### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi my name is Angela and I am 50. A year and a half ago I was in an automobile accident. C5 and C6 went into my spinal cord. I had surgery two weeks later. ACDF w cage plate and screws. It was put in wrong hitting C4 and severely compressing nerve 6. At the end of November 2012 I had posterior laminectomy with 2 rods C4C5C6. Released nerve six as wellas bone graph. I recently just had another anterior surgery taking out plate and screws fro first surgery. The screws had pulled out because it was over a bone spur and I could not swallow. I am still in severe pain. Base of skull, neck, arms are numb. CT Scan shows C7 and T1 are distressed. How do I get out of pain and will I ever be better? I can not live this way.

### output:

Hello. My name is Chat Doctor.  From what is described it seems the first surgery was for decompression and fusion by anterior approach. The indication for second surgery will be more clear from the images however it is very likely the aim was again decompression and supporting the anterior construct from back. If the screw from the front was backing out it is an indication that the segments are not fusing leading to pseudoarthrosis which in simple terms means the bones are not uniting to form single solid mass of bone which ideally should happen. The risk is particularly high in smokers. I am not sure what is meant by C7 and T1 are distressed, but the CT scan needs to be studied to assess if there is instability at the cardiothoracic junction. Also loosening of the screw strongly indicates nonunion. I assume you have tried analgesics and other nonoperative pain management modalities. Though there is no certainty of pain relief but treating the nonunion (if demonstrated on CT) and ad