CT results back - the good news, the bad news about T4-S1 spinal fusion

Some stats for others dealing with long fusions.

62, F, 130.1 lb, 5'3".

I've had three fusions: 

L5-S1 - (2018); left with left leg nerve damage. 

T11-S1 (Feb 2024, then PJK failure) 

T4-S1 (revision, Oct 2024)

MISC: T2D, 5.1 A1C, no insulin needed; rheumatoid arthritis (no meds); neuropathy (moderate in hands, severe from knees down). Labs still stellar.

REHAB: 2 weeks at acute care; pool therapy at 1 year mark for 2 months, land therapy 2 weeks, then home PT + acupuncture. Treadmill 3-4 times a week.

After my one-year checkup on my T4-S1 fusion, all was well, even though I had a fall during that rehab period. All was well until maybe January. I started to have upper body pain that was going away for the most part. I still have pretty significant balance issues (feel like Robocop) because of all the hardware, and driving aside from short jaunts in town for errands pretty much wipes me out for the whole day. Same for chores like mopping, lifting laundry, grocery bags, etc. Stuff able-bodied folks take for granted and keep on trucking puts me in bed because of the acute and chronic pain. 

A good day for me is a 4 out of 10 on the pain scale. But I do all of the chores and driving because, well, it's me, myself, and I to do it all. Balance issues probably means I need to use a cane, but I hate it; it gets in the way, so I usually leave it in the car. I'm stubborn. I cane means I really shouldn't walk outside for exercise alone, so that's why I'm relegated to the treadmill to get cardio in.

Note to fellow spine warriors: yes, I use other assistive devices out of necessity, even 18 months out from surgery:

• grabbers, to pick things up off of the floor (I have 5 around the house)
• shower chair: when the pain is bad, it's immeasurably helpful
• sock put on thing: need it because I can't bend enough.

Since the upper body pain was getting worse since January, included that sensation of my rib cage being squeezed (girdle sensation), it was making it hard to breathe while lying down. I knew something was wrong; I was falling in my home fairly often (at least once a month), and I was dropping things from my hands frequently, suggesting neuropathia and motor issues. So it took months, since the medical system isn't racing to do anything that isn't an emergency.  

I had an MRI, Nerve Conduction Study and lower leg EMG (electromyography) test through a neurologist. BTW, the MRI didn't show anything of note; it appears that it cannot always pick up cervical issues caused by gravity (your head and shoulders) if you are lying down. They do have upright MRIs; I did have one once. They are good for folks who are claustrophobic; I'm not, I fall asleep during them. 

Those NCS/CMG tests confirmed my existing neuropathy and nerve damage from prior surgeries, but it also confirmed sensory delays in my hands (4.48 ms and 3.59 ms) - why I drop things. My pain doctor set up the CT scan, and that occurred in May.

So the takeaway from my May 7, 2026 CT scan of my thoracic area...

🧠 The biggest takeaway first

✅ GOOD NEWS:

The CT did NOT show:

• A new fracture
• Hardware failure
• Broken rods or screws
• Severe instability
• Major spinal canal compression

So that's the good news.

⚠️ The most important finding (The BAD NEWS)

“T1-T2 mild central canal stenosis relating to annular bulging”

🧠 What is T1-T2?

This is the junction between your lower neck and upper thoracic spine VERY close to the top of your fusion

Remember:

• your fusion begins around T4/T5
• so T1-T2 is part of the “transition zone”
• That area is under extra stress because the fused spine below it cannot absorb motion normally.

T1-T2 Mild Central Canal Stenosis: At the T1-T2 level (the base of your neck/top of your shoulders), the report notes "mild central canal stenosis". This means the main tunnel that holds your spinal cord is slightly narrowed

.  

The Cause: This narrowing is caused by "diffuse annular bulging," which is a disc that is slightly flattened and pushing backward toward the spinal cord.  

The Connection: This is likely a major contributor to the "girdle sensation" and the pain you feel between your shoulder blades. When you lift groceries or drive, the muscles and discs in this transition area are under extra stress, which can temporarily increase the pressure on the cord.  

🚗 Why driving hurts so much now (confirmed mechanically)
This CT supports the idea that: the junction above your fusion is overloaded
Driving causes:

• vibration
• static posture
• shoulder/upper back tension

👉 which increases stress at T1-T2/T4 transition areas

You are experiencing:

“JUNCTIONAL OVERLOAD SYNDROME” (aka Adjacent Segment Disease). Junctional overload syndrome, specifically proximal junctional kyphosis (PJK) or failure (PJF) at the T1 level, is a known complication of long spinal fusions (such as T4 to S1) where the segment immediately above the hardware experiences accelerated degeneration, abnormal stress, and structural breakdown. This condition, often termed Adjacent Segment Disease (ASD) or Syndrome, occurs because the rigid, fused spine (T4-S1) forces the non-fused, upper thoracic levels (T1, T2) to absorb excessive biomechanical stress.

X-Ray from Oct, 2025.

---

ANYWAY...so that's the long version of what the CT said. 

Short answer is the CT found problems at T1 that are from the constant pressure on my remaining spine where there's no hardware. And T1 is taking the punishment. It may or may not fracture (as my spine did after the Feb 2024 T10-S1 fusion that failed), but it's at risk, and the spinal cord is already getting triggered there. 

Options: No surgery required yet, thankfully, but that doesn't help with this acute and chronic pain that is truly disabling if I cannot drive far without laying me out, or do activities without ending up spending 70% of the time in bed.

👉What your surgeon will probably focus on next:

Likely:

• conservative management first
• activity modification
• pain control
• monitoring progression

Possibly:

• physical therapy tailored to fusion mechanics
• injections
• bracing
• posture/driving modifications

⚠️ What to watch carefully over time. Tell your surgeon promptly if you develop:

• worsening balance
• worsening hand weakness
• increasing gait instability
• bowel/bladder changes
• rapidly worsening thoracic pain

That's where things stand for now, folks. It really put a damper on my plans to travel to the East Coast due to many things. Traveling alone in this condition is unwise, given my balance issues and degenerating spine. I can hopefully manage the pain and figure out the balance issues so I can do more than sit here and rot for my 63rd birthday in July. Sigh.