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Dr Abhijeet PLEASe help
I had ACDF surgery in 08/07.  I started experiencing burning pain on the right side of my neck approximately 6 weeks after surgery.. I have had several MRI's and the cervical ones indicated I have enlarged lymph nodes on the right side approximately 15millimeters in diameter. They were there presurgery as well. The surgeon says my bones are fused and evertything looks fine. My problem is this burning pain comes and goes on the right side of my neck and it has spread to under my breasts sometimes in the arms and now I have noticed my hands are turning red and they burn and sting as well.  It seems they turn red when the neck burns intensely. My sed rate on 2 different occasions was 27 and 35. My c reactive protein was normal. SOmething just doesnt feel right on the right side of my neck, it feels like a stretching pulling pain. I have seen 2 different neurologists and they have no answser for me. I havent had an EMG yet but think I should schedule one soon.  I am so worried about it and I want some answers. Are there any tests I can have done to get to the bottom of this."?  Could the titanium plate be causing this? I just need some answers and advice. I have an appt to see a Rheumatologist in late April. Please give me some guidance.
Thank you



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368886 tn?1466238884
Hi.

I am not a neurosurgeon. A myelogram would be an additional investigation. We can't right away that it will give us any additional information. As I has mentioned earlier, I do feel this is a neuropathic pain. It may turn out to be something different. The other possibilities are neuromuscular problems.

Regards
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HEllo again. What tests should I have to figure out what is going on. I feel like I am going nowhere with the doctors I am seeing. THats why I am trying to get a second opinion at the med school here.  I should hear something by Wednesday.  What type of neuromuscular problems are you referring to??  What do you think my next step should be?  Do you think the disc at c7-t1 is causing some of these problems since that one is herniated but not pressing on the spinal cord. My doctor didnt operate on that one.? I just dont know. I am not giving up until I have a diagnosis.  Please advise. THanks
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368886 tn?1466238884
Hi.

I think you should rule out extra disc bulging. The disc need not press on the cord to produce symptoms. The nerve roots may also get affected.

I would say a detailed EMG for the C7-T1 disc is needed. And I suspect it to be abnormal. Can't think of any other test at the moment.

Regards

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I have already had an EMG. Do you want me to type the report for you? Would the disc at C7 T1 be causing all the pain I am having in the neck and thoracic back area? I have quite a bit of upper back pain all the time. If it isnt the neck hurting it is the back hurting.  I dont think I could get another EMG at this time since I just had one done. Thanks again
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368886 tn?1466238884
Hi.

Yes, I do recall about your EMG. And I suspect it was normal. That's why we are not sure how this pain could be due to nerve impingement. I won't ask you for another EMG now.

What is the progress about the lymph nodes? Are there any indications from the doctors about the biopsy? FNAC is quite safe.

The nerves from the C7 - T1 do supply the neck and upper shoulder area. We have all the reasons to believe that the pain is originating from this segment.

Regards

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As far as the lymph nodes. THey are not suggesting a biopsy. My primary care doctor discussed with a radiologist. HE said if i wanted to I could get a CT scan of that area if I was concerned.  So I dont know.. THank you
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Hello again. Well I got a call from the CT scan place b/c my primary doctor ordered a CT scan of the neoneck of just my lymph. So I asked the scheduler to call his office to see if they could add it of my c-spine too. HE didnt want to order. I figured with all the complications I am having, that it wouldnt be a bad idea to get this done as well so I wont have to another one later on down the line. I guess I need to contact my surgeon to get this ordered so I can get both done at the same time. I am so frustrated. I am getting nowhere with these doctors. Now do you understand why I want a second opinion preferrably from a neurosurgeon. I just dont know anymore. I do know that there is something wrong in my neck on the right side and I am not GIVING up.... I just wish these doctors would be more proactive in my situation.  
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Hello again.  I am going to have the CT scan of both the spine and the lymph nodes.  I am having a very hard time getting a 2nd opinion. IT seems since I have had the surgery no doctor wants to give me a second opinion.  I made an appt with my surgeon for April. DO you have any suggestions of what I can ask him so I am not ignored.?? If I am not having neck pain I am having upper and mid back pain. Please advise... thank you
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368886 tn?1466238884
Hi.

