[mc6613]

#34306

Hello Dr. Coreman,
I’m a 54 year old male. My symptoms include grip strength loss bilaterally, worse on right side. Numbness right hand pinkie and index finger, neck and upper back pain and headaches. This started about 2 years ago. The grip strength issues seemed to vary and improve up and I got by, but now within the last 2 months my symptoms have worsened and my right hand is becoming un-coordinated and slower than my left hand. My right fingers are also weaker. This has me very concerned. I have gotten a few of opinions, 1)foraminotomy of the c7t1 right side, 2)m6 disc at c7t1, 3)laser surgery (anterior approach) c6c7 and c7t1. Also, I’m awaiting a nerve study as one doctor pointed out to see if it’s even worth operating on at this point. I uploaded my MRI as well. What surgery would you recommend, if any, to address this issue, and can the c8 motor nerve recover in your opinion.
Thank you.
FINDINGS:
Evaluation of fine anatomic detail is partially limited secondary to motion artifact; within these limitations:
Craniocervical Junction / Posterior Fossa: Normal.
Alignment, Vertebral Body Heights, and Curvature: Vertebral alignment is unchanged, including slight reversal of normal cervical lordosis and mild levoconvex curvature.
Vertebral body heights are maintained.
Marrow Signal: There is no evidence of a suspicious focal marrow replacing lesion. There is mild bone marrow edema along the C7-T1 vertebral body endplates, which is likely reactive.
Disc Spaces: Multilevel degenerative changes, including loss of intervertebral disc height, loss of intervertebral disc T2 signal intensity, and a posterior disc-osteophyte complexes.
Spinal Cord: No evidence of a spinal cord signal abnormality.
Level-By-Level:
C2-C3: Uncovertebral and facet hypertrophy. No significant spinal canal or neural foraminal stenosis.
C3-C4: Uncovertebral and facet hypertrophy. No significant spinal canal or left neural foraminal stenosis. Mild-to-moderate right neural foraminal stenosis. These findings are not significantly changed.
C4-C5: Posterior disc-osteophyte complex and facet hypertrophy. Partial effacement of the ventral CSF space. Mild spinal canal stenosis. No significant neural foraminal stenosis. These findings are not significantly changed.
C5-C6: Posterior disc-osteophyte complex and facet hypertrophy. Partial effacement of the ventral CSF space. No significant spinal canal or neural foraminal stenosis.
C6-C7: Posterior disc-osteophyte complex (slightly eccentric to the left), facet hypertrophy, and ligamentum flavum thickening. Partial effacement of the ventral CSF space with mild flattening of the left ventral cord. Mild spinal canal stenosis mild-to-moderate right and mild left neural foraminal stenosis. These findings are not significantly changed.
C7-T1: Posterior disc-osteophyte complex, facet hypertrophy, and ligamentum flavum thickening. Partial effacement of the ventral CSF space and mild flattening of the ventral cord. Mild spinal canal stenosis. Moderate-to-severe right and moderate left neural foraminal stenosis. Slightly progressed on the right neural foramen; otherwise not significantly changed.
Miscellaneous Findings: None.
IMPRESSION:
Multilevel degenerative changes of the cervical spine, as detailed, including moderate-to-severe right and moderate left C7-T1 neural foraminal stenosis.

[mc6613]

#34307

it should say pinkie and ring finger.

[Donald Corenman, MD, DC]

#34308

You have complaints of: “grip strength loss bilaterally, worse on right side” and “last 2 months my symptoms have worsened and my right hand is becoming un-coordinated and slower than my left hand. My right fingers are also weaker”. This is compared to your MRI findings of:
C6-7: “mild-to-moderate right and mild left neural foraminal stenosis”
C7-T1: “Moderate-to-severe right and moderate left neural foraminal stenosis” along with “mild bone marrow edema along the C7-T1 vertebral body endplates, which is likely reactive”.

Adding it all together means you have significant C8 nerve compression (C7-T1 foramen) and possibly C6-7 involvement. With motor weakness and impairment for a long period becoming progressive, in my opinion, you need surgery. The question is whether you need C6-7 addressed and it would depend upon your examination (sensory decrease in C7 dermatome and triceps weakness). If it was only the C8 root that needed attention, I would consider an ACDF fusion of that level.

C7-T1 has very little motion to begin with, you have neck pain with significant degeneration of that disc space and a fusion is pretty benign at that level but will get rid of your neck pain as well as open up your foramen. There are rare patients who due to anatomy, cannot have an anterior approach. In that case, a posterior foraminotomy at C7-T1 would work for nerve compression but wouldn’t help with neck pain relief.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
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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