Neck pain after fusion

In this video, Dr. Castanet will review cervical x-rays and an MRI of a 40 year old woman who had neck fusion done 3 and 1/2 months ago, and she still has left neck, shoulder, scapular and arm pain, tingling and numbness. The x-rays were taken after the surgery to make sure the fusion looks technically fine, and it does.

She is sent to me by her primary physician to see if I can help her. I don’t know yet, but, typically, I don’t treat neck or low back fusions until 6 months after the fusion surgery, and after we know the fusion is complete, and I have the surgeon’s clearance to do so. Unless their is a “non-union” of the fusion, meaning a failure of the fusion, it’s typically fine to do spinal decompression, i.e. traction treatment, 6 months afterwards. The reason is that once the fusion is 6 months out, there is usually a solid fusion that will not be affected negatively by spinal decompression treatment, and the likely source of any other pain is at a different, adjacent level. As you’ll see in this MRI review she also had a herniated disc at C5-6, and this could be the present source of her pain. She has not yet had a new MRI scan since the surgery.

Neck pain after fusion

Often times the value I can provide for patients is to better explain what their problem was, what it is now, and what are the many options to do now and going forward, depending upon how they progress from here. She will be seeing the surgeon again in one week. I told her that she should ask him several questions, and then I can talk with her again. She needs to aks him if she should try an oral steroid dose pack, antoher steroid injection, and when it will be safe to try spinal decompression, i.e. traction treatment.

During her examination I got the impression that her pain was more severe than it should be, therefore I put my usual question to her in this circumstance, which is, “have you been applying heat to your neck”. Her answer was, “yes”. So I told her to stop that entirely. She was only using it about every other day, but heat is seldom indicated for any pain, and almost always contraindicated for pain, as I explained to her.

If I can help you with your neck or back problem, please call me at 404-558-4015.