[BPat]

#8196

I had a foraminotomy (c5/c6) done 8 days ago for right severe forminal stenosis (MRI/CT also indicated severe stenosis at c3/4 and c4/5 – but left those alone for now). Symptoms were tingling in my thumb, uncomfortable sensation in my wrist and the feeling of a knot that lived in my middle of my upper back/scapula (all on right side). 7 months of PT, epidurals, trigger point injections, and Rx led to no relief. There was however an initial improvement over a few months as the hand/wrist numbness/tingling was at first very pronounced – but it plateaued after a few months and then settled in to a level that while better inhibited my active quality of life, but no acute pain (I’m only 39 and have 3 young kids).
Posterior foraminotomoy (c5/c6) procedure seemed to go smoothly with pretty minimal post op pain and outpatient. However, all the numbness, tingling, shoulder weakness/knots are still there … Should I have expected “immediate” underlying symptom relief if this was going to work? Or does even a hopefully successfully decompressed nerve need time (how much) to get back to normal? Any guidelines on when I’d see underlying numbness /weakness subside in a typical success?
Thank you so much!

[Donald Corenman, MD, DC]

#8197

A posterior foraminotomy is a good procedure but has some drawbacks. If there is foraminal stenosis from a large bone spur, the foraminotomy will reduce the compression on the nerve but the nerve still stays draped over the bone spur which originates from the back of the disc space (uncovertebral joint). This bone spur still elongates the nerve root and may not give as much relief as an ACDF or an ADR.

Posterior shoulder pain may originate from a degenerative disc and not from nerve compression. Unless a work-up is performed prior to surgery to indicate the cause of the posterior shoulder pain, posterior foraminotomy may or may not reduce this pain (there is a 50/50 chance of relief of this pain).

Give the surgery three months to determine outcome. If the numbness does not improve in that period of time, the chances of further improvement are limited. Weakness may take up to six months to improve.

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.

[BPat]

#8200

Thank you – this forum is an incredible resource in a sea of uninformed and anecdotal information out there on the web.

[Donald Corenman, MD, DC]

#8203

Thank You

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.

[BPat]

#8342

Sorry quick – follow up …

It sounds like after a posterior foraminotomy I need to be patient (hard!) to really assess results – three months to determine outcome for numbness and up to six months for weakness to improve.

But, what about muscle spasms/aches and pain? I’m 4 weeks post op – should I be concerned if these symptoms are no better either? Or like numbness/weakness do muscle spasms/aches & pain need time before one can assess results? Does the now decompressed nerve need time to settle down / have inflamation come out /heal before my spasms/aches end? Or do your posterior foraminotomy patients typically see relief from muscle spasms/aches and pain more quickly?

The pain runs from the shoulder (mostly around medial border of the scapula ) to the bicep to forearm and my wrist (still numbness/tingling in thumbs, but you addressed patience on that!).

Thanks!

[Donald Corenman, MD, DC]

#8345

I think that after four weeks without any improvement whatsoever from a posterior foraminotomy, I would want to know why this is. Has there been a change in symptoms or are the current symptoms no different from preop?

If no change at all, I personally would be interested in an MRI with gadolinium to see why there were no positive results. Is there a hematoma present? Is there a recurrent disc herniation?

Yes nerve roots need to “calm down” after surgery but normally there are different symptoms present than the initial ones like paresthesias and “numbness”. No change in symptoms would be unusual.

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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