Pain In Between Shoulder Blades Following Anterior Cervical Discectomy Fushion Surgery
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Risks Of Cervical Disc Surgeries
Although cervical disc surgery is generally safe, it does have a few risks, including:
- Damage to the nerves, blood vessels, spinal cord, esophagus, or vocal cords
- Failure to heal
After cervical fusion surgery, some people can develop cervical disc problems above and/or below the previously affected disc. One study found that about 12% of the patients developed new cervical disease that required a second surgery over a 20 year period after the first surgery. It is not yet known if the artificial disc will cause this same problem.
Shoulder And Neck Referred Pain
Because of the close connection of the nerves serving them, shoulder and neck pain are often mistaken for one another.
You may feel a pain in the shoulder thats actually coming from your neck, and vice versa. This is called referred pain.
Some of the symptoms of referred pain from your neck include:
- stabbing, burning, or electric-like tingling pain
- pain that radiates to your shoulder blade, elbow, and hand
- pain that radiates down your arm when you twist your neck
- pain thats relieved when you support your neck
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An Overview Of The Spinal Column
To understand how a neck fusion works, its important to understand the basic structure of the spinal column. In the neck, each spinal segment is made up of a vertebra , a disc, and another vertebra. This same pattern is followed all the way down the column, from the neck through lower back . Each vertebra meets the next along the back of the spinal column at the facet joints. Every joint in our neck and throughout our spine is built to move.
The purpose of a neck fusion, or any level fusion, is to stop movement. The cervical spine is made up of seven vertebrae. A surgeon fuses neck vertebrae together by first removing the disc between them and then either inserting bone or a spacer. Hardware is then commonly used to bolt the affected segments together and all of this encourages the bolted vertebrae to grow into a solid mass. With only seven vertebrae in the neck to begin with, you can understand how drastically fusing two or more neck vertebrae together would affect neck movement.
The problem, unfortunately, extends beyond just the immovable fused levels as the forces are now stressed on the segments above or below the neck fusion. This creates too much movement in the adjacent segments and pain after neck fusion, and there is a name for this: adjacent segment disease .
Patients Undergoing Acdf Commonly Receive High
In September 2019, researchers at The Johns Hopkins University and University of Virginia suggested in their research published in the Spine Journal that Patients undergoing ACDF commonly receive high-dose opioid prescriptions after surgery, and certain patient factors increase the risk for chronic opioid use following ACDF. Interventions focusing on patients with these factors is essential to reduce long-term use of prescription opioids and postoperative care.One of these factors was that some of these patients were already taking high dose opioid doses prior to surgery and continued to do so after surgery.
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What Happens During Neck Fusion
Neck pain is a common occurrence. The neck, also referred to as the cervical spine, contains seven vertebrae. Each of these vertebrae has discs between them that absorb shock and stabilize the spine. Outside of the spine are many muscles, ligaments, tendons, and cartilage that provides a range of motion and support.
The many intricate networks surrounding the spine mean that there is a long list of things that can go wrong. Some injuries that may result in neck fusion include:
- Herniated Disc
- Sudden Traumatic Injury
- Degenerative Disc Disease
There are many solutions for neck pain, so it can be difficult to decide which treatment option is right for each patient. Many cases of neck pain go away on their own, having been caused by a small injury that is capable of healing by itself. When pain persists and begins to interfere with an individuals ability to complete normal tasks, doctors look for the underlying cause of discomfort. Neck pain can be assessed using a physical evaluation, but most doctors will order a series of imaging technology such as MRI or X-Rays to determine the source.
Neck fusion surgery, also called Anterior Cervical Fusion and Discectomy , is the process of fusing two vertebrae together in an attempt to stabilize the spine or remove a disc. This procedure has many different methods, including discectomy, bone grafts, metal cages, and much more. It is up to the surgeon and doctor to determine what will be best for each patients condition.
The Operative Treatment Of Shoulder Pain In Patients With A Concurrent Diagnosis Of Cervical Spondylosis And Shoulder Dysfunction
Ajith Malige, Paul N. Morton, Gregory F. Carolan, Gbolabo Sokunbi
St. Lukes University Health Network , , USA
Contributions: Conception and design: All authors Administrative support: All authors Provision of study materials or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.
Background: Etiology of neck and shoulder pain may be multifactorial. When surgical intervention is indicated, the choice of whether to start with spine or shoulder surgery is an important clinical decision to make based on severity of pathologies, comorbidities, and patient preference. The literature includes with very few studies exploring the incidence or results of the surgical treatment paths followed in this clinical situation. This study compares patient-reported outcomes of patients with both cervical spine and shoulder pathology who underwent intervention for cervical, shoulder, or both pathologies.