It is good to know that you are getting both the areas scanned. The main focus should be on the neck spine. I guess your query should be about pain and symptoms relief after ACDF surgery.

The surgery probably has led to more nerve entrapment. Let us hope hte CT scan helps.

Regards
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HEllo,

I am going to have my ct scan next week. My question to you, if they do it with contrast is it the same as MRI contrast. I am allergic to Gadolinium. As far as I know I dont think they are the same. Also do you have any important questions I may ask my surgeon in April. I just need some help. I am having a hard time getting a 2nd opinion and I want some answers thats all. THanks
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368886 tn?1466238884
Hi.

How are you doing? I will be waiting for your CT scan report.

Traditionally, the CT scan is known to identify bony abnormalities and tumors very well. With the contrast coming into picture, soft tissue abnormalities are also identified. Due to the basic difference in the technologies used in CT and MRI, the MRI is more sensitive and in certain cases, more specific than the CT. This is true with the contrast, too.

We are trying to figure out the nature of the lymph nodes and any possible compressed nerve. MRI with contrast would have been a better choice. But that does not deem the CT scan any less important. In fact, for lymph node diagnoses, CT scan is preferred by many. The CT scan can pick up if there is any calcification in the nodes. If they decide to do a biopsy during the procedure, a CT is preferred.

Let me know.

Regards
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Dr Abhijeet,

I think I may have figured out what may be wrong. IT might be a possibility.  Approximately 4 weeks after my surgery I developed a rash that was on my buttocks and inner thighs and I believe my arms. It was so long ago that I am not sure the exact description. When I had my 4 week follow up with the PA the surgeons assistant I informed her of this. SHe took me off of SOma thinking this was the cause of the rash. That was a new medication that I started. But I didnt think that this was the cause. I stopped taking it but have taken it about a month ago and did fine so this wasnt the cause of the rash. WHen I had the rash I was itching intensely. I did go to a dermatologist and he did prescribe something but it went away. Now this intense burning pain I felt in the right side of my neck started approximately 6 weeks after the surgery and it went on for a long time. Then it spread around my back and under my breasts and in my arms. I believe that I could be having symptoms of Shingles.. The only reason I am saying this is I researched it and have some of the symptoms. It started on one side of my body my neck and it spread. And even wind blowing on that side was intense and clothes on that side aggravated it. IT was like the slightest touch or wind made it more pronounced. Do you think this is a possibilty and how do I go about diagnosing it?? I am so frustrated. I am just trying to figure what is going on. Does shingles cause red hands at times? Thanks
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368886 tn?1466238884
Hello.

Shingles should have a characteristic rash on the skin. It spreads in a dermatome pattern. If you have rash, you can think of shingles. (Shingles can come without a rash, too.)

For a diagnosis, you can just visit your physician and ask for certain lab tests for Shingles. Tzanck's smear, VZV-specific IgM antibody test and PCR for VZV virus can be done.

Regards
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Dr Abhijeet,

I had an MRI of my thoracic and lumbar back in NOvember. I have a question about one of the results.  On L5-S1 this is what it says:  THe disc is of normal height.  IT is markedly dessicated.  There is a posterior central annular fissure and tiny subligamentous disc protrusion. The spinal canal and neural foramina are widely patent.  The facet joints are unremarkable. There is no evidence of nerve root compromise at this level.  COnclusions:  Small posterior central annular fissure, L5-S1 with small subligamentous disc protrusion.  The lumbar spinal canal and neural foramina remain widely patent at all levels. What does this exactly mean?  And would this be causing my frequent urination??  Is this a serious problem?? Thanks
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368886 tn?1466238884
Hi.

The spinal canal is the lumen of the spinal cord. It has the cerebrospinal fluid circulating in it.

Neural foramina are the spaces between two vertebrae, from which the nerve roots) coming out from the cord) exit. This neural foramen is formed by the projections of the bony vertebrae. If the disc flattens out, the two vertebrae come closer to each other and the foramen becomes smaller, compressing the nerve root.

You can see these two images for the foramen and the nerve roots exiting from them.

http://www.accuspinadenver.com/images/foramen.jpg
http://www2.aaos.org/aaos/archives/bulletin/aug04/code-1.gif

Your MRI does not show a nerve root compression.

