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

[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