Methods: The authors retrospectively reviewed 154 charts at a single institution between 20092017 who had both cervical spine and shoulder pathology while undergoing operative intervention of one or both pathologies. For each patient, demographics, patient-perceived success, NRS pain scores, functional outcomes , and post-operative opioid use were reported.
Keywords: Cervical spine shoulder pain functional
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What Can Cause Sharp Pain In Your Neck And Shoulder When Breathing
A couple of conditions can cause pain in the neck and/or shoulder when you take a deep breath, including:
- Pleurisy : Symptoms include sudden chest pain that may be felt only while coughing or breathing deeply, fever, cough, and shortness of breath.
- Pericarditis : Symptoms include rapid-onset stabbing chest pain, possibly pain in the shoulder, fever, weakness, and trouble breathing. It gets worse if you lie down or breathe deeply.
Pleurisy and pericarditis aren’t usually medical emergencies but you should treat any chest pain or breathing difficulty as an emergency until you know for sure what’s causing it.
Risks Of A Cervical Spine Fusion
The first problem with this operation is that in the neck, it is less likely that the disc is the cause of the patients pain.
You may have a disc removed that looked abnormal on an MRI scan. But if it isnt actually the cause of the patients pain, then they will wake up from the operation with the original pain plus the pain from the fusion.
The big issue is that its very hard to diagnose whether a disc is causing pain. Invariably you will get wear and tear in the discs. Seeing wear and tear, or even an abnormal disc does not always mean it is the problem.
In short, a disc not looking normal does not equal causing pain.
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Bone Spur Development After Cervical Fusion
We are going to review a recent case:
- The patient is a woman in her late 60s.
- She came in with right-sided neck and shoulder pain and she had a lot of crepitus, a clicking sensation every time she would turn a certain way.
- She had stiffness, neck pain, and really muscle spasms or muscle tightness.
At 0:34 of the video, the patients digital motion x-ray shows problems surrounding her cervical fusion.
- We can see that the lower bones in her neck are not moving very well
- Theres also a very big reduction in space between these cervical bones so theyve essentially fused together through the degenerative process
- She still has a lot of motion in her upper neck but theres instability here between C2 and C3 and between c3 and C4 and thats very common when you have a segment that is fused because your neck motion has to come from another part of the neck that typically becomes overworked and stressed.
Ross Hauser, MD at 1:05 talks about cervical fusion
- The problem with fusion is the unnatural distribution of force above and below the fusion. This unnatural force can lead to bone spurs and a natural, fusion of the segments above and below the cervical fusion. The bone spurs form to help stabilize the cervical neck instability caused in the adjacent segments of the cervical spine.
- Bone spurs form because of cervical ligament laxity. When the cervical ligaments are weak, stressed, and overused, they cannot hold the vertebrae in their natural position.
At 2:29 of video
What Is A Neck Fusion
A neck fusion is a surgical procedure where one or more of the cervical bones are fused together using hardware. The hardware may be placed either in the front or the back of the neck . The disc between the bones is often times removed and replaced with bone or a spacer. Neck fusion rates are increasing and from 1997 to 2012 increased 114% in New York State .
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Within 10 Years 1 In 4 Patients Can Be At Risk Of Clinical Adjacent Segment Disease
These are some of the things we hear from patients and people who email us with questions who have to contemplate another procedure.
- My surgeon has recommended that I get another ACDF. This time the fusion will be below the first fusion I had at C5-C6. The new fusion will be at C7-C8. I am concerned that this will greatly limit my ability to move. I did not realize how much my neck movement would be after the first fusion.
- I had two ACDF fusions. My first surgery was more than 15 years ago at C6-C7. I just had C5-C6 fused. During the second surgery, they discovered a lot of scar tissue from the first. I am having a lot of pain in my neck, shoulders, and back. I am on painkillers now.
- I had a very successful C4-C5 fusion. My problem now is C3. I have degenerative disc disease with rupture. Now they want to expand my fusion to C3-C5.
Doctors at the University of Alberta noted in the Canadian Journal of Neurological Sciences: Cervical spine clinical adjacent segment pathology has a reported 3% annual incidence and 26% ten-year prevalence. Its pathophysiology remains controversial, whether due to mechanical stress of a fusion segment on adjacent levels or due to patient propensity to develop progressive degenerative change.
Simply, within 10 years, 1 in 4 patients are at risk of clinical adjacent segment disease because of unnatural stress and destructive forces being placed on the cervical spine.
Nerve Pain In The Neck
A primary reason to do surgery on the neck is not neck pain, but nerve pain arising from the neck
If you have pain shooting down into your arm or hand, this can be caused by an obvious compression, irritation, and inflammation of a nerve root exiting the spine in the neck.
