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  • jmc118
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    Post count: 1

    Hello Doctor,

    I have had escalating neck pain for 14 months. My family physician referred me to pain management Nov 2012. At that time I had an MRI. Here are the findings…

    OSSEOUS STRUCTURES: There is a loss of lordosis and a moderate kyphosis of the lower cervical spine. Prominent disc space narrowing anterior, posterior, and uncovertebral osteophytosis is seen at C5-6 and to a lesser extent C6-7. Severe bilateral foraminal stenosis is present at C5-6. Moderate bilateral foraminal stenosis is present at C6-7.

    INTERVERTEBRAL DISCS: There is a right paracentral extruded disc herniation at C4-5. This measures 7mm vertically by 5mm AP by 5mm transversely. This minimally abuts the anterolateral aspect of the cervical cord. A broad based spondylitic disc protrusion is seen at C5-6. This too minmally abuts the ventral aspect of the cervical cord. A shallow central subligamentous protrusion is present at C6-7 which closely approaches the ventral cervical cord.

    SPINAL CORD/SPINAL CANAL: The cervical cord has a homogenous appearance. Borderline central canal stenosis is present at C5-6 and C6-7.

    IMPRESSION:
    1) Severe bilatral foraminal stenosis at C5-6.
    2) Moderate bilateral foraminal stenosis at C6-7.
    3) 7x5x5mm right paracentral extruded disc herniation at C4-5.
    4) Broad based spondylitic disc protrusion at C5-6.
    5) Shallow central subligamentous disc protrusion at at C6-7.
    6) Borderline central canal stenosis at C5-6 and C6-7.

    (Before relating the escalating neck/arm/back symptoms I’d like to mention I have had bilateral releases of the carpal and cubital tunnels (not by endoscopy). Right side in April 2012, and left side in Oct 2012. Other than slight pressure related tenderness at the palm incisions, these surgeries appear to be successful.)

    I did receive 2 epidural injections. Nov 2012 at C7.1, and Dec 2012 at C5-6 after three failed attempts to catheter up to C4-5. Relief was minimal and short term.

    At the onset of cervical symptoms I was having sporadic shooting/stabbing pain from the neck upwards in front of and behind my rt ear. Occasionally experiencing pain up the back of my head that actually brought tears to my eyes. The back of my rt shoulder blade area has been burning more or less consistently even before the pains up the neck began. The burning also at the top of shoulder area near base of neck. Then pain under both arm pits with radiating burning all the way across the clavicle area and corresponding anterior areas. Dull and sharp pins/needle sensation at base of throat moving up into jaw and sometimes the cheekbone. More prominent on rt side but the more I am using left to relieve the rt, left side symptoms are increasing. There are extremely sharp deep stabbing pains in the right anterior mid upper arm that progress around the elbow, deep into the forearm, and now often also include the wrist area at thumb and forefinger side. The rt arm, posterior shoulder, clavicle area, and back of neck hurt so much I am only getting about 3-4 hours sleep a night and often have to sleep sitting up in a recliner to relieve pressure. There is weakness in the rt arm at elbow, wrist, and when gripping with thumb as evidenced during clinical exam. Middle and ring fingers have no strength when splayed open. Spiking pains originating at the cervical spine are increasing, with the area staying sore 24/7. Sensations in the throat itself as if I can’t swallow properly are beginning to freak me out.

    I recently saw an accomplished neurosurgeon at Texas Orthopedic Hospital in Houston, 100 miles from my home. After relating the above I was quite alarmed by his decision to send me home with a steroid pack, Mobic, and an order for PT to include ROM for rt arm and spine stabilization techniques. His clinical exam itself has put me in increased pain for several days so I am very nervous about being able to tolerate PT and doubtful of its necessity at this point.

    Truthfully, after being sent home by this neurosurgeon my faith in his treatment plan that leaves me in physical distress is nil, and wondering if I should seek another opinion. I am very concerned about permanent nerve damage to my rt arm.

    Your thoughts would be greatly appreciated.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Much regarding your symptoms pivots on your physical examination. If you have significant motor weakness, this would lead more to a surgical diagnosis. If weakness is minimal, conservative measures are the path to take, at least initially.

    If you have already failed multiple attempts at conservative measures, then a surgical discussion needs to take place. This requires a careful assessment of your symptoms (neck vs. arm pain), what aggravates and reduces the symptoms (differentiation of disc pain vs. foraminal stenosis-nerve pain). Finally an understanding of what surgery will and will not do for you (a reasonable understanding that you won’t be perfect after surgery but better).

    The fact that he did not jump into a surgical discussion is not a bad sign.

    Dr. Corenman

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