ACDF 5/6 10 months ago

Hello ndt & welcome to the forum. After reading your story I am just floored at what you are now dealing with. This is not the type of outcome anyone wants after surgery.

1. I would like to ask what brought this massive infection on?
2. While you were feeling good, what activities were you doing?
3. Do you have a copy of the written report of your post op MRI? If not get a copy for yourself. Sure would like to see what it says. I do not understand the drs comments at all.
4. Why has the dr not had an MRI done on your back?
5. Did you have a neurosurgeon or orthopedic do your surgery?

We have had people come through here before with what was termed as a failed surgery, however, with all of the problems you are describing, I have not seen any of them with such symptoms like yours.

Obviously you have a lot going on & you need something done. An EMG is ok, however, I expect more out of an MRI. Sometimes an EMG will pick up a nerve problem but not always especially on a neck or a back problem. They just don't have the accuracy that an MRI does.

Would you be open to a consult with another specialist, along the lines of a board certified neurosurgeon? Some times a fresh set of eyes can see things a little more clearly.

Take care.

Nicole, I totally understand what it is like dealing with insurance under worker's compensation. What a nightmare. The infection most likely could have been picked up in the hospital. I am curious as t what type of infection you got its hold on you.

I do urge you to obtain a copy of as many of your medical records that you can. Do you deal directly with the insurance company or do you have an atty? Either one of these can give you copies of your medical records. If possible get a copy of all of your testing prior to surgery & the op records. Be sure to keep copies of everything for your own file.

I know its so difficult to get 2nd & 3rd opinions with decent drs that is not being paid to say what the insurance company wants them to say. What a mess. Every state has different WC laws & the injured worker is limited especially at seeing drs.

Please come back & post your MRI. I just hate seeing things happen like this to people. Your drs comment just does not ring right about the MRI.

Take care.

Nicole, yes we have heard of that happening. Keep us posted.

I had my IME today and it went well enough. The bottom line is, I don't really care what he has to say, he isn't my doctor and he is paid by the Insurance Co to say that there is nothing wrong with me. Also, his specialty is knee and hip replacement. Should he write a negative report, my attorney will got to the Commissioner of Worker's Comp and challenge his credentials. At that point the Commissioner has the option of sending me for a second opinion with a Spine Specialist, which I wholeheartedly welcome.

As promised here are the finding of my two MRIs:

06/14
Exam reveals straightening of the normal cervical lordosis. There is some signal loss of the discs on T2 sequences, indicative of some mild degenerative type changes.
At C2-3, the disc maintains normal height with no focal herniation, central or foraminal narrowing.
At C3-4, the disc maintains normal height with no focal herniation, central or foraminal narrowing.
At C5-6, a broad-based central disc bulge is present. This results in some effacement of the ventral subarachnoid compartment, without significant mass effect upon the cord. The neural foramen appear patent.
At C6-7, a central disc bulge is present at this level, with no focal herniation. The central and neural foramen appear patent.
The C7-T1 level is unremarkable
The visualized cervical cord is normal in signal, with no intramedullary lesion. The craniocervical junction is normal. The visualized paraspinal soft tissues are unremarkable. No additional lesions are otherwise demonstrated.
IMPRESSION:
Cervical spine MRI reveals some degenerative changes with disc bulges, as described. No focal herniation, significant central or foraminal encroachment demonstrated.

12/16 (5 months post op)
Some signal loss of the discs noted on T2 sequences indicative of degenerative type signal change.
C2-3 No focal herniation. Central canal and neural foramen patent.
C3-4 No focal herniation. Central canal and neural foramen patent.
C4-5 There is some loss of disc height, new when compared to prior study of 06/16/14. No focal herniation is demonstrated. Central canal neural foramen patent.
C5-6 The patient is status post anterior cervical fusion bridging the C5/C6 level. In addition, there is some susceptibility artifact at the C5-6 disc indicative of a disc spacer placement. Axial images through this level demonstrates central canal and neural foramen patent.
C6-7 Punctate focus of increased signal along the posterior annulus indicative of an annular fissure which demonstrates some enhancement on postcontrast sequences. Central canal and neural foramen patent at this level with no focal herniation, central or foraminal stenosis.
C7-T1 No focal herniation. Central canal and neural foramen patent.
The cord is normal in caliber with no intra medullary lesion demonstrated.
Craniocervical junction unremarkable.
No significant marrow lesion noted.
Following gadolinium administration no enhancing lesions demonstrated. The visualized paraspinal soft tissues appear intact.
IMPRESSION: Cervical spine MRI reveals postsurgical changes in the patient is status post anterior discectomy with fusion at C5-6. No significant central or foraminal stenosis demonstrated at this time.

I am taking Soma, it helps but does not eliminate the muscle spasms. My state give our WC Commissioner the option of sending me to yet another doctor, which I would hope would be a spine specialist. I have not been referred to a pain management doctor....yet.
My attorney is not surprised at the length of my recovery and isn't concerned about the IME.
The EMG is tomorrow and the follow up with my surgeon is in June. I will let you know what happens.

