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3 Mos Post ACDF5-6,6-7...debilitating hand pain, questionable MRI

Skeeter73SSkeeter73 Posts: 17
edited 06/20/2012 - 8:52 PM in Neck Pain: Cervical
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.



  • that you wake up with no pain, but as the day goes on the pain gets bad. I wonder if wearing a neck brace sporadically throughout the day might help. It will give your neck muscles a rest. Tense muscles might be contributing. Just a thought.
    - Vin

    3 level ACDF, c3/4, c5/6/7 in May 2012
  • Skeeter73SSkeeter73 Posts: 17
    edited 06/21/2012 - 9:57 AM
    I have tried this to some extent. A few evenings I've tried the soft collar, and don't think there was any difference. I am doing
    Chiro, physical therapy, and massage once a week, which has helped immensely with surgical pain, but no noticeable
    difference in hand pain. I have tried avoiding certain activities, (computer, for one...) for no difference. Frustrating!

    I've also tried antiinflammatories for no result.

    Of note, this MRI was at 730 am. I realized that might be unwise if my issue is swelling later in the day, after it was too late to cancel the appt. I did get up at 0330 to try to let some of the issues be visualized on Mri.

    Please forgive any typos or crazy words... This is from my phone.
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  • Skeeter73SSkeeter73 Posts: 17
    edited 06/21/2012 - 10:28 AM
    I'm not going to poo-poo good advice. Tonight, my duties at work are entirely on the computer. I'll be wearing my soft collar. It surely can't hurt to try. :-) Thanks again!
  • It's uncomfortable but it might help to wear a hard collar. Maybe you can put the computer screen on something to raise it. Have a comfortable night.
    - Vin

    3 level ACDF, c3/4, c5/6/7 in May 2012
  • No hard collar here. I was actually not instructed on when to wear the soft collar after surgery, except that I was told that reallydidn't need it...

    I know my surgeon is sounding spectacular. He's supposedly one of the best.

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  • I had 3 Level ACDF C4-C7 and was given a soft collar by my MD told to wear for comfort only. Not required and no hard collar either. Some docs like them and some dont. My doc said I put plates and screws into your neck for stability and the collar is optional. It sounds like you are losing faith in your surgeon, if you dont trust him or he is not listening to you, get another opinion. You also have the right to all your MRI films and reports those are your records. You know your body and if the test they did does not show an issue then take a different one. It is unfortunate but we need to be our own advocate in healthcare these days because docs often dismiss us if it isnt on the test. Keep pushing, you need to make them get to the bottom of this. I wish luck and will keep you in my thoughts. Kim
    Kimberly Martin
  • I am trying not to lose faith in my surgeon before I've spoken with him personally. I know the collar thing varies greatly between docs, and really, going without the collar as much as possible does make a lot of sense... the area is stable, and too much collar weakens muscles that need all the help they can get. I also understand that the BIG reason for fusion is not to cure the symptoms, but to stop further cord damage. I know that even after my magic six months are up, I very well might have residual pain after a successful fusion.

    My big issue is that the MRI report (which I have in hand) does indicate problems. (My chiro reads it as bad news also.) However, when the neurosurgeon's Physician's Assistant called, he said the surgeon said my MRI looks "fine". The MRI was ordered because I told the PA at a post-op appt that while I feel that the fusion is stable, something is "very wrong"... that even though I had babies without meds, I sometimes cry myself to sleep because of the pain in my hands. I made it abundantly clear that I am in significant pain. So, while I have clinically significant symptoms, and an arguably not "fine" MRI, the surgeon doesn't seem interested. We'll talk in July, and hopefully come to some sort of agreement.

    It's somewhat discouraging to read of so many of us here in the same boat. This is my first real experience with bad health, much less severe chronic pain. I wouldn't wish it on my enemy.

    I appreciate your words and encouragement. :)
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