it's a joke what they make you go through.  I was injured on May 25 2005 and it was Nov 2006 before they did my cervical fusion.  The doctor said that could be part of the reason I'm still having so much pain.  He said that the longer you wait on that kind of surgery the worse it gets.  By the time they did it my disks had totally colapsed.

Have you retained an attorney?  That's awlful  that a company would fire you while your out of work because of them.  As soon as I saw how serious my situation was I retained an attorney, and I'm so thankful I did.  He has taken care of several problems during this ordeal.

I'm sorry your having so much trouble, hopefully after you have surgery things will be much better.  Good luck.

[chadry]

I also was injured at work. L4-5 and several cervical disc problems. I retained a lawyer almost immediatelt through my union when I did not agree on the treatment I was receiving. I have been dealing with W.C. since. I have been declared MMI a few times. I was never given any lenght of time off to rest and recuperate. After the last time I was declared MMI I went to see a dr. on my own. He put me out for 4 weeks. I had my contract renewed then I was fired. So like I know what it feels like to be thrown away. I was so crushed that they could do that to me. I went to work so many times where I could not move my neck or could barely walk for pain. I have been unemployed now for about 3 months and I trying to figure out what I am going to do with my life now. I am a 46 year female. I have had doctor evaluations for my case and they said I could not go back to my line of work. I was an Instructuional Aide with special ed children. It is a very physically demanding job that I can longer do. I have limitations so it will be hard to find another line of work. I also encourage you to get an attorney if you have not done so already. You are probably looking at a life long problem.
Take care.
Chadry

[G_Luv]

Yes I was smart enought to seek an attorney.  Intially I tried to go to my own doctors and they had me doing all kinds of things and I got real frustrated.  When I went out on March 6th 2006 about 2 weeks later I asked my absence administrator to get to a Work Comp and she didn't.  Then 2 weeks after that I asked her again and no progress was made, meanwhile I'm out on FMLA and disability.  My primary care physcian intially told me I was out indefinitely.  I've had physical therapy, pain management, 3 MRI's several X-rays, & EMG.  The EMG found Carpal Tunnel in my right elbow, forearm, wrist, & fingers (Thumb & Index-Ring & pinky) also on the pad of my thumb inside my hand.  So after they finally do this Cervical Fusion intially in August 06 was just going to be my C-5, as of July of 07 it has gotten worse I believe it'll be a Multi Level due to the size of both and the disc bulge and the bone spur which I didn't have before.  So Bev62 I understand about the time it isn't on my side right now and that scares me to death.  As far as my lawyer is concerned she filed a wrongful termination suit as well as work comp claim.  It's funny when I did my depo in Nov. 06 I was just terminated and she told the company insurance that they need to be prepared to relay that info to my company.  This has been a most devistating excluding the death of my sister that has every happened to me.  I've worked all my life and to be without money every 2 weeks because I've exhausted my disability, I can't get unemployment due to my injury because you have to be able to work, and SSI doesn't want to give me any money I've exhausted all my savings there is nothing left.  That is very depressing this injury is depressing.  I can't be me I can't do what I use to do and I hate that this has happened to me.  The only good thing is I found a wonderful man who has stood be my side with all the pain,tears, & financially.  That was my blessing through all this.  I know one day I hope to get better.

[bev62]

I know exactly how you feel.  If it hadn't been for my husbands help and support I don't know what I would do.  I don't know if I will ever be able to work again, but right now I'm just worried about being able to care for my children.  My attorney tells me that due to the company being at fault for my injury I am looking at a very large settlement, so hopefully if I'm not able to go back to work I'll be OK financially after all this is over.  I wish you the best.

[Glenna456]

I read some of your comments and hoped that you could point me to a few good resources to understand some of the causes of pain in the neck and upper traps.  For the last 5 years, I've had problems with it burning/tingling as well as chronic neck and shoulder muscle spasms.  I have disc herniation at C5-C6; C6-C7 and left arm pain as well.  My neurosurgeon wants me to undergo cervical fusion, but I don't want to do it if it will not fix the problem.  (Ie. besharpone's ordeal.)  He said it would help with the arm pain, but wasn't sure about the shoulder/neck pain.  I guess it is because the herniation is directed to the left side and the shoulder pain is on the right.  

I have spend countless days looking up cervical disc problems, shoulder pain, etc. and just run in circles.  Do  you have any suggestions of where I could research common causes more?  What type of excercises did the PT have you do?  I'd rather fix it that way than undergo surgery, or at least try.  I have done a dozen other methods cervical traction, etc.