The intervertebral disc is made of two parts, the inner “nucleus pulposus” and the outer “annulus fibrosus”.

http://www.spineuniverse.com/displaygraphic.php/149/invert_disc-BB.jpg

If there is a break in the Annulus (read annular fissure), the nucleus inside tends to come out and press upon the cord.

http://www.ncpainmanagement.com/InfoLumbarDiscography_files/image006.jpg

Overall, the MRI report does suggest a disc problem, but it has not affected the nerves. Any changes since the MRI?

Regards
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Dr Abhijeet,


Hello, how are you? I am doing okay just that I am in alot of pain these days. I had my CT scan today with IV contrast. THey did it of the Cspine and neck including lymph. I won't know my results for 48 hrs probably... I am just having so much upper back pain and its so hard on me.  Do you think it could be failed cervical surgery syndrome??? I just want some answers thats all I want.  I see my surgeon next Tuesday and I have so many questions for him.   DO you have any suggesstions that I may ask for him??  I am so tired of being in pain.. Talk to you soon.. THank you
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368886 tn?1466238884
Hello.

I won't say the surgery might have failed. But the pain could very well be originating from the same vertebrae on which surgery was done. There is a referred pain which can originate at the vertebrae and the disc. This is not a commonly diagnosed pain. The sensory fibers from the vertebrae and the disc, travel along with and end into the same area where those from the shoulder and upper limb end. The brain interprets the pain as coming from the shoulder, arm, etc. This is referred pain.

Might be a good idea to talk to the surgeon about this.

Regards
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Hello again..
I just got my results of my CT scan...Here it is:

CT scan of the neck with IV contrast, Ct scan of the cervical spine with IV Contrast.

History: neck pain, prior cervical spinal fusion, history of enlarged cervical lymph nodes.
Technique:  Ct scan of teh neck performed with IV contrast. Reconstructions of the Ct scan of the cervical spine performed with IV contrast. Multiplanar reformats.
Findings:
Neck Ct: No lymphadenopathy in the neck. A few scattered normal size lymph nodes noted in the neck with the larger lymph node in the right jugular digastric lymph region measuring 1.1cm, image 56.

Great vessels of the neck are patent.

The pharynx, larynx, and oral cavity appear normal.

Paranasas sinuses are clear. Visualized temporal bones are unremarkable.

Impression
No cervical lymphadenopathy.

Ct scan of the cervical spine:

Anterior plate and screw fixation and discectomy noted C5-C7.
The alignment of the cervical spine is normal.  Vertebral body heights are preserved.
At c2-c3, no disc bulge, disc herniation or significant stenosis.
At c3-C4, no disc bulge, disc herniation or significant stenosis.
At c4-C5, no disc bulge, disc herniation or significant stenosis.
At c5-c6, no recurrent disc herniation. NO foraminal or spinal canal stenosis.
At c6-C7, no recurrent disc herniation. No spinal canal or foraminal stenosis.
At c7-T1, no disc bulge or disc herniation or significant stenosis.
Impression: No evidence of recurrent disc herniation or significant stenosis.

My question to you is: Why would it say at c5-c6 and c6-c7 no recurrent disc herniation. Those were removed so I shouldnt have a disc at these  levels??  What is your impression of this and the lymph nodes? Do you think that the pain I am experiencing could be RSD or shingles?? ANy suggesstions what to do next to determine the cause of all the pain I have and the red hands I get intermittently.  Thank you again for everything.
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368886 tn?1466238884
Hi.

Even I was wondering about the meaning of that particular sentence. Is it possible that the radiologist was not informed about your history of the surgery? Such a thing usually does not happen.

Since the CT scan report no lymph node pathology, one has to believe that the lymph node have probably got no connection with the pain.

The suspicion is on the referred pain. This can be actually checked with nerve block. When do you have your next appointment with the neurologist?
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Dr Abhijeet,

Yes the radiologist was informed of my surgery. It was even on the paperwork I had to fill out for them so HE made a mistake....I dont know what to think about that one...I dont have an appt with my neurologist...I have an appt with my surgeon on TUesday at 445pm and the rheumatologist on the 29th of APril.  What type of nerve block are you suggessting?  I was going to ask my surgeon to refer me to a pain managment doctor?? I have been having alot of burning pain lately. It worries me but I try and keep a strong positive attitude that it is going to get better. The burning pain I have been having has been in the right side of my neck, under my breasts across the upper waist and my right arm and hands..Hands sometimes sting.. The pain has been constant for the last 3 weeks.. THis burning pain started 6 weeks after the surgery and it slowed a bit down in January and now it is back with a vengence..  Thanks again for your advice..
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368886 tn?1466238884
Hello.

