Bilateral finger numbness since 4 years

Tagged: Chronic cervical nerve compression and recovery

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peer
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December 21, 2017 at 5:58 am

Post count: 5

#27103

Dear sir
Hope you are fine. Am a 43 year old male and sustained seemingly trivial injuries to my cervical spine 3&1/2 years ago leading to immediate intense and excruciating neck shoulder arm pain that would radiate into almost every digit bilaterally. Weeks after i begain to have fasciculations of arms bilaterally. In addition both of hands would get numb during sleep.More over there was extreme fatiguibility of both triceps. Three and a half years down the line i do not have any pain but the triceps fatiguibility and hand numbness during sleep continues. Usually the numbness affects the back of thumb or the first two fingers or the little finger and ulnar half of ring finger. And this patterns of numbness occurs in both hands.My concern is this numbness and the triceps fatiguibility. MRI reveals diffuse disc bulges from C5 to T1 with impingement of exiting nerve roots bilaterally at all four levels. There is no significant cord compression. Neurosurgeons differ in opinion some say i can wait others say a fusion is required from C5T1. Would like to know your inputs. Regards

peer
Participant

December 23, 2017 at 3:40 am

Post count: 5

#27110

Dear Sir
In addition i would like to mention that 8 months after the initial injury i developed a serious violent head tremor that started all of a sudden and ended abruptly after about 30 hours.since then it has not recurred but occasionally i get a subtle head tremor especially when i am apprehensive or anxious. The neurologist says that it is a Motor Tic Disorder. I am especially worried that if i need a surgery how would i handle the tremor if it happens. Can botoux injections help and be used prior to surgery.And would a disc replacement be more dangerous than ACDF in case a tremor occurs. Regards

Donald Corenman, MD, DC
Moderator

December 23, 2017 at 9:53 am

Post count: 8660

#27113

First, you have to understand how a nerve responds to compressive injury. Initially, symptoms include pain, paresthesias (pins and needles) and numbness down the distribution of the nerve and weakness of the muscles serviced by the nerve (the myotome). After about three weeks of denervation (lack of nerve supply to the muscles), the muscles go on to “twitch” without action on the patient’s part (spontaneous faciculations). The pain can eventually diminish as the nerve compression continues to injure the nerve as some axons die (the nerve tube dies) but the numbness and weakness continue.

The question is whether surgical decompression (ACDF) at this point can allow nerve recovery. The answer is “maybe”. The cervical nerves have a greater capacity to recover than lumbar nerves do due to the shorter length of the nerves in question. I think it is worth it to undergo surgery to allow some recovery but it is uncertain at this point how much recovery you will obtain. See https://neckandback.com/conditions/how-muscles-recover-from-nerve-injuries-neck/ and https://neckandback.com/conditions/peripheral-nerve-anatomy-neck/.

Tremors are generally not related to peripheral nerve compression as the cause is a central phenomenon (the brain can cause this but nerve injury will not). Disc replacement is probably OK with a head tremor but you probably are not a candidate if you have such degenerative changes as I suspect.

Botox injections generally will cause muscles to stop contracting so are good for spasms and headaches. Botox does not work as well for tremors.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

peer
Participant

December 24, 2017 at 12:26 am

Post count: 5

#27138

DEAR SIR
A HAPPY CHRISTMAS TO YOU AND YOUR WHOLE FAMILY. I REALLY APPRECIATE THAT YOU TAKE TIME OUT OF YOUR BUSY SCHEDULE TO ADDRESS THE CONCERNS OF PATIENTS WITH SPINAL ISSUES WHO REALLY FEEL CORNERED.
I AM REALLY ASTONISHED AT YOUR PATIENCE AND CONCERN FOR FELLOW SPINE PATIENTS WHO ASK ALL SORTS OF LENGHTY AND AT TIMES WEIRED QUESTIONS THAT I COULD GAUGE FROM SOME OF THE POSTS ON THIS FORUM.
COMING BACK TO MY OWN ISSUES I WOULD LIKE TO CLARIFY THAT I NEVER HAD ANY OBJECTIVE WEAKNESS I MEAN THE POWER HAS BEEN ALWAYS GRADE 5.Yes i do have a some fatiguibility of the triceps muscles on both sides slightly more on the right side. Moreover the numbness was never permanent only for a minute or so during sleep.It has improved to some extent say from the worst zero to an improvement of 7 (Eg on an improvement scale from 0 to 10)but has sort of platued at that for several months now.I do not have any pain full ROM. I WOULD LIKE TO KNOW IF I CAN SAFELY WAIT OR WAITING FURTHER CAN ONLY MAKE IT IRREVERSIBLE. Moreover if i decide for surgery does that mean i will need to fuse segment C5C6, C6C7 & C7T1 as my numbness patterns correspond to dermatomes supplied by the corresponding nerve roots.
The MRI images are almost similar at all four levels from C5 to T1. BILATERAL IMPINGEMENT OF EXITING NERVE ROOTS WITH NO SIGNIFICANT CORD COMPRESSION. REGARDS

peer
Participant

December 24, 2017 at 3:29 am

Post count: 5

#27139

Dear Sir
I forgot to mention that i am from india rather a remote corner of India.
REGARDS

Donald Corenman, MD, DC
Moderator

December 24, 2017 at 5:59 am

Post count: 8660

#27141

If you are at a remote corner of the world, you might want to consider an ACDF and not artificial discs (ADR). ADRs will eventually wear out and need to be replaced. If you need a “one and done” procedure, then an ACDF should be considered. If no real motor weakness, you can consider epidural spinal injections (if available to you). IF not, then the levels considered for surgery would depend upon a thorough history and physical examination as well as image review. There is the consideration that if the symptomatic levels only are addressed (based upon the above factors) and potential symptomatic levels (but currently non-symptomatic) ate left out, you could develop symptoms down the road. I am however a fan of leaving the non-symptomatic levels out of the surgical construct unless they are so severe as to be predicted to become symptomatic.

Dr. Corenamn

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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