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  • slou92
    Participant
    Post count: 2

    I hope this isn’t too long winded for my first post. I’m confused and looking for advice.
    I have surgery scheduled for Feb 14th to have an ADR on C6-C7. I’ll copy my latest MRI results after the body of this message if you want to read it. Here’s my background:
    I’m 43 years old. In 2006 I woke up with severe upper back pain on my right side. It was so bad I couldn’t move. That pain never fully went away, although it’s usually at a low level and I don’t really notice it all the time. I do have it every day though and it does limit some things about my daily life. For example, I can’t sleep on my right side to this day and certain things make it pretty bad. Long story short the Dr. I saw at the time ordered an MRI and the diagnosis was that it was cervical DDD that was causing the pain. I had facet blocks twice but they were inconclusive. The reason for this is that the pain is inconsistent. My upper back would be very painful when the blocks were scheduled but on both occasions the pain was very minimal on the day of the procedure. I learned to live with this and for the most part if I remained active it was under control.
    Last winter I started having pain in my left upper back. I thought at first that it was because of poor posture while using the computer but one day I woke up with a numb thumb and index finger and severe pain radiating down the back of my arm. I also had neck pain and the upper back pain on both sides. Depending on how I moved my neck, sometimes I would have pins and needles in my hand. If I kept my head forward, the pain was not unbearable but if I attempted to stand with proper posture (or used a pillow that was too flat), the pain was unbearable. The pain was so bad during my MRI I almost gave up and pressed the button. After 5 weeks of physical therapy the pain was a lot better but the numbness remains. The spine surgeon I saw offered an ADR and after trying physical therapy again I consented and scheduled.
    I have a few areas of confusion:
    The numbness in my left thumb/index finger gets worse but it never gets completely better. It’s pretty aggravating. This has been constant since April. I do get occasional radiating pains in my arm and occasional stingers (pins/needles) down my hand, but nothing like they were in April/May. I think I should get the surgery now while I’m relatively young and the nerve damage is minor. I think if I wait I may regret this. I don’t want to have any muscle atrophy or lasting numbness if I can help it and the thought that the pain I had in the spring could come back is unnerving. That said, I’d like any thoughts on getting the surgery if I don’t really have severe pain right now. Now is a good time for me to take off work for surgery, but I don’t know what may happen in the future.
    Second, the surgeon wants to do a single level at C6-C7. This confuses me because my numbness is in my thumb mainly which would point to C5-C6. The MRI shows the C6-C7 level is the bad one and the Dr. did imaging in his office. I’m sure he has his reasons and I plan on asking him at my pre-op visit, but that is February 02. Any thoughts are appreciated.
    Lastly I’m concerned that if I do have pain brought on by facet problems the ADR may worsen it. That is something I just recently read about and has me pretty worried.

    MRI results from late May 2017:
    C2/3 normal
    C3/4 no disc protrusion or canal stenosis. Mild bilateral degenerative neural foramen stenosis.
    C4/5 no disc protrusion or canal stenosis. Uncovertebral hypertrophy mild to moderately narrows the right neural foramen.
    C5/6 no disc protrusion or canal stenosis. Uncovertebral hypertrophy mild to moderately narrows both neural foramen, slightly worse on the right.
    C6/7 minimal disc bulge, mildly narrows the spinal canal without significant cord deformity. Uncovertebral hypertrophy severely narrows the left and moderately to severely narrows the right neural foramen.
    C7/T1 normal
    Thanks for any advice!

    BRONCOFAN1
    Participant
    Post count: 42

    Hi Slou92,

    I’m sure Dr. Corenman will give you some solid advice shortly, but I wanted to share my experience with you. The full saga is under the topic Neck and Shoulder pain on this forum. Bottom line I had a two level ADR back in July. Initially, despite some severe axial pain afterward, I was pretty optimistic that it worked since it eliminated my disc pain. As time went on thought it was clear I had facet syndrome and that proved resistant to conservative measures, so I had a revision to ACDF in December. Very satisfied with the results.

    Long story shorter, I would really quiz your spine surgeon about the potential for facet issues, whether he is confident your pain is not facet related, etc. I used a top surgeon at a highly ranked facility, but my surgeon was confident that in the absence of radiologically apparent facet damage that ADR would work. It did not work at all for me and was a miserable experience.

    Wish you all the best and hope you get some relief soon.

    Kevin

    slou92
    Participant
    Post count: 2

    Definitely will ask more about the facets. I just found out that this may be a concern. I don’t know for sure if the original issue I have on my right side is from facet joints as the blocks were inconclusive. The MRI from that time (2009) said: “at c6-c7 there is a grade 1/4 retrolisthesis of the c6 vertebral body over c7. Small posterior osteophytes, including spurring of the uncovertebral joints, and a moderate size posterior disk protrusion on the right are seen.” Nothing on that MRI or the recent one from 2017 said anything about facet joints.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You are correct in looking at your numbness in the thumb (the C6 dermatome) and questioning the suggestion of a surgery at C6-7 (the C7 nerve root). The MRI report does support a C7 radiculopathy (“C5-6; Uncovertebral hypertrophy mild to moderately narrows both neural foramen, slightly worse on the right”, “C6-7: Uncovertebral hypertrophy severely narrows the left and moderately to severely narrows the right neural foramen”).

    So the three questions are: Is the C6-7 level causing most of the symptoms in your neck, is C5-6 contributing to this condition and are you a candidate for an artificial disc replacement (ADR)? The last question, the use of an ADR can be answered here: https://neckandback.com/treatments/artificial-disc-replacement-adr-for-cervical-spine/ and here: https://neckandback.com/conditions/failure-of-cervical-artificial-disc-replacements/. Is the C6-7 level less than 50% in loss of height, is there central stenosis (narrowing) in the canal and is there no instability? Finally, have the facets been tested to rule them out as a source of neck pain. It sounds like your facet block test did not go too well (see pain diary: https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/).

    To determine if C5-6 is contributing to the symptoms, have a highly selective nerve root block (SNRB) performed. Good temporary relief would indicate involvement of the C6 root and consideration of including it into the surgery should be considered. Of course, this injection has to be precise. Too much medication can “leak down” to the C7 root and give a false positive report.

    Finally, if C6-7 is the major cause, you could simply have a SNRB here. With great temporary relief (greater than 80%), you should have the correct diagnosis and you could have surgery only here (ADR or ACDF depending upon the C6-7 level anatomy).

    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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