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  • drjay
    Post count: 5

    Hello Dr. Corenman,
    I’m a 41 year-old healthy male, dentist by profession. No history of trauma/ accidents, other than broken collar bone at age 9 and 17. No meds, reasonably fit. I’d like to practice for another 25 years.
    I’ve recently been diagnosed w/ degeneration at the C4-5, 5-6, 6-7 levels– anterior and posterior spurring, straightening of the cervical spine. Review of MRI by Neurologist here in Rapid City, SD shows neural compression at C5-6, 6-7 levels. Spur is larger at C6-7 on the left, but compression at C5-6 as well. Nerve root compression with C6, C7 radiculopathy with arm weakness, significant triceps weakness (I observe this, and have slight numbness, tingling of left index finger)ie. difficult for me to dry my hair with a towel with my left arm. Cervical diskectomy and fusion has been recommended at C5-6, 6-7 levels.
    I’m interested in Disk Replacement at C6-7 level.
    Symptoms began out of nowhere in early Nov., 2011. UL back pain radiating to triceps/ forearm area. This pain was constant thru Dec. 5th or so. Then suddenly no pain thru Dec. 18th or so. Dec. 12th I had a select nerve root injection

    Post count: 5

    even though I had no pain at that time. Pain re-appeared around Dec. 18 thru the end of Dec. Pain disappeared again early Jan, although weakness in triceps has worsened.
    I currently have no pain, unlimited range of motion. MRI was taken here in Rapid City on Nov. 28. I’m interested in 3rd opinion on disk replacement if weakness progresses. I’ve contacted PHX Mayo and they say they no longer place artificial disks. This makes me wonder?
    Please give me your take on this, I’m happy to send MRI.

    Post count: 5

    PS, 2nd opinion was orthopedic surgeon in Rapid who has recommended PT and time. ALso, I had an epidural injection in late Dec– again I had no pain at that time, so time line above is a little off–Pain disappeared late Dec.

    Donald Corenman, MD, DC
    Post count: 8652

    According to your complaints, with triceps weakness and paresthesias of the index finger, it sound like you have compression of the C7 nerve root. Compression of the C7 nerve root appears to be caused by spur formation from degenerative disc disease (see website under the section “cervical radiculopathy” for further explanation).

    You also have some degenerative changes at the C5-6 level but apparently no symptoms at that level. I assume a thorough physical examination revealed no weakness of the biceps or wrist extensors.

    If your main complaint is weakness and paresthesias with no significant neck pain, then an artificial disc replacement could be a good solution for your C6-7 level. This surgery allows decompression of the uncovertebral joint spur (see website) and still maintains motion of the segment to reduce the stress on the degenerative segment above.

    I don’t know how long these artificial discs will last. They may last your lifetime or only 10 years. The research is still being compiled. The other question is whether the allowance of motion at a degenerative segment will allow recurrent spurs to form but I think that is unlikely.

    The good news is that if these artificial discs fail- in general, it is not surgically hard to revise them into a fusion. I have revised quite a few (they were surgically implanted elsewhere for the wrong reasons) with very good results.

    Getting back to your problem, the main question is if you should undergo surgery? That is quite a discussion by itself. In my opinion, any patient that has undergone conservative care and continues with upper extremity weakness that interferes with occupation or lifestyle should consider surgery. There is no guarantee that you will regain good useful motor strength even with surgery but surgery gives the nerve the best chance to recover.

    Dr. Corenman

    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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