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  • jake90810
    Member
    Post count: 2

    Dr. Corenman,

    Thank you for reading this post and taking the time to give me your opinion. This site is such valuable source of information!!!

    My history:

    No history with chronic neck pain until weightlifting accident Sept 2004. Resulted in large disc protrusion at c6-7. After 6 months of conservative treatment had ADR surgery with a PCM disc at c6-7. ALL symptoms and pain were completely relieved. Back to work in 1 week. Resumed physical activities – weightlifting, roller hockey, skiing.

    Pain and symptom free until recently, appx Nov 2012. Current symptoms may have been brought about by a roller hockey incident where I fell head first into the boards. I did not wake up the next day and notice immediate neck and radiating arm pain, but that may have been the trigger.

    Current symptoms since early December 2012:

    Pain in neck, down into shoulder blade area, right and left side. Sharp stabing pain shoulderblade area. Pins/needle/ach in the right and left outer upper arm area, near sholder. Pins/needles/ach right outer forearm down into right thumb. Recently, developing same feeling in left thumb as well. Symptoms worse when sitting, coughing, sneezing. I can take the pain, but not the pins/needles/ach in the arms.

    Treatment: Physical therapy/ chiropractor treatments. Medications (motrin, vicoden, Celebrex, medrol pack). EI shot at the C5-6 and C4-5 levels (relief lasted one day, then returned)

    My Question:

    The symptoms point to the C5-6 level as the source. Considering how well I responded to a prior ADR, with similar symptoms, I am leaning towards ADR surgery.

    Also, do you see anything in the MRI report that would be consistent with tingling feelings in both feet and sometimes thighs?

    Any observations, comments or suggestions are greatly greatly appreciated.

    MRI Date: 02/07/2013
    C2-3 All normal
    C3-4
    Mild loss of disc height is present. 1 mm diffuse disk bulge is eccentric towards the right and mildly effaces the thecal sac. Cord not compromised. Right neural foramen is normal. New mild left neural foraminal stenosis is present due to uncovertebral hypertrophy.

    C4-5
    Moderate to severe loss of disc height and endplate osteophyte formation is asymmetric towards the right has increased. Diffuse disc bulge is associated with increased size of 2 mm focal right paracentral disc – osteophyte complex which results in increased mild central spinal stenosis and flattening of the right ventral aspect of the cord. Mild bilateral neural forminal stenosis due to uncovertebral hypertrophy is unchanged

    C5-6
    Moderate to severe loss of disk height, the irregularity of the endplates and osteophyte formation towards the right I unchanged. Diffuse disc bulge is associated with a 2-3 mm focal left paracentral protrusion resulting in mild to moderate central spinal stenosis and flattening of the cord is unchanged. Severe right neural foraminal stenosis is increased and severe left neural foraminal stenosis is unchanged.

    C6-7
    Artificial disc placement which results in geometric distortion at this level. No compromise of central canal or cord is present. Neural foramina are normal

    C7-T1
    Disk, central spinal canal and neural foramina are normal.

    T1-T2
    Moderate loss of disc height associated with irregularity of end plates and osteophyte formation. 5-6 mm hemangioma within T1 vertebral body. Central canal and neural foramina are normal

    T2-T3 All normal

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    An ADR might work at the C5-6 level but there are some considerations that need to be taken into account. First is that this C5-6 level is very degenerative based upon MRI findings with “moderate to severe loss of disc height”. Reconstructing the C5-6 level to the previous height of the disc (which is what the ADR does for the most part) can increase or create new neck pain.

    The second is that the ADR is designed to reduce the stress on the levels above and below to reduce degenerative changes. This device at C6-7 unfortunately did not work for you as C5-6 became very degenerative in spite of this ADR.

    If you have developed myelopathy from compression of the cord, this disorder could be the source of of the tingling feeling in your legs. A simple physical examination can reveal if this is the case.

    You might be better off with an ACDF but without review of your MRI and X-rays including flexion/extension, this is an unknown.

    Dr. Corenman

    jake90810
    Member
    Post count: 2

    Thank you Dr. Corenman for your response.

    Regarding the ADR at c6/7 in 2005, yes it is an unknown whether it simply delayed the inevitable or not. At that time, I consulted with several top doctors in LA. Two recommended a 2-level fusion, one recommended a 1-level and a fourth said 1 or 2 level. Ultimately I opted to participate in a clinical study for a 1-level ADR.

    Regarding your comment “Reconstructing the c5-6 level to the previous height of the disc (which is what the ADR does for the most part) can increase or create new neck pain.” Would a fusion not also do the same since a graft is placed between the vertebrae? Or is the graft not as “thick” as an ADR? What would be the cause of the new pain and why? Is there a term or description for this I can research?

    Also, regarding the level causing my symptoms. The pins/needles/ach raiding down the outer forearm into thumb area indicates c5-6. But would c5-6 also cause the same type feeling in the left and right outer (lateral) middle arm area (I said upper previously by mistake). Occasionally, this feeling seems to be more along the bicep area (middle part) of my arm and sometime it feels closer to the triceps area (back) of my arm. The MRI indicates severe right and left foraminal stenosis at c5-6. The c4-5 level indicates “mild” only. Lastly, is foraminal stenosis caused by the “severe loss of disc height” at c5-6?

    Once again thank you very much!!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    An ADR (artificial disc replacement) restores at least some of the lost height of the degenerative disc and that can be a problem. The long-standing collapse of the disc height produces contraction of the capsules and wear of the facets in the back of the spine. Distracting these facets (which might have worn down over the ensuing years) and reintroducing full motion can create new onset facet pain. Also, the contraction of the facet capsules might not allow much motion of the new ADR. See anatomy of the cervical spine on the website to understand this.

    Yes, the graft used in fusion is about the same height (or sometimes even thicker) as the ADR but the graft fuses the two vertebra together so the motion stops. Without motion, any potential degenerative facet pain is eliminated (pain only occurs with motion).

    The symptoms you note are consistent with a C6 nerve involvement (C5-6 foraminal stenosis).

    Yes, the severe foraminal stenosis is caused by the loss of disc height at C5-6. The uncovertebral joint which is the inside wall of the nerve root foramen develops a mushroom-like bone spur and the combination of this spur and the loss of disc height finally crowds out the nerve.

    Dr. Corenman

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