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View Full Version : Cont. Pain after C5-7 ACDF plus lumbar symptoms


myfreedom
05-25-2007, 08:48 AM
I am a 36 yo female. I apologize now for the length of my question, but felt the history was necessary.

In Sept. 04, I began experiencing severe shooting pains under my shoulder blade, down my arm and in my neck. For years before this, I would have occasional under shoulder blade pain. The pain in my shoulder would increase w/ head movement so I would limit that which in turn, would make my neck hurt (I thought). For a couple years prior, I had tingling and numbness in my arm and fingers and began to experience it again severely. I was treated for Carpal Tunnel, but they finally did an EMG which came up neg. I ended up at Urgent Care & then next day ER after not being able to get out of bed. I was treated for 'back strain,' was advised to seek massage therapy, given demerol, skelaxin, & vicodin. The next day, I was in my PCP's office who put me on oxycontin, percocet, steroids, neurontin & elavil telling me to call in 3 days if I showed now relief. I didn't & was sent for a cervical MRI w/out contrast.

The MRI showed C5-7 mild, moderate & severe disc protrusions, bulges, cord deformities, stenoses, kyphosis, degenerative changes, forminal stenoses

The radiologist said he hadn't seen an MRI that bad from someone not in a severe accident &/or someone still walking. After a couple appts. w/ a neurosurgeon, I opted for a fusion. The C5-C7 ACDF was performed at the end of Sept 04.

I ended up having 2 surgeries that day. The neuro stated while I was in recovery, that he didn't like the placement of the screws in my plate and that I needed to go back in to surgery. The xray wasn't taken until I was in recovery and woken up.

I had immediate relief, post-surgery, of most of the pain, but the numbness was never gone. I was in a Miami J for 1 mo., no soft collar, & was sent to PT when the pain began to return. PT seemed to make everything worse. The neuro put me on neurontin, but it made me ill so I quit taking.

The neuro also sent me for an EMG, but I never heard the results. The neuro stated he didn't recall the EMG at all and never sent me to one.

Right after surgery, I developed a cough that persisted for appx 6 mo. despite antibiotics. An ENT tried to my throat, but I gagged too much. He noticed a lot of scarring in my throat. I then had a barium swallow test that showed a slight narrowing at the C5 level they were unable to see much of C6-7 because of the plate, no sign of acid reflux. Priolosec, and various cough meds did nothing to relieve the cough. I would cough so hard, I'd pee myself &/or vomit.

Eventually, I was given a codeine based cough med & the cough went away in 2 wks, but I still have a dry feeling in my throat which makes it difficult to swallow & gags me. My voice gets hoarse after talking for a short time. I recently noticed that the ENT's report sent to my neuro said 'I will call you to privately discuss the patient's vocal cords.' Nothing was in either file regarding this & no one discussed anything with me.

2 mo. post surgery I had a cervical MRI w/out which showed diffuse disc bulge C2-3 no stenosis or narrowing, C4-5 mild posterior disc bulge and protrusion no canal stenosis or neural foraminal narrowing, minimal flattening of the ventral thecal sac. C5-C7 somewhat limited in evaluation due to artifact, C7-T1 grossly w/in normal limits although there might be a very mild bulge present. My pre-surgery MRI showed most of these levels were previously normal.

I started to have pain and intermittant numbness in my left arm & fingers now as well as shin, knee & hip pain. I was very stiff when I got up from sitting or laying down. I told the neuro & he didn't say or do anything about this.

Work hardening. My former job was a desk job involving continual sitting, typing and writing. The therapist noted a fairly lg. diff in grip strength of my right hand. Decreased sensations & mobility. He noted that I exhibited signs of pain & decr stamina in performing simple tasks. I was unable to continue w/ work hardening as I hadn't been released from PT & the therapist stated I didn't belong there yet. My PT stated that he felt the numbness I experienced was probably permanent.

About 6 mo. after surgery, I got pregnant. The PT was not familiar treating pregnant patients and I suffered from 24/7 nausea and vomiting. I was experiencing dizziness and lack of coordination moving in certain ways. Worse w/ PT manipulation.

3 mo. later, I was in PT again because of the pain & my neck, arm & shoulder mobility kept decreasing even though I cont. home exercises. I began dropping things, my hand/arm would shake & cramp or if I did fine hand tasks, The PT said that I showed signs of Thoracic Outlet Syndrome. Every day after my PT, I would be in extreme pain. I was only taking Tylenol & refused any other pain meds that might harm my baby. My hip & leg pain was getting more severe & interrupted my sleep. I was also having low back pain. My neuro, PT, OB all blamed the pain on pregnancy & hoped it would go away when I delivered. Laying face down, propped on pillows in a doggie type position, alleviated the cramping pain in my legs somewhat. I also began to experience uterine cramping after therapy sessions & when my pain was at it's worst. I was given the ok to stop PT.

During prenatal testing, I had high AFP counts so an amniocentesis was done. It was normal. The neonatal Dr. noted uterine cysts. Then I developed polyhydramnious, then leaking fluid and delivered my son 1 mo. early via c-section.

I was sent to a pain mgmt Dr. who told me there was nothing he could do while I was pregnant and to return after delivery & breast feeding. He noted decreased pinprick sensation, moderate decreased head, neck & shoulder mobility, decreased reflex in my right arm & right leg.