I am referring to a regional analgesia where the anaesthetic agent blocks the nerve. This is just a thought though. I have no experience of trying a nerve block, to be honest. Please communicate this idea to your pain management specialist.

I guess the basic thought should be to identify the root cause of the pain. There are a few reports of post acdf surgery pain. The pain and burning seems to span over more than one spinal segments.

Regards
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Well, hello doctor.  I saw my surgeon yesterday.. Here it goes. HE says there is nothing wrong with my MRI"s and my CT scan.. He says everything looks good and he doesnt know why I am having all this pain. He did say it is a possiblity of RSD..but that usually starts in arms or legs. He referred me to a pain management doctor and also a neurosurgeon.. He is referring me to someone he knows.. He doesnt know why I am in so much pain. He just says that I had a very large disc herniation rupture and it was impingeing on the cord and that it may get better and may not. It was a bad case. I am atypical.. SO what else. THe problem is everyone knows him and he is very well known in this town.. I know what I am feeling isnt normal.. Yesterday my pain was bad.. TOday a little better.  SO I guess the next step is for the pain management doctor and to talk to this neurosurgeon.. Since they know each other, I probably wont get anything out of it.. We will see... What do you think about getting a block?? What are the risks?.. I just want some answers....Please help me Doctor Abhijeet...
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368886 tn?1466238884

Hi.

A spinal epidural block is an option which will give a temporary relief. If it works for you, you might go ahead with regular blocks. There are a few side effects from it, though. The site if injection is usually inflamed for a couple of days. You may feel a local pain in the area. The block should be performed by an experienced person.

The pain management specialist should be able to provide you with the available options. Ask about the advantages and disadvantages of different options. I would suggest you to write down your symptoms in a chronological order, as they appeared, and take the note to the doctor. Offer him the written history if he would like to read. Generally doctors don't read it in the office hours or when a patient is in the office. He may read it later.

Spinal epidural injection is an option you can try.

Regards
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Dr Abhijeet,

Hello again.. I still think there is something that my surgeon is missing. I believe that it is either referred pain like you said from the neck down to my back or something... THe right side of my neck feels like a pulling sensation, sometimes tearing. I have chronic upper back pain that is intractable.  I just dont understand why I cant get any answers from my surgeon... I just want to find one doctor who will listen to me.. Do you think it could be a screw that isnt in right that could be pulling... I asked my surgeon about scar tissue after the surgery and he said "not really." He also said it couldnt be possible that it is referred pain.. Why is it that some doctors think they are perfect and that a mistake couldnt have happened? I am not looking for trouble, I just want answers. I am tired of being in pain.. Will a CT scan show my screws??  I am still waiting for my surgeons office to send my paperwork to the pain managment doctor. I found a doctor on my own for a second opinion. The problem is like I told you before, everyone knows my surgeon..I am not giving up... You have any suggestions? Thank you again
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368886 tn?1466238884
Hello.

The chances of a hardware problem are very low, as the earlier CT scans have ruled out any problems. The screws are fixed during the operation and an internal fixating cervical plate is inserted to give the hardware additional support. With this much precaution, I do not think the problems you are having are due to the screws coming out.

It seems no one has answers for your pain. Have you been taking any physical therapy? How about the neck muscles? Are they unusually stiff?

Regards
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HEllo again.  I stopped Physical Therapy months ago... I believe in December.  My neck muscles do feel tight as well as the upper shoulders too.. I am hurting all the time.  Do you think I could be rejecting the cadaver bone?? What are the symptoms and how do you know if you are?? Are there any tests to determine this?  I see the Rheumatologist in April 29th and a neurosurgeon who treats spine in 2 weeks. Thank you
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Dr Abhijeet,

