Here’s an interesting case of persistent pain after a cervical fusion

I recently had the opportunity to evaluate and operate on a really interesting case.  This is a man in his late 40’s who had an anterior cervical discectomy and fusion 2 and 1/2 years ago.  Prior to his operation, he had really severe right sided C7 pain.  After his operation, even though it was done by an experienced surgeon and appeared to be done well, his pain persisted.  Prior to coming to see me, he picked out this image on his pain diagram.

In my office, it was clear that he was really suffering from a C7 radiculopathy.  He had pain all the way down his right arm to the back of his hand.  He couldn’t sleep at night, and he was basically stuck on pain pills.  I really carefully reviewed his CT scan that was obtained after his fusion, and here is what I saw….

The surgical decision making process

We had a really long discussion.  We talked over all of the options that he had for treating his pain, and ultimately we decided to go ahead with a cervical microforaminotomy.  This is an operation that I really like.  I’ve done many of them in the past 5 years and I feel like it is an operation that is not used as often as it should be.  I have a blog post on my philosophy of why cervical microforaminotomies work really well.

cervical microforaminotomy versus anterior cervical discectomy and fusion

In this case, it was the perfect operation for him.  He woke up without the same nerve pain he had been living with for years.

What is spinal stenosis?

Spinal stenosis is a medical condition where the space available for the spinal cord and nerve root is narrowed.  This narrowing is caused by disc herniations, disc bulges, and arthritis of the spine.  Enlargement of the facet joints, caused by wear and tear, is a common cause of stenosis.  If you think back to your grandmother’s hands, you’ll remember that her knuckles are large and bony.  This process is caused by bone spurs that grow around the edge of a joint that is starting to wear out.

The same process occurs in the lumbar spine.  The facet joints on either side of the spine become enlarged with time and they trap the nerve roots in an area called the lateral recess.  A bulging disc pushing on the nerve from the other side usually makes the pain intolerable.

How does spinal stenosis develop?

Spinal stenosis develops very slowly over time.  The most common cause of stenosis is BIRTHDAYS!   The more birthdays you have, the more like you are to develop arthritis of the spine and stenosis.  Since everyone who lives long enough will develop some degree of stenosis, the question is, when do you know if spinal stenosis is causing your buttock and leg pain.

What does spinal stenosis look like on an MRI scan?

Here is a short video where I describe the findings of stenosis of the spine at two levels.

The 4 questions that will tell us if you have spinal stenosis

A recent study was published in the medical literature which asked medical experts from all over the globe how they knew if someone had spinal stenosis.  It comes down to four simple questions.  The answer to these four  questions can tell us if you are likely to have symptomatic stenosis.

1.  Do you have leg or BUTTOCK PAIN while walking?
2.  Do you FLEX FORWARD to relieve symptoms?
3.  Do you FEEL BETTER if you can LEAN on a shopping care while walking?
4.  Do your legs feel WEAK or NUMB while you are walking?

The scientific consensus on the symptoms of spinal stenosis

The reference for this paper is as follows:

1. Spine (Phila Pa 1976). 2016 Aug 1;41(15):1239-46.  ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.

Minimally Invasive Surgery for Spinal Stenosis

I specialize in microscopic decompression surgery of the spine.  If you’ve already had an MRI scan and are interested in discussing your options, I will review your MRI scan for and tell you whether or not I think a microscopic decompression can improve your symptoms.

To learn more about your options for, click here:

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