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  • Gianna13
    Member
    Post count: 6

    I have a few questions concerning my up coming surgery. I am presently scheduled to have a left C5-T1 anterior cervical partial corpectomy, diskectomies ,foraminotomies,and arthrodesis with structural fibular allograft and local veterbral autograft, and titanium plate and screws. The fusion is to correct the the atrophy and weakness I have in my left forearm and hand.I have very weak grip strength and unable to straighten out my left pinky . The muscle under my thumb has completely wasted away.Initially I had pins and needles running down my arm but that has gone away.My grip strength has come and gone over the last couple of years,however the atrophy is new. I don’t have any neck or back pain whats so ever.

    Im a 44yr old male firefighter who works out with kettle bells, practices martial arts ( grappling,wrestling and boxing).I also do crossfit type work outs, scuba dive and snowboard.I have had 2 past shoulder surgerys to my left labrum over the last 2 yrs.I was diagnosed with a brachial plexopathy prior to my second shoulder surgery.

    On cervical studies I have multifactional stenosis canal and foramen at levels all the way from C3 toT3 with the canal itself maximally narrowed at C5-C6 and behind the body of C6 with opll where the cord is flattened.My thoracic MRI shows multiple levels of bulging herniated disks.Partly,the one that is very slightly touching the cord T5-T6 on the left,but it is not sever or even moderate compression.I have loss of lordosis and cervical kyphosis,the apex around C6, and kypotic angulation at C5-C6 and C6-C7.There is cord compression at C7-T1 where there is very significant left foraminal herniation and moderate to severestenosis of the canal.
    There is also some foraminal narrowing down into the thoracic area at T1-T2 and T2-T3,along with the changes of the herniated disk.

    My doctor says I should have full recovery in 6 months if all goes well. I will be in a Miami J collar 24/7 for 8 weeks,a soft collar 24/7 for 4 weeks and use a pulse electomagnetic stimulator 4 hr a day for 16 weeks. After that begin core strengthening
    physical therapy program and evolve into a wellness program with pilates.By 6 months no limitations if everything goes as expected I should be able to resume physical activites including weightlifiting and martial arts if I insists,although its not recommended.
    My question to you after reviewing my case do you agree with his course of treatment? Also do you think I will have any limitations after surgery?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Much depends upon your physical examination. You could have added carpel tunnel syndrome (CTS) with your workout routine and occupation. If there was any question of CTS, I am sure the surgeon would have ordered an EMG/NCV test.

    Let’s assume that all your symptoms stem from nerve and cord compression. I will also assume that the C4-5 level is not compressing the cord or any nerve roots, is not severely degenerative and is not in significant kyphosis.

    T1-2 is the exit of the T1 nerve root which innervates (goes to) the hand intrinsic muscles (fine motor skills but not to be confused with myelopathy which also causes loss of fine motor skills). I will also have to assume that this level is not causing any symptoms.

    If the above caveat is accepted, then it appears by your description that surgery is warranted at the levels planned. There are many ways to perform this surgery from the front (see ACDF section on the website) and this surgeon’s technique is perfectly acceptable.

    Now “full recovery” is somewhat of a gray area. You have about about a 90% chance of a solid fusion. The surgeon can decompress and stabilize the nerves and cord but these nerves and cord have to recover on their own. That is mother nature and most likely but not guaranteed (see section under “nerve injury and recovery”-“nerve damage and healing”).

    You would have some mild limitations after “full recovery” only in that you will have three discs fused (C5-6, 6-7, 7-10 which will put some increased pressure on the C4-5 disc. If you were my patient, I would have you forego kettle ball exercises and any ballistic exercises that were unnecessary (P90X). Your occupation creates enough ballistic motion. I think Pilates is great.

    Dr. Corenman

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Allowable exercises would allow strength, conditioning (the ability to lessen muscle fatigue) and range of motion. These exercises should not allow significant stress or motion that can overcome the inherent stability of the C4-5 disc and cause a tear of the annulus.

    Unfortunately, life is about risks and your acceptable level of the risk. If you just stayed in the gym and away from kettle balls, the stresses on your neck would be minimal. If you decided to ski, horseback ride or mountain bike ride, you risk goes up if you have an unintended fall.

    If you decide to continue martial arts and just perform katas, risk is reduced. If you spar, risk goes up.

    There is no diet that can change the course of your cervical spine.

    Dr. Corenman

    Gianna13
    Member
    Post count: 6

    I do no gi grappling I guess I could stay away from live grappling.I have a couple of more question do you find it odd that I have zero pain with my condition?Is it a good thing or bad?Does it mean the nerves are past the point of return to normalcy ?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    I have some concerns regarding your diagnosis with no pain associated with your condition. Normally, nerve compression will cause pain to radiate down the arm. If this is strictly cord compression, this could be a painless condition but with other symptoms.

    Do you have paresthesias (pins and needles) or numbness? Are any of the symptoms made worse with neck extension (bending the head backwards)? Do you have long tract signs (hyperreflexia, Hoffan’s sign, clonus). Do you have loss of fine motor control of your hands or imbalance with walking?

    Dr. Corenman

    Gianna13
    Member
    Post count: 6

    At the tip of my left index finger i have pins and needles with a numbness.I use to have pins and needles running down my left arm but they have subsided at this time.Prior to my 2nd shoulder surgery (capsillar release) when I was diagnosed with a brachial plexopathy I had constant pain with pins and needles radiating down my left arm and no grip strength.The symptoms are not made worse by neck extension. I do have trouble with fine motor control of my left hand. I also noticed that my muscles in my left arm and hand tend to spasm every so often when I try to use them.I have no imbalance with walking or any long tract signs.

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