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Posted by CCF Neurology MD(B) on March 19, 1998 at 09:38:08:
In Reply to: horner's syndrome, pain after spinal surgery posted by ricki kaye on March 03, 1998 at 14:02:00:
: I was had an anterior cervical discectomy and fusion c-4, c-5 wiht donor bone in Nov. of 1997. I presented myself at the doctor's office for a one week follow up. I was only allowed to stay one night in the hospital. I complained to the DR's nurse that i was having severe pain and that i was taking an enormous amount of pain killers. The nurse, made an judgement call not to take an xray, even though i complained that i swore the grafts had popped out. I was taking demerol and percodan. I saw the doctor and he put me on Medrol for one week. During the following week the pain got stronger, so I called the Dr.'s office and asked to be put on Elavil, for the pain as that was very useful at the time i first injured my neck in an automobile accident in May 1993. The elavil worked well with the percodan in masking the pain. I was able to function more normally and resumed working while in a Miami J collar. Whenever the percodan started to wear off, the excrutiating pain came back. I called the Dr's office and again his nurse told me this was quite common after cervical discectomy.
I went back to the doctor for the 3 week follow up, and now finally an xray was taken. The graft at the c4-5 was 60% displaced anteriorly. I was scheduled to have another surgery to fix it and have a plate placed over the area, to prevent the graft from. This was done on 12/17/ 97. I took two weeks off after surgery to recuperate. My Doctor said i didn't need my collar, after the two weeks because of the cervixal plate.
Now as a result of that surgery, i have Horner's Syndrome on the left side, the side were the incision was made. I have been going to physical therapy and the pain is less. But now I still had burning in my right shoulder and right braichial plexus along with pain the my trapezious and scapula. I was reffered to another dotor in the office and an xray was finally taken of my right shoulder and it was discovered i have an AC seperation.
My problems now is: i have a very crunch back, when i do shrugs it's worse then someone cracking their knuckles. i have burning and searing pain in the area of the right brachial plexus and under the right scapula. I still take the elavil and try to only take percodan only when the pain is unbearable. I have lived with back pain and neck pain for so long.. and what is the chance of my left getting better.. i have petosis (?). My right eyelid droops. and i have some numbness in my lips on the left side.
i had an ijury to the brachial plexus on the right side in 1980 or 1979.. not quite sure on when. at that time, the right brachial plexus was nicked and the subclavian vein was cut. I went through therapy and recovered from that injury..but now all the pain is back.. it's like the discectomy allowed the feelings of pain associated with that old trauma to make it's way back to my brain..central nervous system. It's like the bulging disc cut off the nerve pain and now that the discs are gone, the pain has a pathway back.
I have been going to physical therapy and i get 15 minutes of massage on my back.. it is so painful to be touched. the massage therapist says i have spasms in my back. i have been taking Soma for the last six weeks..but nothing loosens up my neck, back and shoulders. I missed one week of therapy, last week and i had less pain. I had a cortisone shot in the seperated shoulder about a month ago but the searing and buring is still there. it's the crunchy sound in my back that alarms me.. and i am afraid to stop taking my medication.
do you have another idea about what is causing the pain? can you recommend other pain medications..that my doctor can prescibe? any recommended course of therapy?
Dear R. Kaye, Horner's syndrome presents clinically with miosis, anhydrosis and ptosis. It does not present with pain of either the face or torso. The pain you describe in the face and shoulder region may be secondary to irrritation or damage of portions of the spinal tract of the trigeminal nerve and brachial plexus, respectively. Because of the complexity of your case I would recommend that you be evaluated by a neurologist who specializes in peripheral nerve disorders. I would want to make sure that your only problem is pain and that there is no clinical signs of sensory changes or weakness. For completeness, this may reqiure an MRI of the bracial plexus region plus an MRI. As far as pain management, this could be handled by the neurologist but again because of the complexity plus chronicity of your condition you may wish to consider evaluation by a pain management specialist. Hope this helps. "This information is provided for general medical education purposes only. Please consult your physicians for diagnostic an d treatment options of your specific medical condition."
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