Please help me understand.. I talked with the radiologist yesterday that read my Ct report b/c I wanted to clarify the conflicting report and stories I have been told. When I saw my surgeon last week, he said everything looked good on the CT scan and that I am fused.  I asked him about the report saying "no recurrent disc herniation at C5-C6 and no recurrent disc herniation at C6-C7."  His PA said that it was ligaments. And I asked why would the radiologist report that.. I also asked him if I had any scar tissue at any of those levels and he said "no, not really."  I am so upset.  I cant get a straight answer from anyone.  So I called the radiologist that read the report and he said what he meant by that sentence was I have no stenosis or narrowing at those levels. He also said he saw entire bone at C5-C6 and C6-C7 was 90 percent solidly bone. He said there is a little that isnt bone at that level and that I have normal scar tissue but nothing causing narrowing. My surgeon didnt even inform me of this scar tissue and that I am not 100 percent fused at c6-c7.  I just dont know anymore. I am in constant agonizing pain but I cant give up. What is your impression.. Is it normal not to be 100 percent fused. I have an appt to see a 2nd opinion with a neurosurgeon next week.  I am just so upset, I want answers. All I want is someone to be honest with me and help me..I also see the pain managemnt doctor in 2 weeks..for evaluation.. What is your opinion Dr Abhijeet....?  THanks again for your advice....
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368886 tn?1466238884
Hi.

"Could this be pseudoarthrosis?" is the question now. When the vertebrae are intended to fuse, but do not do so, they are still mobile to a small extent. This is called pseudoarthrosis (false joint). A pseudoarthrosis makes the spine unstable.

Often the neurological examination is normal in a pseudoarthrosis. A revision surgery can be done to correct the pseudoarthrosis and fuse the vertebrae again.

Regards
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Hello again..

I am so appreciative of your knowledge. I know there is something wrong and I cant get my surgeon to be honest with me. He is a highly respected physician here and everyone I speak to in the medical profession knows him.. I am not looking for any trouble, I just want to find out the cause of my pain.  My question to you is,  How can this pseudoarthrosis be diagnosed. What tests need to be run in order to diagnose it? Please help.. I have an appt with a 2nd opinion with a neurosurgeon next Friday.. I would kindly appreciate any information you can give me.. Also how does pseudoarthrosis happen?  Is it because I used a cadaver bone?? I am just searching for answers DR Abhijeet.. THank you..
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Dr Abhijeet,

Hello again.. I wish I could send you the Ct scan report. Well anyways,  I looked at the CD for the first time today. I wanted to find the area that wasnt completely fused and I found it.. It is clearly noticable on the Ct scan report. It is on the right side of the neck where I am having all my problems.. What are the chances of it fusing completely?. I saw where it is not connected at all.. Do I still have hope for it to fuse?  I never had left sided neck pain before or after the surgery.. The intense burning pain started 6 weeks after the surgery and that was probably when I was trying to fuse. What are the symtoms of pseudoarthrosis?  Is revision surgery the only option to fix the problem? And is 90 percent fusion not good and would this be causing all the pain...Please let me know what you think before I see the new doctor on Friday... Thank you again.
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368886 tn?1466238884
Hello.

Sorry for the delay in responding. Symptoms of pseudoarthrosis can be the same as those before surgery.

N. Mutoh et al observed that ".....Symptoms resulted from abnormal mobility, cord compression due to posterior slip or rotation of the upper vertebral body, kyphotic deformity or a problem at the adjacent level........." This suggests why pseudoarthrosis produces symptoms.

There is a very good article on pseudoarthrosis. The link is as follows-
http://www.medscape.com/viewarticle/448387_4

The article mentions the need to identify the pseudoarthrosis. Of particular relevance is this extract,"......... In patients with recurrent or persistent neck pain, however, pseudoarthrosis should be considered as a likely etiology..........."

There is also a good article on how pseudoarthrosis due to ACDF can be managed. The link is - http://www.ncbi.nlm.nih.gov/pubmed/1440001

It mentions a need for a posterior approach surgery to manage pseudoarthrosis secondary to ACDF.

In your case, pseudoarthrosis may be present. Try to get the CT scan reviewed for this purpose again.

