[PTER]

#9449

Dr Corenman,

Thanks for supporting this forum, there is a lot of really good info on your site.

I am a 47 year male, started to get pain and numbness in my left arm a couple of weeks ago and had a MRI with the following results. Had positive Hoffmans signs and hyperreflexia on the right arm. The recommendation from the surgeon was a triple fusion c3-c6. My question is without surgery what can I expect in terms of the next 10 years. Should I have any activity restrictions, and do I risk further complications. Does the MRI support surgery in your opinion?

Thanks again for your help.

MRI cervical spine without gadolinium dated 9/17/2013

Clinical History: Left C7 radiculopathy.

Comparison: No prior comparisons are available.

Technique: Sagittal T1, T2, STIR, axial T1 and gradient echo MRI images of the
cervical spine were obtained without gadolinium.

Findings: The visualized posterior fossa structures and the craniocervical
junction are normal. There is straightening of the cervical spine curvature.
The cervical vertebral bodies are normal in height. The bone marrow signal is
normal. No acute fracture is seen within the cervical spine. The cervical
spinal cord is normal in signal. Degenerative disc disease and disc space
narrowing is most prominent at C4-C5, C5-C6 and C6-C7 levels. The visualized
paraspinal soft tissues are within normal limits.

Axial images:
C2-C3: No stenosis
C3-C4: No stenosis
C4-C5: Disc spur complex and uncovertebral joint hypertrophy resulting in
effacement of the right ventral CSF space, mild left neural foramen and mild
to moderate right neural foramen stenosis
C5-C6: Disc spur complex, large right paracentral disc osteophyte, deformity
of the right ventral cord, uncovertebral joint hypertrophy and moderate to
severe left neural foramen encroachment
C6-C7: Disc spur complex and uncovertebral joint hypertrophy resulting in
moderate to severe left neural foramen encroachment and mild effacement of the
ventral CSF space
C7-T1: No significant stenosis

The visualized upper thoracic spine is within normal limits.

Impression:
Multilevel degenerative changes of the cervical spine, most significant at
C4-C5, C5-C6 and C6-C7 levels, as detailed above.

[Donald Corenman, MD, DC]

#9468

The MRI does not by itself generally signal a need for surgery. Your symptoms (through a good history) and physical examination are very important to add to the global information to assess the need for surgery.

How significant is the stenosis? This is the one finding that can signal the need for surgery without looking carefully at the symptoms. If you participate in sports or occupation that put your neck at risk (horseback riding, mtn biking, skiing, etc..) then surgery could be more warranted.

If the stenosis is not significant then we boil your symptoms down into two weeks of left arm “pain and numbness”. If the physical examination did not reveal weakness of a specific motor group (C5, C6, C7, C8), you would be a good candidate for interventional injections and physical therapy. Even with some weakness, a shorter trial of conservative care can still be helpful.

It is unusual that you would have long tract signs (Hoffmans signs and hyperreflexia) in only one extremity and not others if you had cord involvement. Do you have symptoms of myelopathy (see website for description)? If you did have myelopathy, surgery should be contemplated as cord compression causing dysfunction is serious. If this is the case, a three level fusion might be necessary.

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.

[drjay]

#9590

Hey doc, appreciate your forum and wisdom. I’ve written before, been out of the loop.
Wondering about your thoughts on the DRX 9000 C decompression system? I have been diagnosed w/ C5-6, 6-7 disc protrusion/ herniation/ stenosis.
Thanks
Jay

[Donald Corenman, MD, DC]

#9627

The DRX 9000 is a traction machine pure and simple. It may have multiple bells and whistles but it is only a traction machine nonetheless. Does it work? Temporarily in some cases but it is the most expensive traction machine the world has ever seen. It should not cause injury and its use is up to you if you want to pay the cost of admission.

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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