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    Hello Dr Corenman. Have to say excellent site and happened to find while searching for neck conditions. I am a very active athletic professional and sustained a mod-severe herniation at levels described subject back in january 2011 as result of what i belive was weight lifting. Initial MRI showed a severe bulge at C6-C7 with central and foraminal encroachment particuliarly on left nn root. C5-C6 somewhat less with left nn root impingement as well As a result of these injuries i began having severe 8/10 neck pain with radiculopathy down left arm into tricepts, extensor and dorsum of hand.This pain exceptionally worse when sitting. I also experienced pain into left pectoral area. Weakness and atrophy developed rather quickly into left tricepts, pectoral, forearm and even latissimus. Being in medical field i quickly made contacts with physician collegues and began a short 5-6 week chiropractic regimen that consisted mainly of light manipulation, traction. Without much relief i contacted my pain mgmt friend and began a round of epidurals x 3 spaced 3 weeks apart. Not much relief there either. Followed up after that with an ortho spine surgeon like yourself who suggested surgery. I purchaced an neck decompression device, inversion table and cervical piece that helps improve lordotic curve. Again, not much relief. I began developing parasthesias approx 6 weeks ago into what seems like C7 dermatome. Again, worse with sitting and laying on side. These can be rather severe and range from “pins and needles’ t oalmost full numbness of extremity. Approx 5 weeks ago i had a PRP injection performed on upper and lower cervical area hoping that this would alleviate some of pain and numbness issues. I also began PT 4 weeks ago twice weekly mainly consisting of stretching, massage and acupuncture. So far i have to say that pain level has somewhat decreased qualitative and quantitative to around a 4/10 but worse again when seated. Parasthesias have seemed to stay same (maybe slightly improved) but worse again with certain positional movements and seating. All around seems a little better 5 1/2 months after initial injury but what concerns me is the continued parasthesias, weakness, and of couse atrophy. My question that i have to you is this:

    1. In your medical opinion do parasthesias, weakness and atrophy constitute surgery
    2. What if any other modalities should i consider trying to help relieve symptoms
    3. Could pain relief possibly be from PRP and / or PT and do you have any experience in this area?
    3. Bases on above what would you think my prognosis is? Should i give this some more time? If so how long?

    thank you for your time

    Donald Corenman, MD, DC
    Post count: 8660

    By your description, you have herniations at C5-6 and C6-7 on the left with C6-7 being a larger herniation. These herniations would compress the C6 nerve (C5-6 herniation) and the C7 nerve (C6-7 herniation). Symptoms of a C7 herniation would be shoulder pain that radiates into the middle of the hand, weakness of the triceps, MCP extensors (straightening of bent fingers) and wrist flexion (bending the wrist down). C6 compression symptoms would be shoulder pain radiating into the thumb side of the hand, weakness of the biceps and wrist extension (bending the wrist up and important for grip strength). Neck may or may not be present- it depends upon the tear of the disc itself.

    You have already had a very good conservative treatment program with chiropractic, physical therapy, traction and epidural injections.

    There are new complaints of paresthesias (pins and needles) down the arm which concern you. Paresthesias are generated from the proprioception portion of the nervous system. This is the system that tells your subconscious brain where your body parts are in space.

    Symptoms of paresthesias generally are an indication of nerve root compression and new onset symptoms are slightly concerning. The most concerning symptoms to me however are the generalized weaknesses of the muscles of the arm. This requires some explanation.

    There are four nervous system functions carried by one nerve root. These are sensory (compression would cause numbness), noceceptive (compression causes pain), proprioception (compression causes paresthesias) and motor (compression causes weakness). All except the motor are pure sensation type transmitters. The sensory roots can cause these symptoms with only mild compression but the motor portion of the nerve root is much tougher and more compression is required to make it dysfunction.

    When weakness develops from motor nerve compression, this means the compression is significant. The motor nerve root does not recover easily after compression and some patients even after decompressive surgery may not recover full motor strength. The nerves that are the most to least sensitive are T1, C8, C5, C7 then C6.

    There are four indications for neck surgery, significant motor weakness, spinal cord compression, instability of the vertebra and intolerable pain. You have at least one of the indications.

    In my experience, PRP will do nothing for symptoms of nerve compression. Epidural steroid injections are the single most effective treatment for pain but will do nothing for motor weakness. PT is very important for function but will not help motor weakness.

    My opinion is that surgery for motor weakness is the best option. In the face of a disc herniation without neck pain, surgical options include ACDF or artificial disc (see website for discussions). Motor weakness with neck pain most likely requires ACDF only. There are no studies regarding how quickly the surgery needs to be performed but in my opinion, the quicker the nerve is decompressed, the better the chance of recovery.

    Hope this helps.

    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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