Neck pain doctor for St. Charles. Fused, still hurting, still options.

NECK PAIN · ST. CHARLES

If you have already had neck surgery and the pain is still there, you are not out of options and you are not an unusual case.

Getting here from St. Charles

Across the Blanchette Bridge on I-70 and then a short run to Natural Bridge Road. For most of St. Charles it is a straightforward drive that avoids the inner belt entirely, and there is parking at the door rather than a hospital garage.

Why this page is about surgery that did not work

Because it is the single most common reason people cross the river to see us. Persistent pain after cervical fusion is common enough to have its own substantial literature, and being told that the operation was technically successful does not answer why the pain is still there.

There are usually specific, testable reasons. The wrong level was addressed. Adjacent segments are now carrying load they were not designed for and their facet joints have become symptomatic. Hardware has loosened. Or the pain was never coming from the structure that was operated on.

Sleep after cervical surgery

It is severe, it is common, and it is almost never addressed as a problem of its own. People cannot find a position, wake repeatedly, and end up managing on broken sleep for months — which raises pain sensitivity and makes everything else harder to treat.

It is worth arranging deliberately rather than enduring: neck supported in neutral rather than pushed forward, the arm supported rather than hanging, and medication timed for the night where it is needed. We treat this as part of the problem, not as a complaint to be waited out.

Bring the operative note if you can

Which levels, which approach, and whether hardware was used changes the differential substantially. Anterior and posterior procedures produce different long-term problems — a posterior decompression and fusion carries a distinctly different profile for rotation loss and for persistent pain than an anterior procedure does.

If the note cannot be obtained, come anyway. The examination still does most of the work, and post-operative imaging fills in a good deal of the rest.

What we do not claim

That every persistent pain after a fusion has a treatable cause, or that we can undo an operation. Some of what we find is adaptation to a permanently altered mechanical situation, and saying so is more useful than implying otherwise.

What we can say is that a substantial share of this group has an untested facet joint at an adjacent level, and that testing it is an outpatient procedure rather than a commitment to anything.

What a second opinion here actually involves

A full examination rather than a review of somebody else’s notes. Range measured in degrees. Strength graded muscle by muscle. The facet columns palpated segment by segment above and below the fusion. And a clear statement of which structure we think is responsible and what test would confirm it.

You leave with a named structure and a plan, not a general impression of whether the surgery was reasonable.

What we test for after a fusion

• Facet-mediated pain at the levels above and below the fusion, which is testable with a diagnostic block and treatable with radiofrequency ablation without another operation.
• Rotation loss, measured rather than described, because it is disabling in ways that are rarely asked about.
• A residual or new radicular pattern, separated from a peripheral entrapment by nerve studies.
• Sleep disturbance, which is severe after cervical surgery and almost never addressed as its own problem.

Bring the operative note

Which levels, which approach, and whether hardware was used changes the differential substantially. Anterior and posterior procedures produce different long-term problems, and a posterior decompression and fusion carries a distinctly different profile for rotation loss and for persistent pain than an anterior procedure does.

If you cannot obtain it, come anyway. The examination still does most of the work.

What we will not do

Route you back to a surgeon on the strength of a scan and a description. A second operation for pain after a first one is a serious decision, and it deserves a diagnosis established by testing rather than an assumption that more surgery will finish the job.

Where we are

12174 Natural Bridge Rd, Suite 302
St. Louis, MO 63044

Suite 302. Parking at the door.

Adjacent segment disease, specifically

Fusing a segment transfers load to the ones next to it, and degeneration at those levels is a recognized long-term consequence. It matters most in younger patients, who have the most years for it to develop.

The practical point is that adjacent-level facet pain is testable with a diagnostic block and treatable with radiofrequency ablation, on an outpatient basis, without another operation. That is one of the more common findings in people arriving here after a fusion and one of the more satisfying to identify.

If you are considering a first operation

The most useful questions to ask are which structure is generating the pain, and how that was established. If a fusion is proposed for neck pain rather than for arm pain or cord compression, ask whether a diagnostic block has been done.

A surgeon with a clear indication will answer all of that directly. Difficulty with the block question is the signal worth noticing, because the asymmetry between the two options is severe: a wrong ablation wears off, and a wrong fusion does not.

Rotation loss, which people rarely raise

Loss of neck rotation after a posterior fusion is disabling in ways that do not appear on a pain scale. Checking a blind spot, holding a conversation with somebody beside you, and turning in bed all become effortful, and people adapt by rotating the trunk without ever describing it as a symptom.

We measure it in degrees rather than describe it, because that is the only way anybody can tell later whether anything changed.

What St. Charles patients ask

My surgeon says the fusion looks perfect. Why do I still hurt?

A solid fusion means the bone healed. It does not tell you whether the level that was fused was the level generating your pain, or whether the adjacent segments have since become symptomatic. Where the practice sits in St. Louis.

Can anything be done without more surgery?

Frequently, yes. Adjacent-level facet pain is testable with a block and treatable with ablation, and it is one of the more common findings in this group. What happens at the first appointment. Where surgery is clearly right, and where the question is premature.

Is the drive worth it?

That is your call to make. What we would say is that if nobody has done a diagnostic block, the question has not been asked yet. What gets missed after fusion.

Do you do second opinions before surgery?

Yes, and that is a substantial part of the work. Confirming the level before a permanent decision is the point. Where the practice sits in St. Louis. The three questions worth putting to any surgeon.

Related reading

• Failed neck fusion
• Posterior hardware failure
• Loss of neck rotation after fusion
• Ablation or fusion?
• Sleep after neck surgery
• Neck pain doctor in St. Louis