ak31153MemberMarch 23, 2013 at 8:58 amPost count: 6
Hello Dr. Corenman,
First of all, thank you for this wonderful service. As I researched leading up to my surgery, your website and forum answered many of my questions. As you can see in my subject line, I recently (1week ago) had a minimally invasive, microscopic laminoforaminotomy at C6/C7 to relieve left tricep/pectoralis weakness, and constant numbness in middle, and index finger, and half of thumb. Additioanlly, fasciculations through tricep, pectoralis and lat muscle. Prior to surgery, I had an MRI which noted:
C6-7: normal disc height with left uncovertebral joint disc osteophyte/extrusion. There is impingement of the left C7 nerve root. Vertebral canal and right neural foremen are patent.
C5-6: small anterior traction osteophyte. Normal disc height without stenosis.
Now that I have had the surgery, I continue to have numbness in the same area of my hand and I have not noticed any improvement in strength in the triceps, etc. Is it unrealistic to think that I would have relief of my symptoms by now? I had been experiencing the neurological and motor issues for approximately 8 weeks prior to surgery. Also, forgot to mention, two weeks after MRI I had a myelogram with CT pictures, which showed essentially the same thing as the MRI. The numbness was worse upon waking up post-op, but has improved since then. Thank you so much!ak31153MemberMarch 23, 2013 at 9:05 amPost count: 6
Also, failed to mention that my surgeon told me post-op that the nerve root was “tented,” by the herniation, but he chose not to remove the herniation, as it would have required too much manipulation of the nerve. Will this extruded portion of disc, which I was told is small, but positioned perfectly to impinge the nerve root, eventually be reabsorbed? Also, is it common to leave the herniated portion of disc in order to not further irritate the nerve?Donald Corenman, MD, DCModeratorMarch 23, 2013 at 7:54 pmPost count: 8460
A laminoforaminotomy (posterior foraminotomy) can be a good surgery for the right condition. A cervical nerve root that is trapped by a disc hernation can be decompressed by this procedure without the need for a fusion. The herniation has to be accessible by this approach meaning that if the herniation also extends under the spinal cord, in my opinion, there would be too much manipulation of the cord to allow access the hernation to allow a safe decompression.
This procedure works less well if the compression is caused by a bone spur which is a common finding. See the section under “cervical-radiculopathy” to understand the difference. Accessing and removing the bone spur from the back of the spine (which is the laminoforaminotomy approach) is very difficult and requires significant manipulation of the nerve root. This can leave more numbness and pins/needles after the surgery than before.
I assume the surgeon found this bone spur compressing the nerve root and decided after some attempts that it was better to leave this spur than to try and remove it but possibly injuring the nerve more. This was a good decision on his or her part. There are times that a successful surgery cannot be completed without further danger to the root.
The most appropriate treatment if the symptoms have not improved (especially with continued weakness) is to consider an ACDF surgery (anterior cervical decompression and fusion). This procedure will remove the bone spur and free up the nerve root allowing the best chance for nerve root recovery.
Dr. Corenmanak31153MemberMarch 23, 2013 at 8:30 pmPost count: 6
Thank you for the quick response, it is much appreciated! My surgeon told me that the material compressing the nerve was an extrusion from the disc, and that when he was operating, removing the extrusion would have been unnecessarily risky. Additionally, he mentioned that the extruded portion of disc could possibly reduce in size over time as it is reabsorbed by the body. Have you seen patients experience this before? Also, am I being overly ambitious expecting a complete relief of numbness by the 10-day post-op mark? Again, thank you for this wonderful service, and I hope you have been able to get some good skiing in this season! I used to snowboard at Keystone/Vail every weekend when I was attending CU-Boulder!Donald Corenman, MD, DCModeratorMarch 24, 2013 at 8:43 pmPost count: 8460
The surgeon was probably correct in abandoning the surgery if he or she thought that removing the fragment was more dangerous to the spinal cord or nerve root. He or she is also correct that the fragment might shrink down over time but that is not guaranteed and in fact, if the symptoms continue-especially weakness, the ACDF surgery needs to be given hard consideration.
It is true that it might take some time to recover from the surgery but with no real change in symptoms after this surgery, it is not uncommon to repeat the MRI to see what the condition of the nerve root is and what residual compression remains.
Dr. Corenmanak31153MemberApril 25, 2013 at 11:14 pmPost count: 6
I posted this in a different topic, but for some reason it didn’t stick.
I am now 6-weeks post-op, and as I mentioned previously, immediately after surgery, my numbness and weakness increased, which lasted about two weeks. At that point, the numbness started to dissipate, and the weakness started to improve, and today, 6 weeks post-op, the numbness is only noticeable in the tip of my left index finger, and I feel weakness is slowly improving. However, I have noticed that I still get some electrical “shock” sensations in my left hand, where the numbness used to be if I position my neck certain ways. For example, if I pull my head back like I’m trying to make a double-chin, or if I tilt my head back too far to drink water. This doesn’t hurt, but it feels like a sharp zap. My concern is that the nerve root is still being impinged, despite the fact that I had surgery. I am curious to get your thoughts, as I don’t have an appointment with my NS for another two months. Thanks!
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