Thanks for your thoughts.

[mike1105]

hey glenn-- hope i can help. I am a dentist, not an MD, but i have done ALOT of reding on neck back shoulder pain syndromes after the traditional medical/surgical community failed me-- and i fixed this nastiness on my own. so- i may be able to help. tell me about your pain--what kind, where, when is it the worst, anything that makes it better.. and what you do, your habits, work etc-- on the computer alot?? also are you overweight, in shape, athletic etc....

if your herniationion is to one side and you have pain on the other side.......logic would tell you.that pain aint from a disc !!

[G_Luv]

I have the same issue as Glenna,  my QME Dr. is recommending Anterior Cervical Fusion.  I have C5-C6 6mm to the right and C6-C7 4mm to the left.  I also have bone spur C3-C4 & Disc Bulge C4-C5.  I've been off work for a year and nothing helped.  I've done it all PT, Epidural, C-Collar,  so what is next.  I live a life of pain and I want it to go away.  What will be my future after surgery I can't live like I'm so limited right now.  I hate this!!!!!

[needhelpsoon1]

Same problems here, it has been a year of pain after my first corpectomy with fusion (plate, cadavar bone) at C6-7, now herniation at C4-5, disc bulge, bone spur at C-4 as well.  Mike1105 how do you have cord flattening and fixed yourself?  I'm interested in your therapies to fix the rice krispies (loved that one!).  I'm on so many meds my head is spinning most of the time and I too feel like I am not the mom I want to be due to all this "stuff."  Two neurosurgeons have now suggested another fusion and said I would be a great candidate for the new artificial disc BUT due to the fact it is made of stainless steel they would suggest against it.  So I guess that leads me back to another fusion, only this time they want to take the bone from my hip, oh goody.  I was power walking 5-10 miles a day prior to Sept 06 and been down hill ever since.  Now if I walk to the mailbox it is a good day.  I have burning in both shoulders, traps (between traps is really bad), down both arms and now can hardly move my right arm/elbow.  I have just been told I have tennis elbow.  Really?  Or is this from the nerve impingement?  I, like all of you, am ready to scream.  Pain managment says don't do more surgery, however, epidurals, trigger point injections, electrical contraption, postural pump, tens unit have all failed.  All the surgeons say another fusion with plate.  I have no idea what to do either, but would be greatful to hear your ideas on the crossed syndrome (had never heard of that before) or anything else you can tell me about getting this pain under control!

Thanks.

[needhelpsoon1]

Sorry one more question (newbie to this site), how do you find out where you post?  I've been leaving it up so I don't get lost on the site, but I'm sure there is an easier way to find my posts??

[mike1105]

Mike1105 how do you have cord flattening and fixed yourself?   cord flattenning does not need to be fixed usually. symptoms involving pinvhing of the cord itself are usually loss of function/weakness--not pain. i really cant advise you on what to do as I am not a nuerologist or neorosurgeon. you've had surgery already and it is possible that your symptoms may be FROM your surgery. i'm good at helping people if their symptoms seem muscular in nature. weakness after surgery is out of my realm.

[Sharon854]

Hi.  I read everyone's comments with much interest!  I had an anterior fusion of C4/C5 done 3 weeks ago.  The pain in my left arm has decreased somewhat but is still present, no more tingling in the hands thank goodness, but bad muscle spasms between the shoulder blades and in the neck.  Would like to contact you re the exercises you mentioned in your comments on 09/10/07 (my work is computer related)  Thanks :)

[mike1105]

i think there is a way to contact me through Med help directly----- try clicking on my name

[tracy21454]

Hi! I've read your comments.I too, have had a C-5-6 discectomy back in 2007 using my own bone from my left hip.I continued to have burning and tingling on my left side. I went thru vocational rehab and returned to work. I had many x-rays and MRIs' my doctor said, Looking Good! I was only back to work for 2 days and I was in 'Wicked" pain. After many x-rays which the reports stated all looked well[and many months] later a myelogram was performed and it showed that the bone did not fuse/grow,therefore my neck was collapsing. In March of 2009 a repeat surgery was performed using a 'Ball" as well as screws etc. Only 50-50 chance of improvement given.I'm wearing a bone stimulator 1005 of the time except when I have to use the TENS machine.I continue to have pain and tingling but, I'm still recovering. I also have an unsightly scar on the front of my neck . I'm extremely worried that I will not be able to return to my career as an L.P.N. and  I am researching new careers. Good Luck To You! tracy21454