[Donald Corenman, MD, DC]

#9016

So the question is whether the brachial plexopathy is causing some or all of your symptoms. The EMG/NCV would be very helpful to understand what contribution the brachial plexus shares. This test however will not help define what portion the spinal cord has in all this.

That is where the physical examination is so important. The presence of long tract signs (again-hyperreflexia, Hoffman’s sign, clonus) would help to implicate the cord compression as part of the overall disorder. Without long tract signs, cord compression is less implicated. However, your job associated with spinal stenosis is not a wonderful combination. Look up central cord syndrome on the website to understand a potential risk you might have as a firefighter.

WIthout neck extension as a part of the symptom generation, radiculopathy may not be part of the disorder (although there are unusual cases where radiculopathy does not have pain and paresthesias as part of the presentation).

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.

[Gianna13]

#9017

I have had multiple EMG/NCV and a MRI of the brachial plexus.The senior neurophysiologist and neurologist thought the findings were nonspecific and nonconclusive.The MRI was also cleared for any abormalities.Do you still think I need a 3 level cervical fusion?

[Donald Corenman, MD, DC]

#9018

In your case, the question of whether or not you need surgery is a difficult one to answer without an in-person history and thorough physical examination with careful evaluation of the images. When you report “the canal itself maximally narrowed at C5-C6 and behind the body of C6 with opll where the cord is flattened”, this worries me when added to your symptoms and occupation.

You also noted “There is cord compression at C7-T1 where there is very significant left foraminal herniation and moderate to severe stenosis of the canal”. These two separate readings are serious and at the very least, put you in jeopardy for significant injury to your spinal cord.

To add these to your symptoms of atrophy, even though the information is not perfect to implicate the nerve roots or spinal cord as the source of your symptoms due to your history of brachial plexopathy, I think you could be a ticking time bomb. If the C5-T1 levels as you note are so very degenerative with significant kyphosis, the surgery should correct this deformity, decompress the cord and roots, remove the threat of spinal cord injury (at least at these levels) and should make you taller as a bonus.

I cannot answer if surgery is required based upon the information you supplied but I would have grave misgivings if you continued your occupation and lifestyle and did not address this disorder.

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.

[Gianna13]

#9020

I guess my best option is to go with the surgery .I’m becoming a liability on my truck at work .My surgeon basically told me the same thing that you are saying.He said, if I do nothing to address the issues I could have a catastrophic injury.Its just hard to comprehend when I have no pain.Hopefully my nerves respond and my atrophy subsides .

[Donald Corenman, MD, DC]

#9022

Please keep us informed as to your results.

Good Luck!

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.

[Gianna13]

#9023

I will ! surgery is scheduled for july 16

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