Dr Abhijeet PLEASe help

[ms38]

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

[Abhijeet Deshmukh, MD]

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

[Abhijeet Deshmukh, MD]

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

[ms38]

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

[Abhijeet Deshmukh, MD]

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

[ms38]

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..

[Abhijeet Deshmukh, MD]

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

[Abhijeet Deshmukh, MD]

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

[bowhunter0310]

63 posts, I'm sure that can't be good on your neck.

[bowhunter0310]

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.

[jmanderson]

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.    

[ms38]

bumping up

[ms38]

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...

[ms38]

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.

[Abhijeet Deshmukh, MD]

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

[ms38]

bumping up

[ms38]

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.

[ms38]

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..

[Abhijeet Deshmukh, MD]

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

[ms38]

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....

[ms38]

bumping up

[ms38]

bumping up

[ms38]

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

[Abhijeet Deshmukh, MD]

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

[ms38]

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