I’m a 39 year old female. I had ACDF with plating, PEEK with Allograft, C5-6, 6-7 on Feb 29th 2012 due to “severe stenosis, cord impingement, near-complete CSF effacement, mild increased T2 signal on the cord, and mild bilateral neural foraminal narrowing”, blah blah blah… Two minor car wrecks in my late teens, but no neck complaints up to my date of surgery. Hand numbness starting Nov 2011 progressed into intolerable hand pain by January 2012.
I do have my pre-op Feb 2012 MRI report and one pic from that MRI, Feb 1012 surgical report, and June 2012 post-op MRI report (no pics post op). I will happily clarify any questions about the medical records that I do have, but am not going to type it all unless it’s needed. Partly because the fiery pain in my hands, which is why I’m posting here to begin with…
I do understand the normal disclaimers, that the ACDF surgery is mainly to avoid things like paralysis and that nothing is guaranteed. Since I’m a big fan of bowel control, surgery seemed like the best plan.
Immediately after surgery, I had NO hand pain. I was thrilled. After a few hours, some numbness started, and was intermittent for the first month, but really was not problematic, and was understood to be a possibility. At about six weeks, my hands started becoming painful again, and now that pain has ramped up alarmingly to the point that even medicated - 1800mg Gralise (slow release Gabapentin, equivalent of 600mg Q8) and a 5mcg/hour Butrans patch (opiate pain patch) the pain is worse than it was before the surgery. (Not to mention I’m profoundly sleepy, pretty stupid, and not overly safe to drive, though I have to drive, not to mention work, where I’m in charge of patients on a 14 hour overnight shift…) (Note, before surgery, I was only taking Gabapentin 300mg Q8, and 5mg Vicodin very very rarely, as it tends to nauseate me.)
At my 3 month post-op appt recently, I saw the physician’s assistant. I told her that while I don’t feel like there’s anything wrong with the fusion, I DO feel that there is something wrong. The pain in my hands (fourth and fifth digits, to be precise) is basically the same pain I had before the surgery, only more painful. I also have, as I did pre-op, symptoms of myelopathy… heavy, klutzy feet, mainly. I am ok with this, as I do believe this might go away as the spinal cord bruising heals. Or not. Either way, the myelopathy is tolerable. The thing with my hands, no. The PA ordered an MRI, which still shows a few things that seem alarming to me.
Disclaimer… I think a lot of this surgeon; he has a fantastic reputation. The anesthesiologist even told me the doc is good, and the anesthesiologist had had a fusion performed by my dr recently. (Of all people to know who’s good, I’d say the anesthesiologist would be pretty reliable…)
That said, …from my recent post-op MRI… “residual disk osteophyte complex which is most prominent centrally does efface CSF space adjacent to spinal cord at C6-7, however the amount of spinal canal stenosis at this level has diminished since prior study. Bilateral neural foraminal stenosis is present. “ Myelopathy is mentioned also, but isn’t such a concern to me.
The MRI is a bit alarming to me, but I’m admittedly uneducated. I’ve done a lot of research, but that can only get you so far. Here is my real problem, though… I received a call from the PA today that the Surgeon went over my MRI, and it looks “fine”. I’d love to argue that “fine” judgment, but while the Surgeon gave me the pre-op MRI photo, the other reports were received in a less honest way, so I must, to an extent, play stupid.
It is my best guess that the cause of the pain in my hands is the neural foraminal stenosis. In the post-op MRI, foraminal stenosis is mentioned at C4-5 and C5-6, described specifically as “mild”. There is no “mild” in the description at C6-7, so it feels safe to assume that it’s significant. While the spinal cord swelling may continue to diminish, lessening the effect of the spinal canal stenosis, I don’t see any way that the foraminal stenosis is going to become less significant.
Something that may or may not be of note, the only thing, aside for heavily medicating, that helps my pain level in my hands, is to sleep for at least 6 hours. My pain is practically zero on waking, but it ramps up as the day progresses. I’m very uncomfortable by afternoon, and there are nights that I cry myself to sleep. (I’m no wuss… I had babies without meds.)
Also curious… in the surgical report, there is no mention of correcting any foraminal stenosis. Is that something that would be corrected by the disk replacement/fusion, or was it neglected?
Thank you so much for any answers/shared experiences, and for tolerating my wordiness.