Cervical fusion, adjacent segment disease, herniated disc and spondylolisthesis.
In this 2 part video Dr. Castanet explains and shows you a cervical MRI scan of a patient who had a previous cervical fusion of C5-6-7, about 10 years ago. He has done fine until recently, when he slept in a bad position and irritated his neck. Now he is complaining of left scapular pain, left tricep pain and tingling of his left 4th and 5th fingers(little and ring). He wanted a new MRI scan so he could see if anything has changed. His new MRI scan shows some “adjacent segment disease”, i.e. problems arising from the joints that are still moving after the fusion of two joints. His adjacent segment problems consist of two herniated discs at C3-4-5, and a mild spondylolisthesis at C7-T1.
The good news is that these problems will probably get better with some conservative treatment, specifically some spinal decompression to alleviate the pain and inflammation arising from these newer lesions.
It is common for patients, especially those who have had previous surgery, to become anxious when they have an exacerbation of pain, imagining that the worst may be possible, and surgery may be necessary again. Most of the time, their concerns can be allayed with an explanation of their status and reassurance that they will likely improve again to their pre-exacerbation status.
A larger point to be made here is that when you have a neck or back problem, it is usually the result of a small change in your anatomy, not a massive change. And, hence, only a small change for the better is required to get you improved to normal again.
Back to this particular patient and his MRI scan. He has, undoubtedly, had these two disc herniations and this spondylolisthesis for several years. Yes, they tend to be slowly progressive problems, but it’s quite possible they will not progress to the point of necessitating another surgery, and can be treated intermittently, as needed, with conservative treatment, effectively enough, for the rest of his life. It is important for doctors to not only explain your problem, but to frame it in a realistic way so that you’re not unduly anxious about the long term consequences of your problem.
If I can help you with your neck or back pain, please call 404-558-4015.