[Craggy]

#28479

I had C4-6 ACDF IN JANUARY for left sided arm symptoms. I had no right sided symptoms pre surgery.

In the last month, I have had increasing numbness on the right hand side from my shoulder through to my thumb. It’s a dense numbness, now accompanied by deltoid, forearm and bicep weakness.
No foraminotomy was performed on the right side during ACDF as he didn’t see the need at the time.
I have also had a slight return of left arm pain and numbness over the upper arm. It’s nowhere near as bad as Pre surgery, but it’s there.

I had a new MRI done, but my surgeon says as the fusion is solid, and there is no movement at those levels, that the MRI results showing foraminal stenosis shouldn’t be relevant.

Recent MRI Results at the operated levels are as follows:

C4/5: status post ACDF with persistent left sided uncovertebral hypertrophy and moderate to severe left foraminal stenosis.
The left subarticular herniated disc component has been resected. Spinal canal and right foramen are patent.

C5/6: status post ACDF. There is spondylosis and mild facet joint degeneration with moderate bilateral foraminal narrowing. The left foraminal herniated disc component has been resected and the foraminal stenosis significantly improved on this side.

Comment: satisfactory post operative appearances in relation to C4-C6 ACDF. There is persistent left sided foraminal narrowing from c4-C6. There is potential for ongoing impingement of right C6 nerve root due to a moderately stenosed right C5/6 neural foramen.

I’ve just undergone a week long course of Dexamethasone 4mg, 3x a day with no change in symptoms. If anything they continue to worsen.
What is your take on these results? What would your next step be?
Thanks for any advice.

[Donald Corenman, MD, DC]

#28480

It is unusual but not unheard of to have a new radiculopathy in an area with a prior ACDF if there is continuing foraminal stenosis. I think that not performing a foraminotomy on the non-symptomatic side while doing an ACDF can lead to this very problem however. Your symptoms sound like a C6 nerve root (“right hand side from my shoulder through to my thumb. It’s a dense numbness, now accompanied by deltoid, forearm and bicep weakness”) except for the deltoid weakness which typically originates from a C5 root disorder. The possibilities could include Parsonage Turner syndrome (https://neckandback.com/conditions/parsonage-turner-syndrome-neck/) and not a radiculopathy depending upon the examination findings.

In my opinion, the next step should be a selective nerve root block at C5-6 right. With good temporary relief, (https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/) that would confirm a C6 radiculopathy. Hopefully, the steroid affect will significantly reduce symptoms. If not, more likely than not, you would need a posterior foraminotomy. There are occasions that a revision ACDF could be needed.

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.

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