Arm Weakness 2 years after Decompression and Fusion

[reneew97]

Thank you in advance for taking my question.  My father is 54 years old currently.  2 years ago he had herniated disks and had disectomy at the C5-C6, C6-C7, and T1-T2 regions with fusion and bone grafts.  Immediately after surgery, the pain in his left arm persisted.  After intensive physical therapy and pain management, he was discharged.  The therapists claimed there was no more that could be done for him.  His left arm has progressively gotten weaker and weaker, along with numbness and tingling.  Two weeks ago, his arm was completely "dead".  He is no unable to even roll up his car window or hold a piece of paper in his hand.  After getting MRI's and CT Mylograms, a neurosurgeon found that the fusion was either done wrong or failed.  His vertebrea are sitting on top of each other, constantly rubbing together with every motion.  A hard cast was immediately prescribed to wear full time, to prevent further injury.  After all of this, and the NSG claiming he could fix the "problem - weak arm", he has suddenly changed his mind and said it is out of his expertise.  Now we are left with this dabilitating problem.  My father is so weak, he is unable to work, he can't do anything with his left arm, and can't walk more than 5 feet without having to sit down. BTW: Before having the hard collar put on 2 weeks ago and after surgery 2 years ago, his chin is resting on his chest, and is virtually impossible for him to move it in any other position.  What could this possibly be? And who can we call to help us get my dad back to a some what "Normal" life?  Why did his arm go numb?Thanks

[CCF-Neuro-M.D.-CS]

It is not possible for me to make an accurate clinical diagnosis over the internet. It appears, based on your description that your father needs to be re-evaluated regarding his cervical fusion and weakness. At this point I would recommend an evaluation at a Spine center, such as the one here at the Cleveland Clinic Foundation. Given the complexities of his case, he would benefit from a second opinion at a large academic center. Consultation with a neurologist at the same time would also be of benefit to ensure that there is no other neurologic cause for his symtpoms. If he develops severe weakness of his legs, or loss of bowel/bladder control he should be evaluated sooner rather then later. Good Luck.

[CyndyisMe]

I am so empathetic to your Dad's situation. I also had to have a cervical fusion (mine die to osteomyelitis destroying the C6 and part of the C7 vertebrae, requiring a iliac crest (hip) bone fusion from C5 to the remaining portin of C7). Because of the nerve affected by this area of the spine, I was paralyzed from the neck down, prior to surgery, which is now resolved 95%, 7 years later. Your description of his chin resting on his chest mirrored my own experience prior to cervical fusion (and just prior to paralysis). Forstly, I believe it is urgent that your Dad be seen to make sure an infection has not taken hold (osteomyelitis) in the affected vertebrae. Secondly, the possibility of a "failure" with spine fusion is always a concern.
In my case, they were concerned about this and I was placed in a halo brace (attached with 10 screws to my skull)for 4 months until they were sure a good fusion was taking place. Then I was put into a rigid cervical collar for several months. I had to have intensive physical and occupational therapy to regain use of my hands and arms and lower body and legs. My arms still remain weak but I have full function. It did take awhile and hard work ONCE the correct neurosurgical and orthopedic procedures had been performed. If the bone graft fails on its own,pinning and metal plates can be incorporated to get his vertebrae up into more normal positions, to take pressure off the
spinal cord and peripheral nerves (allowing him to lift his head up off his chest)and restoring some or all function to his arms.
I cannot turn my head to one side, and have residual weakness in my arms, but this is a small price to pay for regaining mobility.
It took 2 full years for the most overt symptoms to "die down" following surgery. Your Dad may be in for a long haul, but good results can and do happen IF he can find a competent set of surgeons (neurosurgery or orthopedic surgery) to stabilize his
cervical spine.