dustingfabMemberJanuary 11, 2012 at 11:50 pmPost count: 27
Dear Dr. Corenman,
I’ve discovered a left hand tremor since the end of December. I notice it when performing very fine and detailed tasks like punching the alarm code or sometimes writing.
I’m very nervous about this symptom because I am left handed.
I have a history of cervical herniations with central canal stenosis as a result of a car accident in May 2011.
Initial I did have a tremor and was very clumsy. But this last for about a week. Until recently.
I’ve been going to physical therapy since early June 2011 and has help the pins and needles tremendously. My doctor has recommended a discectomy but I’ve been very weary about considering it.
I’m concerned with recovery time and pain and outcomes if I considered surgery.
If I had the discectomy, would that eliminate the tremor 100%, will surgery eliminate the muscle twitching which has been ongoing since August? I’m at a point where I feel the damage is done. But now my biggest concern is the tremor, will this symptoms progress and become more pronounced over time?
Here are the results: C3-C4, C5-C6 and C6-C7 disc herniations; mild to moderate C5-C7 stenosis and mild C6-C7 stenosis.Donald Corenman, MD, DCModeratorJanuary 12, 2012 at 12:39 amPost count: 8427
I cannot comment on the need for surgery as there are many more factors involved to make that surgical decision. Your physical examination is paramount for some of this decision-making. If you have long tract signs (see section on myelopathy on website) indicating spinal cord irritability or motor weakness that has not improved, you could be a candidate for surgery.
The tremors in your left hand could be from weakness of a specific motor group or from a familial tremor. A familial tremor is a genetic predisposition and not related to the neck or your injury. If the tremor is from muscle weakness, surgery does give the nerve the best chance to recover but there is no guarantee that the nerve will fully recover. Again, if the tremor is from nerve compression, the sooner the surgery, the better the chance of recovery.
Depending upon the surgeon, recovery time is not too bad for an ACDF (see section on website). For a sedentary job, you could be back to work in one week and driving in one to two weeks. You won’t be climbing Mt. Everest until 8-12 weeks however.
Dr. CorenmandustingfabMemberJanuary 12, 2012 at 1:08 amPost count: 27
Thank you, thank you for your quick feedback. At the present time, I’m stuck between a rock and a hard place as I am scheduled for shoulder arthroscopic surgery due to a tear in my labrum and supraspinatus. I’ve already informed my employer of the need for a leave. But the idea of a leave for another surgery is pretty scary.
Is it possible for both the arthroscopic surgeon and spine surgeon to perform surgery at the same time?
You mention an ACDF, which according to whats described on your site seems more involved than a microdiscectomy surgery.
Is the recovery time for an ACDF vs. microdiscectomy similar?Donald Corenman, MD, DCModeratorJanuary 12, 2012 at 2:31 amPost count: 8427
There are three procedures to decompress the cervical nerve root, an ACDF, an ADR and a posterior foraminotomy (see website). The ACDF is the “gold standard”. This procedure has been used for more than 60 years and is generally safe, effective and reproducible. The “failure rate” in the right hands is less than 4%.
The ADR (artificial disc replacement) is a relatively new procedure that allows surgical decompression but continued motion of the segment. This has some benefits and some risks. The benefit of course is continued motion of the surgical segment. This theoretically will reduce the stress on the segments above and below and may somewhat reduce the degenerative breakdown that can occur. This is still theoretical and not yet proven by long term studies.
The risks are that this artificial device will wear out and need to be replaced or changed to an ACDF. This device allows motion which can produce bone spur formation and possible nerve compression down the road but I have not seen this phenomenon at this point. Revision of this device to an ACDF is relatively simple with generally good results.
The posterior foraminotomy is a good procedure in the right patient. If there is disc herniation that is not under the cord itself and there is no neck pain that accompanies the nerve compression, this procedure can work well. Post-operatively, there is neck pain that can be associated with this procedure. The posterior foraminotomy is not always successful however (remember Peyton Manning’s failure after two separate procedures).
Recovery time is fastest for ADR, second for posterior foraminotomy and third for ACDF but all are quite fast in general.
I would generally not consider performing both cervical surgery and shoulder surgery at the same time. Risks of infection and prolonged surgery time would not be beneficial.
Dr. CorenmandustingfabMemberJanuary 12, 2012 at 3:20 amPost count: 27
Thanks Dr. Corenman. Your explanation is very helpful.
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