1 yr. post surgery xray showed flexion and extension maueuvers demonstrate limited range of motion in upper cervical spine. No motion noted C5-7.

After delivery, the back/leg pain didn't go away, my neck/shoulder/arm pain didn't get better, the neuro sent me for a shoulder MRI & referred me to an ortho. The MRI stated:
Left shoulder-mild osteoarthritic change at the acromioclavicular joint w/ osteophytic change effacing subacromial fat & abutting the supraspinatus muscle belly. Signal abnormalities in the supraspinatus tendon most consistent w/ a partial thickness tear and tendinopathy.
Right shoulder-osteoarthritic change at the acromioclavicular joint w/ marrow edema suggesting active inflammation. Osteoarthritic change effaces subacromial fat & indents the supraspinatus muscle belly near the musculotendinous junction. Supraspinatus tendon signal abnormalities suggesting bursal surface fraying & intrasubstance tendinopathy w/out frank full-thickness rotator cuff tear.

I went to PT again for shoulder strengthening excercises. The therapist who treated me was the first one to see me after my ACDF & she was alarmed at my loss of mobility in my head, neck & arms. The excercises did little to to help.

continued..........

myfreedom
05-25-2007, 08:49 AM
continuance of original thread.....sorry for the length.

I was given another EMG. The Dr. noted decreased pinprick sensation, decreased reflexes & moderate decrease of mobility. I was told the EMG was normal. Dr. noted that my continued pain was probably a result of the catastrophic insult to my cervical spine prior to surgery.

A finally convinced my neuro to order a lumbar MRI. It showed:
L4-5 mild disk dessication w/ normal disk height, mild disk bulge is present w/ mild ligamentum flavum hypertrophy resulting in mild canal stenosis. Left posterolateral annular tear is present. No evidence of foraminal stenoses.
L3-4 normal, L2-3 normal, L1-2 normal
W/in the L4 right vertebral body, there is a 1.8cm round focus of T1/T2 hyperintensity w/ interspersed short vertical linear areas of hypointensity consistent w/ hemangioma. The remaining bone marrow signal is normal. Lumbar spine is normally aligned. Vertebral body heights are normal. No evidence of endplate osteophytosis.
Everything else stated as normal or unremarkable.

The neuro never reviewed the films or report despite bringing them to him personally. To date, he hasn't discussed them with me & I am now looking for another Dr.

I have begun experiencing difficulting defecating. I have to lean back or elevate my legs to accomplish it at times. I alternate between diarrhea and constipation from wk to wk. I often have to make urgent bathroom trips especially after eating. I sleep maybe 1/2 hour at a time before my shoulder, neck & leg pain wake me. I experience tingling, numbness, a soft touch to my right arm especially, but other parts of my body feels like scratching like w/ needles. I have about a 2 inch round lump on my head right in the hairline which a CT showed as a likely fatty deposit.

I lose footing & slip or fall on stairs or uneven surfaces. I sprained my ankle badly a couple months ago when my foot turned going up one step. I can't turn doorknobs sometimes. When I get up, I am really stiff and walk hunched over, shuffling. My feet are often cold & difficult to warm. The pain in my right arm has changed to under my arm and down instead of on top. I still drop things. My strength wanes when trying to hold anything of weight & my grip or hold on it slips. My legs tingle, feel like they're asleep often and I cannot balance on my heels at all.

I still experience dizziness and my PCP said I have positional vertigo. If I hold my head up w/out support, I get cramping pains in my neck and shoulders randomly. Most xrays I have had of any part of my body show bone spurring.

My PCP prescribed Lyrica recently & it helped only a little, but made me extremely dizzy, sleepy, nauseous & made my eyes feel weird at only 50mg/day. My PCP took me off of it and put me on neurontin again at 300mg building up to 3x per day (900mg/day) It makes me sleepy & slightly dizzy.

I have fluctuating menses that are really heavy & long one mo. & extremely light & short followed a few days or week later by another light one. I used to be so regular you could set the clock by it. I also skip months here & there.

There are darkened patches of skin on my neck, under my breasts and arms. Jaw pain, frequent headaches, exhaustion, weakness throughout my body, difficulty maintaining focus on tasks, memory & hearing problems. I'm unable to maintain any position for long & must frequently shift around to try to get comfortable. Sitting straight up on my tailbone causes the most intense burning/aching type pain in my tailbone area. I have numbness on my outer hips.

Essentially, my whole body is stiff & hurts. I feel like I'm 80. My dad has the same back probs as me, but not as bad. My 24yo daughter was diagnosed with degenerative disk & positional vertigo. My mom and maternal grandmother had/have back & shoulder problems. My maternal grandmother had severe osteoporosis & vertigo problems too.

My PCP (internal medicine) is at a loss for what to do for me. I do not want to have another surgery unless absolutely necessary and have a toddler to take care of all alone which prevents me from taking pain meds that might hinder my alertness. I'm suffering & everything is getting worse.

What kind of physician should I see now? I am limited by medicaid, but my PCP is willing to refer me anywhere I think might help. There is obviously something wrong with me, but what exactly is wrong & what can be done to help me?

It has been suggested I had fibromyalgia & perhaps PCOS. I can't work & even minor housework or grocery shopping, puts me down for a few days. I have tried TENS, hot/cold therapy, exercises, rest, motion, massage with no relief.

HELP PLEASE!!