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Suggest Treatment For Cervical Inter Vertebral Disc Without Myelopathy
Question: I had cervical spine surgery on my C-4 thru C-7 10/07/15. My diagnosis was displacement of cervical intervertebral disc without myelopathy. I had a Anterior Cervical Diskectomy and Fusion. When I returned for my follow-up appt. 6 weeks later the bones in my cervical spine had bent the screws and other hardware. The doctor said that my bones were soft and had crumbled. I was put back into the hospital on 17 Nov 2015. On 19 Nov 2015 surgery was performed again. Repeat surgery was done through the front of my neck to replace the hardware that had been damaged. Then I was turned over and another doctor came and made approximately a 8" cut from the base of my neck down my back. A titanium cage was placed around my cervical spine. Now the left side of my head is numb with shooting pains and so tender I can't my hair. I didn't have this problem until my second surgery. I have a 50% blockage in my head. My doctor put me on 75 MG Plavix and now I have bruises all over my body. I don't know what to do.
Brief Answer:
Treatment with neuropathic pain medication.
Detailed Answer:
I read your question carefully and I am sorry about the many complications there have been after your surgeries.
The symptoms you have seems to be related to suffering of your upper cervical nerve roots, considering the shooting pain probably occipital neuralgia. It is not typical for C4-C7 involvement but usually degenerative spinal changes you suffer from involve all cervical levels and so the repeated surgery, its complications and lack of spinal mobility are likely to increase strain on upper levels as well and exacerbate their symptoms.
Usually it is tried treatment with medication for neuropathic pain, like anticonvulsants Pregabalin or Gabapentin or antidepressants like Duloxetine, Nortriptyline. If drug treatment doesn't work, another MRI should be scheduled to evaluate the compression and treatment with local nerve blocks through injection can be considered if necessary.
I am not sure about Plavix and the reason your doctor gave it to you, it is usually given to prevent vascular disease like heart attack or stroke, I don't know whether he gave it just as a precaution or because there is a reason to believe you are a high risk person. Since you seem to be having bruising due to it, the extent of these bruises, the presence of hemorrhage from other sites be checked out (stool, urine), a complete blood count and coagulation tests be taken and afterwards its use must be reconsidered whether necessary with your doctor. If you have extensive bruising in the absence of trauma you should stop it right away.
I remain at your disposal for further questions.
Treatment with neuropathic pain medication.
Detailed Answer:
I read your question carefully and I am sorry about the many complications there have been after your surgeries.
The symptoms you have seems to be related to suffering of your upper cervical nerve roots, considering the shooting pain probably occipital neuralgia. It is not typical for C4-C7 involvement but usually degenerative spinal changes you suffer from involve all cervical levels and so the repeated surgery, its complications and lack of spinal mobility are likely to increase strain on upper levels as well and exacerbate their symptoms.
Usually it is tried treatment with medication for neuropathic pain, like anticonvulsants Pregabalin or Gabapentin or antidepressants like Duloxetine, Nortriptyline. If drug treatment doesn't work, another MRI should be scheduled to evaluate the compression and treatment with local nerve blocks through injection can be considered if necessary.
I am not sure about Plavix and the reason your doctor gave it to you, it is usually given to prevent vascular disease like heart attack or stroke, I don't know whether he gave it just as a precaution or because there is a reason to believe you are a high risk person. Since you seem to be having bruising due to it, the extent of these bruises, the presence of hemorrhage from other sites be checked out (stool, urine), a complete blood count and coagulation tests be taken and afterwards its use must be reconsidered whether necessary with your doctor. If you have extensive bruising in the absence of trauma you should stop it right away.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had a MR-Brain w/o contrast on 2/3/15 and the impression was: Mild cortical atrophy and chronic small vessel ischemic changes. On the same date I had a US-Carotids-Duplex-Complete and the impression was: Minimal intimate thickening and atherosclerosis plaque burden without demonstration of hemodynamically significant stenosis. On 2/24/15 I had a MR-MRA Head without contrast and the impressions was: A focal area of at least 50% stenosis is noted in the most medial aspect of the A1 segment of the right middle cerebral artery near it's junction with the common trunk of the anterior cerebral arteries; Diffuse congenital hypoplasia of the A1 segment of the right middle cerebral artery is also demonsrated. What does all of this mean?
I didn't have a problem with the left side of my head until I had the back surgery on 19 Oct 2014.
I apologize but my back surgery was done 19 Nov 2014.
I didn't have a problem with the left side of my head until I had the back surgery on 19 Oct 2014.
I apologize but my back surgery was done 19 Nov 2014.
