[slik999]

#5965

I am a 49 year old male with a herniated disc between C7 – T1 (MRI confirmed) the injury happened Nov 2011 and I am pain free and med free since the beginning of January. I have weakness and tingling pinky and ring finger. I have tested my hand strength and my left hand is 66% as strong as my right hand (clench test). I have no other previous spinal issues MRI does show some bulges at other levels but of no significance.

I have seen a neurosurgeon and he wants to do an ACDF, I am not sure this might be to agressive plus complications of fusion, not to mention degradation of other levels in spine itself.

My question specifically is whether a foraminotomy might be a better solution less invasive quicker recovery etc. What do you see in practice as more successful ACDF or PCF. In terms of recovery is PCF vastly better than ACDF?

[Donald Corenman, MD, DC]

#5966

There are two questions to be asked. The first question is what is the chances of motor strength recovery in the C8 nerve? The hernation was in November, five months ago. This C8 nerve is one that is very sensitive to compression and motor strength may not recover after decompression. None the less, the best chance of motor strength return is the surgery.

The other question is what is the best method to decompress the nerve? If this is truly a disc herniation and not a disc spur causing foraminal stenosis, your options broaden. If this is a disc spur from the uncovertebral joint (and not the facet joint), the best treatment in my opinion is an ACDF. If this is foraminal stenosis from a facet spur, the foraminotomy is the best procedure.

If it is a disc herniation, you have some choices. An ACDF is a standard procedure with a 95% success rate for fusion and full removal of the herniation. It requires a rehabilitation period of six weeks in my hands before the patient can return to most activities. There is the possibility of dysphagia (swallowing difficulties) for a period of time post operatively.

A foraminotomy is a procedure that does not require fusion. It has a success rate of about 80-85% for satisfaction and good decompression of the nerve root. The foraminotomy has some potential for residual neck pain. The foraminotomy may allow a recurrent disc herniation but there are no current studies to indicate the percentage of that possibility. The recovery period is about four weeks before a patient can return to most activities.

The good news is that either procedure can be successful to decompress the nerve. I can tell you that most patients pick the ACDF by about two to one in the face of a disc hernation. I personally don’t have a favorite procedure. If you look at Peyton Manning and his course, he had two foraminotomies before he had an ACDF at the same level to finally resolve the nerve compression.

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.

[slik999]

#6002

My problem is that I have no pain and take no medication and work out at the gym everyday. I read that if your pain resolves in under six weeks then conservative treatment should be your first option. I was under the impression that surgery is not a conservative treatment, perhaps I was wrong.

In any case from your comment with a C8 nerve root problem perhaps surgery is a waste of time at this point. I am primarily looking at surgery to potentially regain strength as pain reduction is not a motivator for me. So in general with a C8 nerve root what is the chances typically of gaining any strength back? What do you typically see?

The other question are there any risks of leaving the herniation in the spinal area? Should I have the surgery to remove this herniated material as a safety precaution?

I can live the way I am for sure as I am capable of virtually anything it does not have a huge effect on my life other than slightly weaker grip and a couple of numb fingers.

[Donald Corenman, MD, DC]

#6004

If pain resolves in the first six weeks with no motor weakness, then conservative non-surgical care is appropriate. If there is motor weakness, especially of the C8 nerve, it is my protocol for timely surgery, either an ACDF, an ADR or a posterior foraminotomy.

With the length of time from the HNP to now, there very well may be no immediate need for surgery. Especially if you are functioning well and don’t notice any significant impairment from your hand weakness.

Understand that I cannot comment on leaving the disc herniation alone as I have not examined you and have not reviewed the films. In general, if there is no cord compression and the examination was normal, I would leave the disc herniation alone.

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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