nmcclymoParticipantAugust 20, 2019 at 7:58 pmPost count: 1
I have a small right sided disc foraminal protrusion/extrusion at c5-6. I have had two epidural steroid injections with some relief. However, I am ten days out from the second one and have started having symptoms on the opposite side of my herniation (per MRI in April). I have started having pec insertion pain radiating down to my left thumb.
I have been offered an ADR but have been trying to do everything to avoid surgery. I am an active 30 year old female. I have heard of young females having poor outcomes (dislocation) due to hypermobility? Do you have any input on this? Also, is there any reason a foraminotomy wouldn’t be appropriate instead?
This injury occurred in January 2018. I have symptoms into my thumb and atrophy through my trap, bicep and thumb (shoulder blade area as well according to PT).
I am open to any input!
Thanks, NinaDonald Corenman, MD, DCModeratorAugust 21, 2019 at 4:47 amPost count: 6907
If you have pain and atrophy (which means motor weakness/muscle mass loss due to nerve root compression) and you have had these symptoms for well over 18 months, you should consider surgery. I think 6 months of symptoms with some mild motor weakness without atrophy is the point that surgery should be considered. You might have some chronic problems at this point even with surgery due to the longevity of the root compression.
I have not seen artificial disc replacement (ADR) dislocation due to hypermobility but I only implant ADRs in patients without instability (degenerative spondylolisthesis). If there is any slip of the offending level, my patients get an ACDF (fusion).
Posterior foraminotomies can work but if there is a large uncovertebral joint spur associated with the nerve root compression, this procedure is much less effective.
As far as developing opposite sided symptoms after an epidural injection, it really depends upon the type of injection and the technique of delivery. I have seen epidurals (injection from the posterior interlaminar route) have a volume effect and cause temporary symptoms. If this was a SNRB (selective nerve root block) performed through the foramen on the symptomatic side, it would be much less likely.
Dr. CorenmanPLEASE 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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