Regards
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Dr Abhijeet,

Hello again.. I called my surgeons office and spoke to his PA, his assistant. They still are saying I am fused...Why would the radiologist say I am only 90 percent fused? My surgeons assistant tells me not to listen to him and that he is not a neck surgeon. I feel like I am being medically neglected on my surgeons side. They refuse to listen to my symptoms and tell me that the radilogist is wrong... I have seeked a 2nd opinion for Friday with a neurosurgeon.. Will he be able to tell if I am fused from my CD?  I am so frustrated.. I want to get to the bottom of this.. If I am only 90 percent fused like the radioligist said if that is true, do I still have time to fuse completely/??  I really dont want to have a 2nd surgery.. And why would one vertebrae fuse and not the other?? Do you have any suggestions I might ask the neurosurgeon..? I also see the pain management doctor next week....for an evaluation.. Thanks again.
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Dr Abhijeet,

I saw the neurosurgeon yesterday... Didnt go that well. He of couse knows my surgeon.  Anyways, the good news is from his standpoint I am fused...So, he suggests I go to the pain management doctor that my surgeon referred me to and have some type of block whether it be a facet block, stellate ganglion block or an ESI.. SO that was about it.. I asked him about the red hands bilaterally and he said RSD doesnt usually manifest it bilaterally that it is usually one sided.. The only thing I got out of the visit that is I am fused and that was it... A waste of money on the insurance part.. I just wanted an honest unbiased second opinion and he knew my surgeon... Oh well... I guess I will see the pain doctor and hopefully something will be figured out...
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Instead of consuming all of Dr. Abhijeet's time with your endless questions that are essentially the same thing over and over again, why don't you find another Dr to go see?  I can tell that you would like Dr. Abhijeet to be your doctor, but he can't.  He also can't diagnose you online.  Go to another part of your state to see someone if you are that concerned about the care or lack of care that you are getting from your current doctor.  I know that sounds harsh, but this is a place for "advice."  You have to get your care somewhere else.  I have been searching for a diagnosis for many years now- keep trying- you'll eventually find someone who will help you.    
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216175 tn?1226099185
This is probably why Dr Abhijeet isn't posting anymore.  I too suffer from burning pain, but it is everywhere in my body.  I am now finally after 7 years getting help, from one doctor to the next.  Thank you jmanderson, you took the words right out of my mouth.
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216175 tn?1226099185
63 posts, I'm sure that can't be good on your neck.
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368886 tn?1466238884
Hello.


I hope you are still on the forum. How did your visit with the pain management doctor go? I would agree with the neurosurgeon about the possibility of RSD. But one really has to examine the patient before ruling RSD out.


Regards
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368886 tn?1466238884
Hi.

How are you? Are you still there on this forum? I have been checking this thread off and on. Is there any progress?

Regards

Abhijeet Deshmukh, MD
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Dr Abhijeet,

HEllo.. I just thought I would check this site today and I am so pleased I saw your post.I am getting worse.. I have multiple symptoms still and still very few answers.. I dont know where to turn anymore.. I did see a Rheumatologist and had a complete workup..HE thinks I have an undifferntiated spondylarthropy seronegative RA.. but I feel that is not what I have.. He wanted me to start taking Plaquenil but havent until I get another opinion.. I know what is going on with my body and have done so much research.... It is all stemming from my neck and I believe I have nerve damage in my CSpine that is wreaking havoc on my body and my  circulation.. I was sick about 2 weeks ago with a sore throat and swollen lymph nodes and a PA put me on Keflex 2000mg a day for 10 days.. 3 days into the antibiotics my burning neck pain was relieved and my red hands were not inflammed anymore.. I think this is significant..Also when I had those MRI's and mylegram last year I was premedicated with steroids and that helped too.. SO I have multiple things not a clear picture for the docors.. I believe I have some type of brachial plexus injury or nerve damage in the neck...I also have inflammation chronic and not sure what that is.. I did find out my Vit D level was real low and I am on 50,000 Units a week for 3 months.. I have 3 weeks left of that. I was also started on Fortical for osteopenia.. I am so stressed..that no one can figure out was is going on...NOw my right eye is drooping where I have all that neck pain and I am scared.. I have that terrible right side neck pain that radiates up to my skull on the right side and my scalp is tender on that side... I have pain behind my right eye and my eye is drooping a bit... I just am so worried and I cant seem to find anyone who cares.. I am having trouble sleeping too and this has been going on for a long time b/c I am in chronic pain...My sed rate was 31 the last time they checked.. I tested positive for Sgogrens syndrome too in my blood.. SSA I believe.. My primary care doctor had blood cultures drawn on me recently but dont have those results yet.. My antibiotics were complete on a Thursday and they were drawn on a Tuesday so I dont know if that would interfere with the results.. I think there is something that dr's are missing.. I am very fatigued so fatigued that I have no energy to do much..
What are your opinionss? Do you have any suggestions..?
My hands started turning red and inflammed again.. and it was weird that the short time I was on Keflex my hands werent red.. I hope there is no infection deep in my cervical spine that they arent catching or something left in my neck like a sponge.. I just dont know what to do.... Please help me Doctor. I am so happy I decided to look at this website and you showed your concern for me.. I really want to thank you for that..

