Question
I am a 54 year old male who had to undergo instrumentation at 3 levels in my cervical spine.  I believe the levels were at C5,C6, and C7.  The surgery was done in June of last year.  So it has been almost a year and a half. In the last month or so I have developed pain in my neck again and it seems to be growing more intense as time goes on.  The surgery I had, involved using bone from the bone bank, and titanium plates to fuse the three levels together.  Now the pain has returned and it hurts when I move my neck from side to side, or even front to back.  It also feels like when I move my head to one side, that my neck is going to lock up on me, and I won't be able to move it back again.  What could be causing this.  Is this something that is going wrong as a result of the surgery I had?  Do you think they may have to go back in and take a look to see why it feels like it is going to lock up?  It really is very uncomfortable and it does feel like when I move my head to the side that it is going to lock in that position.  It also hurts real bad when I get the feeling that it is going to lock up on me.  Can you offer any light as to what may be happening here.  I would appreciate your comments about it.  Do you think I need to go back to the surgeon who did the operation and tell him what is going on?  Please advise what you think may be going on.

Answer
/
Dear Mr. Clontz,

I assume you underwent an anterior discectomy and fusion Of C5-6-7 with the implanted bone placed between the vertebral bodies. This is called a two level (not three) ACDF. Another alternative would be that the body of the C6 vertebra was removed, and the implanted bone serves as a bridge between C5 and C7. This is called a Corpectomy.
In both cases, in the months following the surgery, the implanted bone has to fuse with the vertebral bodies above and below it. This process takes time and if it does not happen, we call it a non-union and it can be quite painful sometimes.
Other reasons for pain might be infection, degeneration of the level adjacent to the fused level, soft tissue problems and more.
I suggest you return to your surgeon and tell him/her what you feel. If the pain is severe and does not resolve with simple measures such as mild pain killers and Physiotherapy, an evaluation is in order. The evaluation would include spiral CT reconstructions in flexion and extension to assess fusion, blood tests for infection, and an MRI.

Sincerely,

Dr. Rahamimov