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  • exercise453
    Member
    Post count: 53

    Hi Doctor,

    I read the excellent thread on nerve injuries and recovery. Aside from the great technical education what struck me was your candor and use of “we just don’t know”. I have some questions and hope it is ok to ask a couple at a time.

    I understand the timeline for recovery of a motor nerve but does that timeline apply to sensory symptoms. Specifically would you recommend any type surgery for classic symptoms of a non-motor c4 unilateral nerve root radiculopathy that you knew was compressed and symptomatic for seven years??? (or c3)

    In a typical cervical epidural steroid injection in thru c7-t1 (vs snrb) for left side symptoms, would the medicine reach and benefit nerve roots (and discs) higher up like c4 and c3 (or even c2). Would there be benefit to “tilted left???

    Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    A sensory nerve injury is not as problematic in day to day activities as a motor nerve injury but the healing potential is about the same. Nonetheless, this is a preganglionic nerve (dendrite) and seems to questionably have a better chance to heal.

    There is some evidence that the longer a nerve is compressed, the poorer chance it has to heal (within reason).

    A steroid injection at C7-T1 will not reach the C3-4 level unless the bolus of liquid injected during the ESI or SNRB is very large and most injectionists will not do that for fear of a pressure injury.

    Dr. Corenman

    exercise453
    Member
    Post count: 53

    Dear Doctor,

    I did not understand your answer about surgery on a compressed c4 nerve root if you knew the compression was 7 years old and the symptoms debilitating. I tried to shape the question to be a yes-no answer and I did see your words within reason. I want to be absolutely certain of your opinion on this because I believe this to be one of my problems and its elimination might make a major difference. It may be the one thing something can be done about and the one thing I might be willing to do. I also believe it to be out in the foramen and I wonder what would happen if the nerve were decompressed. Way back on my c2-3 facet thread I mentioned that there was superb relief on a C3-4 block but a later radiofrequency failed. I cannot help but think the anesthetic may have dripped on the nerve root. I had two mri’s. The first shows some compression. (tesla 1.5). The second a year later unfortunately was an open mri and it is awful (didn’t know better at the time)…but there are some revealing axial cuts that show the disc at c3-4 sitting on 95% of that nerve like a boulder on an ant.

    So…if this was a simple (for you) foraminotomy would you perform surgery if you knew it was a debilitating sensory c4 radiculopathy that was traumatically induced (weight lifting/fall while jogging) 7 years ago or is it simply too late for any rational hopes of recovery of that nerve???

    No response necessary here. Thought you might find this interesting. We went back and forth on the c2-3 facet thread and also the cervical trigger point thread about “the thing” near c3-4 that I am always pressing and also some atrophy (prior to any radiofrequency). One doctor called it a calcification and your last words were puzzle. I think I know what it might be. I think it is a neuroma, one of the small posterior muscles innervated by c4 (longissumus or semispinalis capitus….or a muscle in that area). Am I paying attention or what. 

    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The injury to a sensory nerve from a disc hernation is pre-ganglionic meaning the dendrite of the nerve is affected and not the axon of the nerve. See the nerve anatomy section to better explain this.

    It is thought that the dendrite has a better healing ability than the axon does so that a sensory nerve injury has a better chance of recovery than a motor nerve root does.

    Let us assume the compression of the nerve root is 7 years old and has been “stable’ for that seven years. If the injury “has already been done” over this long period of time, decompression of the nerve would not be as helpful. Nonetheless, if the nerve still generates pain, there could be some component of continuing injury that could be improved from a surgical decompression.

    A “simple foraminotomy” can be helpful but it depends upon the location of the bony compression. If there is a large spur generated off the uncovertebral joint (located in the front of the spine), a posterior decompression will “open the nerve hole” so the nerve does not have constriction. The problem is that this procedure will not remove the spur that projects from this uncovertebral joint and the nerve, while not squeezed, will still be tented over this spur. This is why satisfaction from this procedure is generally not as high as an ACDF under these circumstances.

    Probably the best test to determine if surgery can be helpful for you is a SNRB (see website). The problem with this test is it will anesthetize the nerve regardless if the origin of the nerve pain is from compression or from chronic injury.

    Dr. Corenman

    exercise453
    Member
    Post count: 53

    Dear Doctor,

    We see a procedure called accurascope by one of these “spine centers”. A cervical procedure places dye and a thin wand into a herniated disc under fluoroscopy and a laser shrinks and seals the disc, shrinking the herniation off the nerve. They put on a band-aid and you go dancing (so to speak). It surely looks like the way things should be treated in the 21st century.

    They do make a valid point in their literature where they claim to offer 30 treatments/procedures. They state that doctors diagnose whether the procedures they perform fits versus what is the very best or newest treatment out there. Sadly I believe this to be spot on.

    What about this type of procedure to reach and eliminate some herniations as alternatives to acdf and foraminotomy??? Is it a viable alternative or is it flawed and steer clear in your TRUSTED opinion???

    Thanks.

    exercise453
    Member
    Post count: 53

    P.S.

    Of course I do not believe this although I sure do want to. It sure would be nice!

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