This type of pain can get better on its own. However, if its not getting better, then this is a good reason to have surgery on your neck.
This surgery has a much greater chance of success because you can be much more confident about the cause of pain. If you look at nerves, and one is much more compressed than the others, it is more likely to be the cause of pain than a worn or slightly bulging disc.
You can also work out anatomically which nerve is irritated. This is because if you squeeze a certain nerve, it will cause pain in a specific area of your body.
Therefore you can work backward from effect to cause. For instance, a different nerve supplies the middle finger of your hand than the one that supplies your thumb.
With this type of analysis, you can be much more confident that you have the correct cause of the persons pain. When youre dealing with structures in the neck like the disc, the process is much less specific, the spine level is harder to define and the actual structure is much harder to determine. It often comes down to best guess and this is not ideal for a destructive and irreversible operation.
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Chronic Neck Pain After Cervical Fusion
It is not uncommon to have pain in the neck following fusion surgery which slowly gets better over 12 to 18 months. If you have pain early on, that can actually just be part of the operation. Its a slow healing process, but in the end, the operation may end up being successful.
But you cant know this for sure until almost a year has passed.
If the fusion doesnt take, then what you have is a group of crumbly bones sitting in a hard metal cage. This cage can then push into the vertebrae above and below the fusion.
The metal cage is not structurally strong enough to provide support for your spine. This comes from the bone growth. If the bone doesnt grow, this can cause pseudo arthrosis, a fairly common cause of chronic neck pain following a cervical neck fusion.
The third risk is that something goes wrong in the surgery. You may have some structural damage or you may introduce infection.
With a fusion, youre putting a foreign body into an important structure of the body. If the area becomes infected, it can be very hard to settle.
How Long Does Pain Last After Spinal Fusion
When people are recovering, how long do they usually take?
This really depends on whether the pain was truly coming from your disc and not some other structure. Assuming the correct disc was taken out, below are the different possibilities.
Some people wake up and find their pain is worse because theyve had a destructive operation on a disc and had bone taken from their pelvis. Theres a lot of healing that needs to take place before they can be sure of how much pain relief theyve gained from the operation.
Occasionally somebody wakes up feeling a lot better. Thats great, but its incredibly rare.
Usually, by two to three months, the pain is starting to improve and the bone graft is starting to take.
On scans, you can see bone appear and grow in the fused segment over the next 12 to 18 months. As this carries on, you may still improve, but as the months go by, the proportion of people that are actually going to get better gets smaller and smaller.
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Inclusion And Exclusion Criteria
The study reviewed patients who underwent cervical spine surgery in a tertiary referral university hospital from April 1995 to May 2012. A total of 862 patients were collected from a medical data bank. Ninetysix patients were referred to a shoulder surgeon for persistent shoulder pain over 3months after cervical spine surgery. Inclusion criteria was made according to the PICO principle as follows: Patients: skeletally mature with documented neurophysiological study prior to cervical spine surgery Intervention: persistent shoulder pain despite conservative measures following cervical spine surgery Comparison: patient with matching age, sex, and operating spine surgeon without persistent shoulder pain following cervical spine surgery and Outcome: level of cervical surgery and approach of cervical surgery. Exclusion criteria were as follows: skeletally immature history of trauma and surgery to the affected shoulder and lack of radiographic data.
Severe Pain After Cervical Fusion C5/c6
Immediately after surgery and up to today Feb 21st, I am experiencing severe neck pain on both sides pain level without meds a 9 – Right shoulder right arm pain about a 6 when arm is extended and when reaching across my body – Upper back pain gets really bad about an 8 at times.
My first post op was Feb 18th and the doctor seemed to have an answer for everything saying that everything was normal and I’m where I should be in the recovery process then at the end of are meeting he tells me I’m behind in progress. FYI, I didn’t wear a neck collar for recovery. My doctor prescribed PT which really aggrivates the conditions. My doctor believes its all muscle spasms. I know nobody can answer with certainy, but has anyone experienced or known anyone that has had similar conditions after surgery and was it muscle related spasms or me having the large herniation for over a year before surgery is it possible that I have nerve damage? Everything that I’m experiencing is pain , no numbness that I can tell nor really any weakeness. I have to hold my head down just enough otherwise I really start causing a lot of pain if the head is looking straigh ahead or down too much. Any thoughts on what TYPICALLY causes the conditions I’m having.
Thanks for reading.
I am NOT a doctor, I DO NOT have a degree in medicine. I am a post surgical cervical fusion patient and have been seeing my surgeon or his P.A on a monthly basis since 2006.
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