tlav86MemberOctober 14, 2014 at 12:58 pmPost count: 5
Hi Dr. Corenman
14 weeks ago i had pain in my shoulder, which was misdiagnosed as bursitis. I was given anti inflammatory drugs to treat this. It got to feeling much better and the pain has subsided. However the symptoms seamed to have changed to significant muscle weakness in my left arm, mainly in my grip strength. I also have intermittent tingling in my pointer finger and thumb. I have got a CT scan with these findings…
TECHNIQUE: IV contrast enhanced CT cervical spine, from C3 to Tl,
with sagittal and coronal reformats.
Mild degenerative arthropathy is noted, with intervertebral disc
height loss at Tl-2.
No cervical spine fractures are identified.
There axe no paraspinal or epidural collections.
C3-4: Mild central disc protrusion with no significant spinal canal or neural foraminal narrowing.
C4-5: No significant spinal canal or neural foraminal narrowing.
C5-6: Disc osteophyte complex with mild symmetric disc bulge, which produces mild bilateral neural foraminal narrowing and effacement of the anterior CSF space. The spinal canal is narrowed to 8 mm at this level.
C6-7: Mild central disc protrusion, with no significant neural foraminal or spinal canal narrowing.
C7-Tl: No spinal canal or neural foraminal narrowing.
Limited evaluation of the apices is clear.
Mild degenerative arthropathy, worst at C5-6, where a disc osteophyte
complex produces mild bilateral neural foraminal narrowing and mild
spinal canal stenosis. Further characterization with MRI is
recommended if surgery is considered.
I have since seen a surgeon who recommended a disc replacement surgery at c5-c6 with an mri before the surgery to clarify, if a few more months of conservative treatment did not help my symptons. The muscle weakness being the biggest of my concerns. I have been doing physical therapy with neck traction and have been on anti inflammatories for months now.
Wondering your opinions on this and the disc replacement surgery itself. wondering what quality of life would be like after a surgery like that. I am 28 years old, love to run, snowbaord, and hike. very active, very scared to have these problems so young…
thanks for your time.Donald Corenman, MD, DCModeratorOctober 14, 2014 at 9:00 pmPost count: 8503
You need a thorough physical examination to point out what nerve is compressed. Grip strength can be the C8 nerve (somewhat rare) but the C6 nerve can occasionally have this effect. See the section on this website “symptoms of cervical nerve injuries” to understand what these nerve root symptoms can cause.
“Intermittent tingling in my pointer finger and thumb” is typically the C6 nerve which might fit with your CT scan findings. I am unclear why the CT scan was performed as an MRI is a much better tool for discovering the cause of nerve compression and there is no radiation used.
A CT scan by itself (without a myelogram-the dye injected in the CSF space) is not a good tool to determine what is occurring in the canal or the nerve root exit zone. I assume you have a C^ nerve compression problem and you should consider an MRI and then a SNRB (selective nerve root block-see website).
It is my opinion that an artificial disc is not useful where there is central canal stenosis (narrowing of the central canal compressing the spinal cord). In this situation, you want to stop motion of this segment as extension (bending the head backwards) can put the cord in jeopardy if the artificial disc allows too much motion. An ACDF (see website) is a much procedure for this situation.
Dr. Corenmantlav86MemberOctober 14, 2014 at 11:58 pmPost count: 5
I’m actually in canada. I went to emergency to get help on a diagnosis, this is where the ct scan was done. I met with the surgeon afterwards and he just examined the results I had already got. I’m interested in other types of care to such as microdiscectomy or cortison shots? (Not sure if that’s exactly what they are) but I’m concerned about the quick move to pull the whole disc… Can you not simply trim it and see how that works? If it is in fact this nerve are that is affecting me…
Thanks for your quick responsetlav86MemberOctober 14, 2014 at 11:59 pmPost count: 5
Also what kinda of results can you expect with a fusion or disc replacement relating to lifestyle? Will I be limited?Donald Corenman, MD, DCModeratorOctober 15, 2014 at 10:36 pmPost count: 8503
First, the diagnosis is not absolute with just a CT scan. In my opinion, you need an MRI or a CT myelogram to determine the source of your pain. I understand you are in Canada but there should be certain standards that are held for imaging in Cananda that would allow for an MRI.
If this is a disc herniation (a soft jelly mass compressing the nerve root), the treatment could be different. An ACDF, and artificial disc replacement (ADR) or a posterior foraminotomy could be considered. Each surgery had advantages and drawbacks.
If this is a bone spur compressing the root, the choices are ACDF or ADR. If there is also significant disc height loss or central canal narrowing (stenosis), the choice is only an ACDF.
A one level ACDF or ADR will not cramp your lifestyle (think Peyton Manning of the Denver Broncos). You would have no restrictions in my practice.
Dr. Corenmantlav86MemberOctober 16, 2014 at 1:00 amPost count: 5
Thanks again for your help and opinions. I’m finding this whole injury and process of getting the best and right help available to be very difficult. I will search out the best way to get an MRI. Is there anyway possible to have send you my MRI and have you take a look at it without me having to make the trip down there? Or is that pointless?
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