C6-7 fusion post op

I had C6-7 fusion May 08.  I am back to office work and am experiencing severe neck and R arm pain in the past month.  My pain was mainly L sided prior to surgery.  I was told also that C5 was bulging but I had no symptoms pre- surgery.  Doctors feel that it is nerve related due to surgery and may improve. This is getting progressively worse and I am in a great deal of pain.  The pain I have in the neck is actually at the base of my spine on the 'hump' below the fusion site.  I can hardly touch it as hurts a great deal.  My right arm is weak and I do have tingling in fingers at times.  I have also had pain in the L arm too. This has not been as bad as the R side though.  I have not run to the Dr. as I wanted to allow some time.  I have had PT post-op and did very well with it.  I am now perplexed and concerned that this may be yet another herniation.  Please advise

[Nassim Abi Chahine, MD]

You are not the only new member in Medhelp, I am too a 2009 member; founder of the international neurosurgery forum with medhelp great administrators..
Look Shireley, I expect that your surgery was done through an anterior approach, I mean an incision in the anterior neck (called Cloward’s procedure), I can also imagine that a « cage «   was implanted between C5 and C6, with some bone paste to enhance the fusion of these 2 vertebras. OK all that could be with minimal variations,  I mean the surgeon could take a natural  bone graft from your right iliac (pelvic) bone.. the important is to know either a second disc herniation is the cause of your pain or simply a muscular spasm is causing that. To help you  send me name of the drugs you’ve tried and the treatment you did after the surgery if any, and one more thing: I couldnt understand  what do you mean by PT !
You knw that in a human vertebral column 8 discs are candidates to cause herniation. Wishing that no second herniation, lets inspect what could cause such pain.
Waiting for your reply

[shirley214westmain]

I am replying to your questions regarding my C6-7 neck fusion and subsequent problems.
First of all, I did have an allograft from cadaver bone.  I also have had the metal cage at only C6-7 site.  C5 was bulging prior to my surgery but as I presented without symptoms for this disc, my Neurosurgeon opted not to fuse C5-C6. The C6-7 site of fusion was done as the disc had fully extruded and had dislodged my spinal cord off to one side.  this had resulted in severe pain in my left arm and left shoulder.  I also would have total numbness down the left arm.  I did not however have any symptoms on the right side until after surgery,  I received Physical Therapy (PT) post op at about 8 weeks.  It involved modalities of Ultrasound, Infrared, and myofascial releases to numerous trigger points along my upper trapezius and cervical spine areas.
the medications I have been on since surgery and are now on at a reduced dosage amounts are:
Methocarbam 750mg 1 tablet and I take this in the morning and at bedtime if needed.  Again, my areas of pain now that I am experiencing are in my right arm and at the base of my neck.  I also experience pain across my upper shoulders and neck.  I feel that this may be spasms but not altogther positive.  I am concerned as the right arm my does not improve and will be quite bad at times, especially in the morning upon awakening.  thank you very much for coming back to me with a reply and I look forward to further answers
Hydrocodone 7.5-750mg 1 tablet in the morning and at bedtime if needed.
Most days I will likely need at least one dosage of each above.

[Nassim Abi Chahine, MD]

Let me first of all express my happiness about what you know about yourself and your disease and your procedure.
PT is totally un-needed and does not help in your case, medications you are taking are also a kind of temporary anesthetic.
In my opinion no effective treatment in your case except; the " long time" which could resolve any problem including your pain.

However you can try this treatment as a final medication-oriented resort:
(and here I'm giving you the chemical name of the medications, except 1 brand name of a complex of neuro vitamins, unavailable under other notes)
1- Metylprednisolon 1000 mg for 3 consecutive days, then 500 mg for other 3 consequtive days
2- Citicholine syrup 2 ml 3 times daily for 1 months
3- Pantothenic acid 1 tab morning
4- "Natrol Memory Complex" 2 tabs morning for 1 month

if any improvement please repeat your treatment for 1 more month and let me know