Viewing 6 posts - 13 through 18 (of 18 total)
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  • Malcolm
    Participant
    Post count: 5

    Dr Corenman, thanks for the quick response. I have read the sections suggested. The main issue I have is that the pain is very diffuse and does not match a particular dermatome but is the whole of the hand and the forearm to the elbows with occasional parathesia and electric shocks in the hands. The ache is continuous but until the last week there was no neck pain (this is just beginning to get stiff – may be due to my worrying). The upper back has had stiff muscles which are mainly the large ones that run down just inside the scapula and a pain in a straight line across just below them. The cervical angina has been only since Jan. It looks to me very like surgery will be the main option as conservative care has been unsuccessful. I can only sleep by taking a sleeping tablet. A minor point (I hope) you did not refer to the C3-4 impingement. Where would this affect please? Much appreciated for your time and input

    regards Malcolm

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    To determine if the pinched nerves in your neck are causing the arm and hand pain, a selective nerve root block (SNRB-see website) should be used in my opinion. Keep a pain diary (again-website) to determine how much (if any) relief you gain. Little or no temporary relief calls into question the pinched nerve cause of your pain.

    Now, good relief does point to your neck nerves as the source of pain but does not absolutely prove that the nerves are the cause. (Chronic nerve injury pain CNIP-see website, will also be relieved by this injection but CNIP will not be helped by surgery). CNIP occurs in less than 5-7% of patients so don’t be too worried about this diagnosis.

    C3-4 nerve compression can cause cervical angina (the C4 dermatome radiates over the front of the chest wall). Typically as in the case of any pinched cervical nerve root, the pain will increase with neck extension (bending the head backwards) and be relieved with neck flexion )forward head bend).

    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.
    Malcolm
    Participant
    Post count: 5

    Dr Corenman

    I have now had a nerve root block at C5/6 and C6/7 which has had some effect in that the pain did diminish initally but never really went away.It is now as bad as before but more localised in the hands, wrists and elbows. It looks like I will need surgery. As I am a type 1 diabetic I am concerned that although in good health now this amy not be the case in years to come. As a result I do not know whether it is better to have foraminotomies done on both sides of the C5/6 and C6/7 levels (how much will this weaken the spine?) or 2 disc replacements. I would be interested on your thoughts on this.

    many thanks for your input aand for this site

    regards Malcolm

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You now plan to decompress the nerve roots at C5-6 and C6-7. You mention posterior foraminotomies or “disc replacement” but do not mention ACDF (decompression and fusion).

    Posterior foraminotomies have their place with mild to moderate compression of the nerve root without large anterior spurs (uncovertebral joint hypertrophy-see cervical radiculopathy on the website). WIth large spurs or motor weakness (muscle weakness), the posterior foraminotomies are much less effective (remember Peyton Manning?). See the section on posterior foraminotomies on this website.

    Artificial disc replacement vs ACDF is a topic I have covered on a sticky at the beginning of the neck pain forum. Please review that on the forum. Being a type 1 diabetic makes surgery somewhat more challenging but you could still consider either ADR or ACDF surgery.

    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.
    Malcolm
    Participant
    Post count: 5

    Many thanks for your reply. I have looked at the MRI’s with the surgeon and he showed me that the discs concerned on impinged at the foramina and did not bulge in the middle. I cannot comment on how large the spurs are but he is confident that doing the foraminotomies gives a high chance of success without affecting the stability of the neck. I have not considered ACDF as I would rather keep as much flexibility as possible.If necessary (which one hopes of course is not the case) I am informed that a disc replacement could be done later. The surgeon also advised that a foraminotomy is least invasive option available to me. Again many thaks and my regards Malcolm.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    If the spurs are not too large, then the foraminotomies should be a good choice. Please let us know how you do after surgery.

    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.
Viewing 6 posts - 13 through 18 (of 18 total)
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