[Rehabilitation / Postoperative Spine Surgery Questions] Neck still stiff 6 months after cervical fusion at C6-7

[herniated C6-7]

Initially, I was elated after my 12/14/10 discectomy and fusion, as my symptoms of upper back pain were entirely gone. But I am having a hard time recovering from the surgery and the six weeks subsequent, in which I wore a soft collar 24/7 and, on surgeon's instructions, avoided all head movement.

I still suffer from symptoms that newly appeared 6 weeks post-surgery when I began moving my head. My neck is very stiff, and I tend to unconsciously tilt or rotate my head and to hold it off center. Tight neck muscles are frequently referring pain to my head.

The physical therapists I have consulted have different theories as to what is going on, and do not claim to fully understand it, which causes me no little concern. My surgeon does not offer a theory himself. I now have over 5 months of physical therapy behind me, and have done a lot of strengthening and stretching, but there does not seem to be any easy fix.

I am spending 2 months this summer with family in the Boston-Worcester, MA area. I am thinking that perhaps I should see a specialist in physical medicine, or an osteopath, with a reputation for being able to figure out difficult cases. Does anyone out there have a recommendation as to such a doctor in the greater Boston area? Or in California where I live? Or other advice on how to proceed?

There has been some improvement. My sternocleidomastoid muscle is much less tight than it was a few months ago. And my right shoulder, though still a good deal lower than my left, now hangs a bit more normally. But the trapezius and other muscles still feel extremely tight.

Some physical therapists think the trapezius is weak and shortened. One or two think it may be elongated as a result of the depressed right shoulder pulling on the neck.

The latest theory is that perhaps my deep neck flexors atrophied after the surgery and are not playing the role they should in stabilizing the spine, leaving too much for the trapezius and other muscles to do. On this theory, the central nervous system has gotten used to having the trapezius and other mobilizing muscles inappropriately play the stabilizing role that properly belongs to the deep neck flexors.

Another possibility is that my nervous system is still healing, and that the muscles will recover if and when the nerves recover.

It is hard for me to sort out the different theories of the physical therapists, as there seems little hard science or evidence. We don't really know if my trapezius is elongated or shortened, or if my deep neck flexors are atrophied or ok. Checking out a theory seems to involve weeks or months of physical therapy with uncertain results.

Has anyone had parallel experience or useful advice on how to approach and manage my choices with regard to physical therapy? Anyone had success with a particular MD in idenitifying an appropriate course for cervical rehabilitation post-fusion?

[Katie]

I'm sorry for your complications and lack of answers. I hope I can offer some encouragement to you, as while I didn't have fusion in my cervical, I did in my lumbar, and I remember a length of time when I was very tight and worried about things. I wore a brace for quite awhile and know I lost what little core strength I had. It is a slow uphill climb, but my life is getting back to normal. I am very thankful to have a wonderful chiropractor who works on exercises and releases when things get knotted up and throw me out of whack. But you have to find that special one.

I used to live in another province and saw an Osteopath who I jokingly called my 'witchdoctor'. Before my back got horrid, but bad enough that I couldn't walk at times, she could magically do some easy adjustments and have me dancing out of her office. Yet when I moved here and saw her classmate, there was no connection, no real help. So yes, I highly recommend them, but the right ones...easier said than done. I've gone through a ton of other chiropractors and PTs with not much success in the past. It is tough to keep looking when things don't seem to be improving, but keep the faith.

Your neck brace may have messed with your supporting muscles, tissues, etc., as you think. I had an ADR in my C5/6 after severe compression and neurological problems, but have very little memory of issues with healing...probably because my lumbar level incisions were giving me more grief at the same time You are on the right track, and in another six months, where I am now, this will hopefully be just a memory. Not sure that I am helping much, but I remember that stage in my healing seeming to go on forever...somewhat better, but not enough for my liking.