[Higgi]

#7590

I suffered a significant SCI two years ago. My neck is fused anteriorly C3-C6 and
posterior C3-C7. My left arm has weak movement to the forearm (supination), but only trace movement in the wrist and thumb. The left obliques contract as well as weak abdominals and back. For clarification the aforementioned is all I have of motor function below my chest. . I am technically sensory incomplete and motor complete per ASIA qualifications.

Reviewing my MRIs I believe that the C4 & C5 nerve roots are pinched.

Two questions;

1) With posterior fusion already in place is it possible to free a pinched nerve root via foraminotomy (or ?)?

2) My cord is located “intimately ” in contact with the anterior side of the spinal canal from C4 to C6. It is that way even in the first post surgery MRI just 3 months and two weeks after. I have created 4 short YouTube videos of axial MRIs that can be found simply by entering my YouTube username (“danielhiggi”) into the search field (with one exception its all I have out there and they are all public). Would you please take a look at these and let me know your perspective as to why my cord is “positioned” where it is? Note: The images are all zoomed to display only the area of the vertebral body & spinal cord/canal. [Best viewed full screen.]

[Donald Corenman, MD, DC]

#7598

Unfortunately, you have suffered a significant spinal cord injury. Your surgery looks to have been completed well. Yes- posterior foraminotomies can be performed to decompress even a fused level but I am not sure that decompressing the root will yield much function.

Now, if you had pain that radiated down through the nerve into the arm, that might be another story. Look up the new thread on the website regarding injury to specific nerves and see if one of the roots matches any symptoms you might have.

If there is some indication of pain that radiates into a specific dermatome, then you might need to undergo some testing. First, a thorough physical examination would be important. If the nerve under question has significant signs of hyperreflexia, this still might not be a solvable compressive issue. A selective nerve root block (SNRB) might then be called for.

Even a good response from a SNRB does not guarantee that a surgical decompression will solve the pain. Anesthetic will temporarily relieve both a compressed nerve and an injured nerve. Surgery to decompress the nerve will only yield relief in the case of a compressed nerve but not an injured nerve.

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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