[c4-c7]

#22305

Dr. Corenman

I am a reasonably in shape 31 year old male with a 10+ year history of cervical disc herniations and degeneration. I’ve participated in physical therapy from August 2015 until the present day (I started going to a specialized personal trainer February 2016). I have not received any cervical steroid shots for over 3+ years (I don’t think they worked last time). I use a Saunders Home Traction unit for an attempt at relief. Over the years I have had shooting/major nerve pain in arms, and while I still do get arm/finger numbness a few times a month, neck pain is the core issue. I have never really gotten good answers about my symptoms and condition, so that’s why I’m writing you today.

CURRENT ISSUES:
I have very uncomfortable, unwavering neck pain all day long, every day, unless I am constantly moving around (sit for 5 minutes, get up and walk around, sit for 10 minutes, get up and walk around, etc), or laying on my back, on a firm bed.

Within 5 minutes of sitting (working at a computer, at desk in office, in meetings, on a couch, on a plane, in a car, etc), I start to have neck pain. Within 20 minutes, the neck pain raises to a pain level of about 4-5 out of 10). At about the 20 minute mark, I also start getting numb triceps on either my left or right arm, left numbness (under the forearm), and also fingertip numbness. If I continue to sit (like if I’m stuck in a seated meeting), or have to meet a crazy deadline at my computer, it will keep getting progressively worse. If I am stuck and can’t move around, I’ll have severe neck pain and arm numbness for days. This usually happens a few times a month.

I recently switched to a standing desk at work, and while it helps a little, I still have the same problem, even while working at a properly set up ergonomic work station.

Any type of moderately strenuous exercises causes discomfort (including low impact elliptical, and swimming). The only way I can ever truly relax for any meaningful period if time is when I’m laying down on my back in bed.

The neck pain has affected every part of my life, from reading, to going out to eat, to sitting in movie theaters, sitting on planes, working, etc.

I recently saw a well-known surgeon, and he suggested a Mobi-C at the C5-6 level (I added in my MRI below). He said most of my problems were coming from there.

MY PROFESSION:
I do video and photo work, and travel 30% of the time, and sit/stand at a computer for the other 70%. I feel amazing when traveling (except for the plane and car rides, neck pain comes on), but I’m finding the computer portion harder and harder to do. I am not outputting the kind of work I’d like to do anymore.

LIFE ADJUSTMENTS:
I’ve been to PT 5+ times (months long series, not only 5 literal visits) over the past 10 years, with varying degrees of success. I have an ergonomic computer work station, I do not lift heavy things, I do not run, I do not play contact sports, or sports in general. I have good posture, and currently work with a licensed physical therapist/trainer. I do exercises that promote good posture, and strength. I typically have to take Ibuprofen at least 2-3 times a week, sometimes more, but I’ve tried cutting back because it’s not healthy. I do neck and back exercises 4-5 times a week. Most of the time the neck exercises (the basic PT kind with bands) cause discomfort.

MRI (2 months old):
C2-3: Mild desiccation with focal 1.5mm central disc protrusion. Abuts thecal sac no cord abutment. no foraminal encroachment.

C3-4: Unconvetebral osteophyte formation on the right with minimal foraminal narrowing. No findings for foraminal nerve root impingement. Cord abutment was noted.

C4-5: Focal 2mm disc protrusion which abuts the thecal sac and slightly abuts the ventral cord. Bilateral uncoverebral osteopyte formatin is noted. Foraminal narrowing, but no findings to correlate with foraminal nerve root impingement.

C5-6: Central right paracentral 2mm disc ostephyte fomplex. Abuts ventral cord with some cofrd flattening. No significant foraminal encroachment.

C6-7: Disc desiccation with broad based central 1.5mm disct ostephyte complex. Abuts thecal sac but no cord abutment or definite findings for foraminal encroachment.

MY QUESTIONS FOR YOU:

1. What would you do in my situation, and how would you treat it?
2. Would getting ADRs or fusions help slow down the degeneration?
3. If #2 is a yes, would 2 artificial disc (Mobi-C’s) be my best option (my insurance would cover it)
4. Because there is so much degeneration happening, is it better to be aggressive with treatment?
5. Are there any new cutting edge technologies I can look forward to? I feel like I’m getting shafted because I’m so young.

Thank you so much!

[Donald Corenman, MD, DC]

#22311

There are some questions that need to be answered. Neck pain normally generates from degenerative disc or facet disease. Arm pain and numbness generates from foraminal stenosis.
(see https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/)

The neck pain can be explained but the arm symptoms do not fit with your radiological report as there is no mention of foraminal stenosis in C5-6 or C6-7 (the two nerve that travel to you hands) Foraminal narrowing as noted at C4-5 (“Foraminal narrowing, but no findings to correlate with foraminal nerve root impingement”) would cause C5 nerve compression and this nerve does not go down below the middle of the upper arm.

I am unclear as to the surgeon’s plan. X-rays would be helpful to ascertain how degenerative the discs really are. X-rays are as helpful as MRIs when it comes to alignment and disc degeneration.

ADRs generally can somewhat help neck pain when implanted at the correct level but are not as effective as fusion for neck pain relief as if the facets are also pain generators, allowing motion through an ADR can allow pain at that level to continue where fusion stops motion and therefore pain. Why he or she does not fell that C6-7 could also be involved is unclear to me as your report notes significant degeneration at that level (“C6-7: Disc desiccation with broad based central 1.5mm disc odtephyte complex”).

Neither fusions or ADRs will slow down the degenerative process. You are young to have three level degenerative changes but unfortunately, you are a victim of genetics. Look at the X-rays and especially the motion X-rays (flexion and extension). You can measure the motion of the suspected levels and measure disc heights. If you are a candidate for surgery and there is at least 50% of disc height remaining and at least 7-10 degrees of motion at the level of the proposed ADR, you can have an ADR. If not, I would recommend a fusion. This is presuming the pain generators are obvious.

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.

[c4-c7]

#22326

Dr. Corenman, thank you so much for answering in such great detail. What’s the best way to set up a paid phone consult with you? I can mail you copies of my MRI and X-ray CDs.

[Donald Corenman, MD, DC]

#22333

Please call Lori Fugate, my office manager at (970) 479-5863 to obtain the appropriate information for a long distance consult.

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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