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]

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

[ms38]

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...

[Abhijeet Deshmukh, MD]

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

[ms38]

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..

[Abhijeet Deshmukh, MD]

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?

[ms38]

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