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What Do My CT Scan Test Results Indicate?

Posted on Fri, 26 Aug 2016

Question: I need an opinion. I had a 4 level cervical fusion 14 months ago which they said was for early signs of myelopathy. I have nothing but neck and arm pain ever since. A surgeon I am seeing now ordered a CT scan which showed moderate to severe stenosis at C7/T1 and a transforaminal pedicle screw at C7. It feels like this hardware is in the wrong place and causing much pain and spasm in neck and right arm. I am not sure what to do or why the screw was placed the way it was. That placement is not right, correct?

Answered by Dr. Dr. Erion Spaho (1 hour later)

Brief Answer:
More information is necessary.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

Regarding to your description of the problem seems that the screw is not at the right place, but it is necessary to upload the CT scan results and/or images in order to have a correct answer to your question.

Also it is necessary to describe your symptoms more in detail regarding to exact distribution of the pain, any sensory changes and location, in order to identify the nerve root involved.

Please provide also the levels included in the fusion.

Awaiting for further information....

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Erion Spaho (1 hour later)

I will see what I can do about uploading but I must somehow remove my name. But my symptoms are an irritation on the lower right side of my neck at the bottom of my fusion, right upper trap muscle spasm and strain, right shoulder pain, right forearm ache and occasional sharp jabbing pain there. The dr wants to do an ACDF for the c7/T1 stenosis and move the screw in question to the T1 pedicle. Transforaminal means it is impinging on the nerve root right? I have an MRI and CT scan to prove it is not in the right place.

Answered by Dr. Dr. Erion Spaho (14 hours later)

Brief Answer:
The nerve root may be damaged.

Detailed Answer:
Welcome back.

Yes, transforaminal means that the screw may impinge the nerve root.

Awaiting for images to be updated.,..

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Erion Spaho (5 hours later)

Not sure how to upload the images. Have you used drop box? I am seeing a surgeon on Thursday so will also ask him about the images. It's strange because an MRI last October mentioned the screw but said it didn't have a "gross" impact on the nerve. My arm pain flares up and dies down during the day and goes away completely at night while in bed.

Answered by Dr. Dr. Erion Spaho (4 hours later)

Brief Answer:
Ok, post the drop box link.

Detailed Answer:
Welcome back.

You can use dropbox too, so please post the link to Dropbox uploaded images.

Greetings.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Erion Spaho (40 hours later)

Hi I haven't yet been able to update dropbox. There are at least 70 images on the CD. Did you happen to have an opinion on whether my symptoms in the neck and right arm are consistent with a transformaninal screw or c7/T1 stenosis? My surgeon suggested an ACDF but only if I can stand the pain any longer. I'm hesitant to have further surgery with its risks after what I've been through already. Maybe though the new surgery would go well and solve the pain issues.

Answered by Dr. Dr. Erion Spaho (18 hours later)

Brief Answer:
Clinical correlation needed.

Detailed Answer:
Hello again.

If the symptoms you describe are distributed along the C8 nerve root territory at the arm and if it is the same side of the transforaminal screw with the affected arm, then yes, the screw is causing these symptoms.

This needs to be confirmed by your Doctor after examining you physically.

If the pain is unbearable, ACDF may be necessary.

Greetings.

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Dr. Erion Spaho (32 hours later)

If a person has had a multi level fusion and starts to have problems somewhere in the middle (stenosis) can a surgeon still get at that area to fix it?

Answered by Dr. Dr. Erion Spaho (19 hours later)

Brief Answer:
It is possible.

Detailed Answer:
Welcome back.

It is possible to treat surgically stenosis after fusion, by revision surgery.

A part or all hardware is removed, stenosis is decompressed and hardware is replaced or substituted.

Hope I helped you.

Take care.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Arnab Banerjee