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  • brianc7
    Member
    Post count: 3

    Hi Dr. Corenman,
    I herniated my c6c7 disc in May, 5 months ago. I had terrible pain in my neck, right tricep and shoulder blade lasting 2 weeks. I had an EMG in May when the pain was much less. EMG said I have significant right tricep weakness, and moderate finger and thumb extensor weakness as well as my latissimus dorsi. my tricep had no reflex. I visited a spine surgeon in May. He said the Prodisc ADR was an option. After discussing the emg report, which stated that if strength was beginning to return, I could follow conservative measures. I felt the pain was lessining and my triceps, finger and thumb strength was getting slightly better, definitly not getting weaker. So I told the surgeon I would like to try to wait and see if it continues to improve. I had started to lift some weights in to strengthen my arm further. About a month ago I started to get some pain in my shoulder blade, and even a little in my forearm. I still have some tricep weakness, but not as bad as it once was. original Report stated a 3/5 and now a 3+/5 or 4/5. depending which doctor.

    Originally I thought I had 6-12 months to have good surgical results. Now after reading internet posts and people saying they have not gained any more strength 1-2 years post op,I’m not sure.

    Being a c7 nerve, what should my expectations be if I were to have the ADR at about 7 months after injury?

    If I do not have the surgery, what are the chances of losing the use of my right arm/hand? I never had any numbness or pins and needles, just weakness.

    MRI: Mild central canal stenosis and moderate bilateral neural foraminal stenosis at c6-c7.

    Thank you for your help and knowledge on this scary injury,

    Brian

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Generally, I recommend a decompression surgery for significant motor weakness of an important motor group. For the neck, there might be some room to wait as the cervical nerves seem to be “more forgiving” of delayed decompression than the lumbar nerves. C7 is one of the more forgiving nerves. If the patient chooses, I typically will wait three months for recovery of patients that have triceps motor weakness. Most individuals want to have surgery more quickly than that to have a better chance to recover the motor strength.

    In my opinion, if the strength has not returned after five months, I generally recommend surgery to give the nerve the best chance to recover. There still is a chance that the nerve can recover on its own but the chances are much less than a surgical decompression can allow.

    Dr. Corenman

    brianc7
    Member
    Post count: 3

    Dr. Corenman,

    I agree, surgery would give the nerve the best chance to recover. But I might be willing to take the chance with what I have gained and the small chance to gain a little more without having the surgery. This because as I mentioned my ADR surgery would be done at about 7 months and my spinal surgeon, well respected, who has been doing spinal fusions for many years, has only done about 3 cervical Prodisc ADR’s. So my best chance to recover is perhaps limited. I am concerned about things like, new pain in the neck.

    Because I have gained some strength back, and a lot less pain than originally, does that indicate the c7 nerve is healing a little?

    Thank you,
    Brian

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    The C7 nerve is “healing” somewhat. You can take the risk of trying to live with it in the expectations that the nerve will continue to improve.

    I however have to think in terms of percentages. That is, yes there is a chance that the nerve will improve but at 7 months you have the law of diminishing returns. The longer you wait, the chances increase that it will not heal.

    The ADR from Synthes (Prodisc) is not that hard to implant for a skilled spine surgeon. There are some pearls to know but essentially, the implant technique is not too different from an ACDF. It is the indications for implantation that are so different than the ACDF.

    Dr. Corenman

    brianc7
    Member
    Post count: 3

    Hi Dr.

    Could you tell me, if the Prodisc had to be removed for some reason in the future,
    Is there room for a plate and screws at that same level (c6-c7)? (used to help it fuse) or would it be likely to have to put a plate at the level above (c5-c6) and /or below the disc being removed, to help stabilize it?
    I am wondering because of the cut outs for the “keels”
    would it affect the bones, therefore, cause you to modify a standard c6-c7 acdf?

    Thanks again, Brian

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    The Prodisc can easily be converted to an ACDF and yes, there is plenty of room for a plate and screws. I have revised two Prodiscs to ACDFs (implanted by other surgeons) from patients who had continued pain after this implant. I each case, the revision was easy. The keel is not too deep and can be filled in with autograft which in turn incorporates into the host bone.

    Dr. Corenman

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