If I remember correctly he was not a specialist that deals with spine issues. I do hope the atty you have will ask for another opinion with a spine surgeon. As far as I am concerned his report is nothing but garbage, so therefore, I would ignore any & all of this report. Traction, is he serious, lol. Any time an insurance company requests an IME, its not your employer involved, it is the insurance company calling the shots, its called saving them money. Your employer carries this insurance strictly to protect them from being sued if an employee is injured & nothing more. The insurance companies have a list of drs they use to send for an IME.

Take care.

I remembered the dr was not someone that knew about spine issues. I do not recall us having anyone come through here having the issues that you are this far out from surgery.What does the surgeon say about this? I am sorry that your dr feels Pt would not be of benefit because many here have had great benefit with PT. Has your dr tried you on a short course of a steroid pack? I am wondering if you have some nerves that are just irritated from the surgery. This may be something to discuss with your surgeon for his thoughts.

Please keep us posted.

nb171:
I would keep an open mind regarding physical therapy. A good therapist can make a decidedly beneficial impact on recovery.

To be honest, most likely you will experience some degree of pain with your recovery of function. You will be mobilizing and stretching tendons, ligaments, and joint interfaces that have been relatively immobile and guarded.

Not all pain is indicative of something wrong or amiss in the body. Recognize the differences between " good" pain (pain associated with beneficial tissue elongation and range of motion) and " bad" pain (pain associated with pathology). I think most of us with chronic pain are able to distinguish between the two.

As a PT, I never held to the saying "no pain no gain." Recovery does not demand that you endure detrimental pain or pain that is your body's correct warning that something is amiss. Recovery does demand, however, that one be tolerant of pain associated with regaining of functional movement, strength, and good postural alignment of the cervical spine and shoulder girdle/scalula- which will, by necessity, require mobilization of tissues that may have become weakened and shortened due to disuse.

Cervical traction is far from barbaric. It involves 5 - 10 pounds of long axis distraction. It is enough to release excessive co-contraction of the vertebral muscles that run the length of the spinal column, interlocking segmentally. The whole focus is on relaxing excessively tense muscles, muscles that are bracing as a protective response that is not advantageous.

You will want to put forth some positive engagement with a physical therapist or other to see the gains and recovery that you need and want to have a life with quality of meaning and worth. Working with a physical therapist should be a collaborative effort. A good PT is constantly evaluating and treating based on the feedback that you share with your therapist. At its best, it is a positive and enriching experience that often has benefits beyond the intended area of healing or recovery.

But it is best to get the process started. One thing about sensory nerves is that they have "memory." Sensory nerves can perceive and process pain even when the area of injury has fully healed. Desensitizing sensory nerves is an important aspect of a successful recovery.

Best wishes,
- Karen -

I had my a PT eval on Thursday and I am feeling optimistic. I really like the woman I am working.

I agree Neurontin is not helping and I am no longer feel any benefit from the Soma and my doctor isn't willing to try anything else. Honestly, I feel as if he has become 'bored' by my continuing pain. I asked a ton of questions at my last appointment and all I got was "I don't know, I've done thousands of these surgeries and haven't seen this happen with anyone else." His only definitive response was to start PT and request a 'Functional Capacity Evaluation." Has anyone else had one of these? I have no idea what to expect or even what they are looking for. My doctor didn't even tell me that he was requesting this test, my attorney told me. Does this mean he doesn't think I can return to work? UGH, I just want my life back!!!

You have nothing to fear as Karen posted above, this is to your benefit. I have done them before, no big deal. Great to read you like your therapist.

Hello ndt, I am sorry to read that you are suffering so much. I had to go back to your original post to look at when your neck surgery was done, I couldn't remember. To be honest, the FCE helped you more than hurt your from a legal standpoint with your claim. It did not return you back to full duty with no restrictions.

The term failed spine surgery syndrome is a term used by surgeons after a patient has had either neck or back surgery & the end result was not the optimal outcome that was hoped for, usually the patient ends up with chronic pain such as yourself. A surgeon will only treat for so long, if no further surgery is an option they always release the patient back to the referring dr.

I looked at your MRI report you posted after the surgery, if you will look at the paragraph at the C6-C7 level, you will see they spoke of an annular fissure, this is the tear. Sometimes they can heal on their own. Surgery for a tear is often not warranted.

With this being work related I am sure that another opinion with a neurosurgeon would have to be approved by the insurance company. You mention your atty, what is he doing to help you? He should be working to have you seen for another opinion. He should know drs that are not tied to the insurance company for payment. One obstacle you have is getting a dr that will see you since it is work related. Short of seeing a dr on your own & having to pay out of pocket that can get very costly. I would be pushing the atty to help. Please let us hear from you.

Take care.

When I had the FCE, they asked about my symptoms & such, however, my eval was based on what I was physically capable of doing at the appt. I can't recall what all they had me do, but my eval was based on that.

Is this atty one of those that is what I call jack of all trades & master of none? By that I mean does he handle a little of this & a little of that in his practice? If he doesn't handle workers comp cases only, that is a huge issue. In many states if a person is injured at work & there is worker's compensation insurance coverage, private insurance refuses to pay for treatment. I am shocked he told you that.

Each state has a state commission/office that assists injured worker's. They are not connected with the insurance in any way. They usually have a website that gives a lot of information. You need to go through your paperwork as you have probably had some correspondence from them. I would look for information about what an injured employee's rights are on obtaining 2nd opinions & that sort of thing. Each state is different.

Keep me posted.