ColoradoPTParticipantDecember 28, 2011 at 11:17 amPost count: 4
Thank you so much for this very informative web site. I am a 44 y.o female and I have had two lumbar discectomies (1991 and 1996); No surprise, I now have cervical disc issues. I was diagnosed with two C/S disc herniations about 6 years ago. My symptoms would periodically flare up for 2 or 3 days and with physical therapy and medication, it would resolve. This past Thanksgiving, I had a flare of nerve pain that did not resolve. An MRI showed a rather significant posterior/right herniation of C5C6 and mild disc herniation C6C7. I have had severe aching in R biceps/deltoid and an inability to extend C/S because of pain. I had an epidural injection on 12/22/11. Still waiting to feel results. Still is quite painful to do cervical extension–disc herniation causing physical blockage?
My interest in contacting you and doing it with this forum is to ask: When would you do a posterior foraminotomy vs. disc replacement? (other then bone spurs) I have read your site on these two procedures. How many cervical disc replacement surgeries have you done? What year did you start doing disc replacements? What has been your experience with the outcome? I have been an outpatient orthopedic physical therapist for the past 20 years and I am pursuing any alternative treatment to a fusion. I am lucky enough to live in Summit County so I will be seeing you personally, but I wanted you to share with the community your experience with cervical disc replacement surgery.Donald Corenman, MD, DCModeratorDecember 28, 2011 at 11:39 pmPost count: 8507
Your symptoms fit with foraminal stenosis from the disc herniation or spur formation. Extension of the head will narrow the foramen and compress the nerve root. Pain in the deltoid/biceps area most likely would fit with the C6 root but C7 can occasionally cause this. A thorough physical examination will most likely be able to identify the nerve root.
If you had an epidural injection, I hope you paid attention to the first three hours after the injection. This is when the diagnostic portion of the injection holds value. Numbing the root should have given you 2-3 hours of temporary relief. If not, it is possible the injection did not reach the level of the compression.
Cervical disc replacements work well with herniations and spurs not associated with severe degenerative changes of the disc and no significant axial neck pain. The longevity of the replacement remains to be seen but many have done well 10 years out. I started replacement surgery about three years ago and have done quite a few.
Dr. CorenmanColoradoPTParticipantDecember 29, 2011 at 5:50 amPost count: 4
Thank you very much for your feedback. The epidural did eliminate all radicular symptoms. What I am left with feels like a mechanical block to extension. As you stated, a foraminal block from the disc herniation. If now all I’m dealing with is a blockage (which causes rather constant pain and discomfort) & I have no radicular symptoms or weakness–where do I go from here?
thank you so very much for this forum and your website.Donald Corenman, MD, DCModeratorDecember 29, 2011 at 6:02 amPost count: 8507
Treatment depends upon how significant the symptoms are, how much these symptoms impede your lifestyle and if there is motor weakness associated with the herniation.
I tell patients that if no motor weakness is present, activity restriction is acceptable and they can tolerate the symptoms, they can consider continuing with physical therapy. If there is bi-weekly improvement, then they stay the course. If the symptoms become intolerable, weakness develops or no progress is noted, then a decision has to be made whether to consider surgery.
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