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]

Hello again..
I just got my results of my CT scan...Here it is:

CT scan of the neck with IV contrast, Ct scan of the cervical spine with IV Contrast.

History: neck pain, prior cervical spinal fusion, history of enlarged cervical lymph nodes.
Technique:  Ct scan of teh neck performed with IV contrast. Reconstructions of the Ct scan of the cervical spine performed with IV contrast. Multiplanar reformats.
Findings:
Neck Ct: No lymphadenopathy in the neck. A few scattered normal size lymph nodes noted in the neck with the larger lymph node in the right jugular digastric lymph region measuring 1.1cm, image 56.

Great vessels of the neck are patent.

The pharynx, larynx, and oral cavity appear normal.

Paranasas sinuses are clear. Visualized temporal bones are unremarkable.

Impression
No cervical lymphadenopathy.

Ct scan of the cervical spine:

Anterior plate and screw fixation and discectomy noted C5-C7.
The alignment of the cervical spine is normal.  Vertebral body heights are preserved.
At c2-c3, no disc bulge, disc herniation or significant stenosis.
At c3-C4, no disc bulge, disc herniation or significant stenosis.
At c4-C5, no disc bulge, disc herniation or significant stenosis.
At c5-c6, no recurrent disc herniation. NO foraminal or spinal canal stenosis.
At c6-C7, no recurrent disc herniation. No spinal canal or foraminal stenosis.
At c7-T1, no disc bulge or disc herniation or significant stenosis.
Impression: No evidence of recurrent disc herniation or significant stenosis.

My question to you is: Why would it say at c5-c6 and c6-c7 no recurrent disc herniation. Those were removed so I shouldnt have a disc at these  levels??  What is your impression of this and the lymph nodes? Do you think that the pain I am experiencing could be RSD or shingles?? ANy suggesstions what to do next to determine the cause of all the pain I have and the red hands I get intermittently.  Thank you again for everything.

[Abhijeet Deshmukh, MD]

Hello.

I won't say the surgery might have failed. But the pain could very well be originating from the same vertebrae on which surgery was done. There is a referred pain which can originate at the vertebrae and the disc. This is not a commonly diagnosed pain. The sensory fibers from the vertebrae and the disc, travel along with and end into the same area where those from the shoulder and upper limb end. The brain interprets the pain as coming from the shoulder, arm, etc. This is referred pain.

Might be a good idea to talk to the surgeon about this.

Regards

[ms38]

bumping up

[ms38]

Dr Abhijeet,


Hello, how are you? I am doing okay just that I am in alot of pain these days. I had my CT scan today with IV contrast. THey did it of the Cspine and neck including lymph. I won't know my results for 48 hrs probably... I am just having so much upper back pain and its so hard on me.  Do you think it could be failed cervical surgery syndrome??? I just want some answers thats all I want.  I see my surgeon next Tuesday and I have so many questions for him.   DO you have any suggesstions that I may ask for him??  I am so tired of being in pain.. Talk to you soon.. THank you

[Abhijeet Deshmukh, MD]

Hi.

The spinal canal is the lumen of the spinal cord. It has the cerebrospinal fluid circulating in it.

Neural foramina are the spaces between two vertebrae, from which the nerve roots) coming out from the cord) exit. This neural foramen is formed by the projections of the bony vertebrae. If the disc flattens out, the two vertebrae come closer to each other and the foramen becomes smaller, compressing the nerve root.

You can see these two images for the foramen and the nerve roots exiting from them.

http://www.accuspinadenver.com/images/foramen.jpg
http://www2.aaos.org/aaos/archives/bulletin/aug04/code-1.gif

Your MRI does not show a nerve root compression.

The intervertebral disc is made of two parts, the inner “nucleus pulposus” and the outer “annulus fibrosus”.

http://www.spineuniverse.com/displaygraphic.php/149/invert_disc-BB.jpg

If there is a break in the Annulus (read annular fissure), the nucleus inside tends to come out and press upon the cord.

http://www.ncpainmanagement.com/InfoLumbarDiscography_files/image006.jpg

Overall, the MRI report does suggest a disc problem, but it has not affected the nerves. Any changes since the MRI?

Regards

[ms38]

Dr Abhijeet,

I had an MRI of my thoracic and lumbar back in NOvember. I have a question about one of the results.  On L5-S1 this is what it says:  THe disc is of normal height.  IT is markedly dessicated.  There is a posterior central annular fissure and tiny subligamentous disc protrusion. The spinal canal and neural foramina are widely patent.  The facet joints are unremarkable. There is no evidence of nerve root compromise at this level.  COnclusions:  Small posterior central annular fissure, L5-S1 with small subligamentous disc protrusion.  The lumbar spinal canal and neural foramina remain widely patent at all levels. What does this exactly mean?  And would this be causing my frequent urination??  Is this a serious problem?? Thanks