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368886 tn?1466238884
Hello.

Nice to see you are back on the forum. I am sorry you are still not able to get your symptoms under control.

I can not comment on the RA, but I do agree that there is some residual nerve compression in the cervical cord.

There are various tests to find out if there is any infection. I guess you can ask for those.

It is really difficult to find out one common thread to all the symptoms you have been experiencing for such a long time.

Hope your eye problem hasn't increased.

Abhijeet Deshmukh, MD
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Hello again,

I just wanted to post something they found out.. I had a WBC scan and a Spect Bone scan and they found activity at C6-C7.. THe new doctor I am seeing believes  I am not fused at that level and possible infection at that level even though infection didnt show up there. I have all the inflammatory markers. He recommends a revision surgery but with risks.. My bone could be infected in my spine. He recommends I go out of state and with a surgeon who has done alot of revisions since my case is complicated.. How can so many doctors I have come across miss this diagnosis.. after all the scans and xrays I have had.. I just dont understand it.. Do you have an email I can send u some information to? Please Dr Abhijeet, now that i have nonunion at C6_C7 would this be contributing to all my pain in my neck and shoulders? I just dont know.. My surgeon always told me I was fused and not infected.. I asked my original surgeon several times this question..Please give me advice..Thank you
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368886 tn?1466238884
Hello.

Hope you have some relief from the pain as you read this.

There has been some good reasearch on post - ACDF non fusions. One of the studies, done on a series of 19 patients with non-unions suggests a revision surgery with allografts from Iliac crest has 100% success. (Coric D et al, Journal of Neurosurgery, 1997)

In this series, they had diagnosed non-union with SPECT bone scans, which "....has the potential to reliably confirm the diagnosis of pseudarthrosis." (Abstract)

One more study suggests a 'posterior' cervical fusion is more beneficial than a repeat anterior fusion. (L. Carreon, The spine Journal)

Your SPECT reports do hint stringly towards non-union. In my opinion, you should approach this issue as a non-union and see the other surgeon suggested by your current surgeon. You can mention to him/her about these two evidences / approaches to non-union.

I can not comment upon the possibility of infection here. I hope your surgeon will figure it out soon. But the infection has to be treated sooner than later, as it may not allow for a corrective surgery.

I can understand you have to suffer from the constant pain. I think you can go ahead and see the other surgeon.

Regards,

Abhijeet Deshmukh, MD
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368886 tn?1466238884
Hello Marisa.

I am sorry for the late reply.

I don't think 'number of surgeries' is the only criterion for a surgeon to be good. But I guess, like any research trial, the doctor should have done a sizable number of surgeries.

In my opinion, you should see a Spine surgeon. An added neurosurgeon will be a bonus. But the two surgeons should be able to discuss your case and reach a goal together.

The problem of missing the non-union/malunion (or any other post-surgical complications) is quite universal. That doesn't mean they are not good doctors. It's just that there may not be a proper communication among all the specialists you have seen. And by the word 'communication' , I mean everything including phone conversations, notes, etc. If you have a case manager (a doctor who oversees all your investigations and progress), the process becomes well directed.

The WBS scan may also suggest inflammation, if not infection. A long standing non-union is bound to produces inflammatory markers.

I am not an expert on the subject, but in my opinion, you should consider a revision surgery. And please do consider your own graft. It's always better than any other. A posterior revision surgery is found to be beneficial. If you were to construct a decision tree, you would always have better prognosis with a spine surgeon's consultation, and perhaps a revision surgery. (taking into consideration the risks / possible side effects of a revision surgery).

Please let me know what you decide.

Regards

Abhijeet Deshmukh, MD
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