[BoxerLover]

#23010

I have severe neural foraminal stenosis at C3-C4 (severe left sided; “moderately severe” right sided); bilateral severe at C4-C5 (left greater than right, but severe bilaterally); bilateral severe at C5-C6; and “markedly stenotic” post-op at C6-C7 (despite an anterior fusion at that level where the foraminal stenosis was also allegedly addressed during surgery). My symptoms, both pre and post ACDF, are all left-sided.

I am 9 months post-op C6-C7 ACDF and have much less neck pain than before ACDF, and the surgery also fixed l’Hermitte’s sign that I was experiencing in my right thigh pre ACDF. I still have some left sided neck pain (although not as severe as pre ACDF); intermittent numbness and tingling in left thumb and index finer (EMG showed “electrodiagnostic evidence of a left C6 radiculopathy characterized by no denervation
and well-established re-innervation”), some pain in scapula and some left-side restriction in shoulder movement despite a successful shoulder surgery 7-weeks ago for bursitis, adhesive capsulitis and posteroinferior torn labrum – shoulder feels much better than before shoulder surgery, but the scapula still feels restricted.

The neurogsurgeon who did my ACDF wants to do a multi-level foraminotomy. I recently sought out a second opinion from an orthopedic surgeon and his advice was (1) don’t go rushing into any more surgeries; and (2) if I had l”Hermitte’s sign before my ACDF and it resolved, that means my ACDF was done for the proper reason and hit the proper level.

Other than just sucking it up and living with neck and scapula pain, which is not pleasant, but is livable without pain medication, of which I take none, is there any danger in just living with severe neural foraminal stenosis?

[Donald Corenman, MD, DC]

#23073

Foraminal stenosis is some risk to live with but generally can be ignored unless or until symptoms get in the way. This is different than central canal stenosis where cord compression is riskier to live with.

Generally, if the symptoms of foraminal stenosis are present (cervical radiculopathy or arm pain, numbness and weakness) then these should be treated (unless the symptoms are minimal and you could live with them). The danger is with permanent nerve injury (rare but possible). Continued compression of an injured nerve could lead to chronic radiculopathy.

If symptoms are not present, then the risk is lower. I would avoid activities that cause extension (bending backwards) to prevent or reduce the compression of the nerve roots.

Posterior foraminotomy can be a good procedure but has some risks as well as benefits (see the section here on cervical foraminotomy ). Only you can determine if you need further surgery by the amount of impairment you have based upon the intensity of your symptoms.

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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