Brief Answer:
Read below.
Detailed Answer:
Thank you for bringing some more info.
I had realized that the problems started after the surgery. My opinion regarding the cause and the management with the medication for neuropathic pain I mentioned above. As I said the fact that you didn't have issues prior to surgery doesn't mean they were in perfect condition, degenerative spinal changes are diffuse and the limited mobility after surgery in lower levels adds to the strain and chance for symptoms corresponding to upper cervical levels.
The MRA report issue. It would have been useful to know why did you do an Angio MRI, it is not a routine exam, it is a highly specialized tests done usually when a stroke or transient ischemic attack happens to investigate issues with blood vessels. If that is the case can you describe your symptoms history?. Do you suffer any other conditions like high blood pressure, diabetes, high cholesterol, heart arrhythmias etc? Do you smoke?
You must have made a mistake in writing the report because the A1 is not in the middle cerebral artery, it denotes the first segment of the anterior cerebral artery. So it's either A1 segment of the right anterior cerebral artery or M1 segment of the right middle cerebral artery. (The A stands for anterior and M for middle).
Anyway, without risking to confuse you more with abbreviations, whichever of those two arteries is the case, it means that an important blood vessel in the right side of you brain is narrowed to approximately half of its diameter. That means you are at risk for having a stroke. To lower the chances of that, you need in first place to address those conditions I mentioned earlier (high blood pressure, diabetes, high cholesterol, smoking) and also be treated with a blood thinner like Plavix. If Plavix causes only minor bruises due to trauma I suggest it is continued for the moment but to have those tests I mentioned earlier for hemorrhage from other sites and blood tests. If Plavix causes major bleeding it must be interrupted. Apart from blood thinner it is recommended treatment with a statin like atorvastatin, even in the absence of high cholesterol, because that too fights atherosclerotic narrowing process. If you have repeated strokes or transient ischemic attacks endovascular intervention with angioplasty and stenting (small expendable tubed placed in the narrowed vessel through a catheter) can be used to preserve flow in the narrowed vessel.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for bringing some more info.
I had realized that the problems started after the surgery. My opinion regarding the cause and the management with the medication for neuropathic pain I mentioned above. As I said the fact that you didn't have issues prior to surgery doesn't mean they were in perfect condition, degenerative spinal changes are diffuse and the limited mobility after surgery in lower levels adds to the strain and chance for symptoms corresponding to upper cervical levels.
The MRA report issue. It would have been useful to know why did you do an Angio MRI, it is not a routine exam, it is a highly specialized tests done usually when a stroke or transient ischemic attack happens to investigate issues with blood vessels. If that is the case can you describe your symptoms history?. Do you suffer any other conditions like high blood pressure, diabetes, high cholesterol, heart arrhythmias etc? Do you smoke?
You must have made a mistake in writing the report because the A1 is not in the middle cerebral artery, it denotes the first segment of the anterior cerebral artery. So it's either A1 segment of the right anterior cerebral artery or M1 segment of the right middle cerebral artery. (The A stands for anterior and M for middle).
Anyway, without risking to confuse you more with abbreviations, whichever of those two arteries is the case, it means that an important blood vessel in the right side of you brain is narrowed to approximately half of its diameter. That means you are at risk for having a stroke. To lower the chances of that, you need in first place to address those conditions I mentioned earlier (high blood pressure, diabetes, high cholesterol, smoking) and also be treated with a blood thinner like Plavix. If Plavix causes only minor bruises due to trauma I suggest it is continued for the moment but to have those tests I mentioned earlier for hemorrhage from other sites and blood tests. If Plavix causes major bleeding it must be interrupted. Apart from blood thinner it is recommended treatment with a statin like atorvastatin, even in the absence of high cholesterol, because that too fights atherosclerotic narrowing process. If you have repeated strokes or transient ischemic attacks endovascular intervention with angioplasty and stenting (small expendable tubed placed in the narrowed vessel through a catheter) can be used to preserve flow in the narrowed vessel.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You have helped me more than any of the doctors I have seen. I am having a terrible headache right now, but I did recheck the report and it did read word for word what I sent you. If I may, I would like to scan my labs and radiologist reports tomorrow and send them to you. I would send them now, but my headache is so bad I am going to take my medicine and lay down. Thank you so much for helping me understand why I am suffering so bad.
Brief Answer:
Of course
Detailed Answer:
I will look at your reports whenever you can upload them.
Looking forward to hearing from you.
Of course
Detailed Answer:
I will look at your reports whenever you can upload them.
Looking forward to hearing from you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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