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  • jr999
    Participant
    Post count: 5

    Dear Dr Corenman. I am in the NY city area and have been handed a diagnosis of severe right foraminal stenosis at level C5-C6. My right hand grip is 50% of my left hand grip even though I am right handed. I also get shooting pains, burning, pains in right chest and inability to type at a desk or use a bicycle with severe right arm pain. My spine doctor recommends meeting a surgeon since 2 weeks after a steroid injection the symptoms are unchanged. My symptoms started 2 months ago. I have a few questions:

    1, Should I see a orthopedic surgeon or neurosurgeon?

    2. Should I consider both ACDF and foraminectomy?

    3. Should I bother with pre-operative physiotherapy? Is it even safe?

    4. Can I possibly have a second contributing condition like pinched ulnar nerve or thoracic outlet syndrome that I should investigate first?

    5. Is it possible to regain grip strength?

    jr999
    Participant
    Post count: 5

    FYI: Radiologist report
    MRI CERVICAL SPINE W/O CONTRAST

    Age: 45 yrs

    Sex: M

    Exam Date: 05/27/2017

    Clinical statement: 2 weeks of right arm numbness and tingling

    Technique: An MRI examination of the cervical spine was performed without intravenous contrast. The examination consists of sagittal T1, sagittal and axial T2, sagittal STIR, and axial 3-D gradient echo sequences.

    Comparison: None available

    Findings: There is straightening of the normal cervical lordosis. There is no cervical spondylolisthesis. The cervical vertebral body heights are maintained. No destructive osseous lesion is identified. Multilevel cervical degenerative changes as detailed below.

    C2-C3: There is minimal left uncovertebral hypertrophy. There is no canal or foraminal stenosis.

    C3-C4: There is mild bilateral uncovertebral hypertrophy. There is mild left foraminal narrowing. There is no canal or right foraminal stenosis.

    C4-C5: There is a disc osteophyte complex, mildly eccentric to the right. There is mild canal stenosis. There is minimal left foraminal narrowing. There is no right foraminal stenosis.

    C5-C6: There is a disc osteophyte complex, with an eccentric right foraminal component consisting of both a disc protrusion and associated osteophytic ridging. There is severe right foraminal stenosis. There is mild canal stenosis. There is no left foraminal stenosis.

    C6-C7: There is no canal or foraminal stenosis.

    C7-T1: There is no canal or foraminal stenosis.

    T1-T2: There is a left central disc protrusion. There is no high-grade canal or foraminal stenosis.

    The cervical cord is normal in morphology and signal characteristics.

    No epidural collection or mass is identified.

    Impression: Multilevel cervical degenerative changes as detailed above. Findings are most pronounced at C5-C6, where a disc osteophyte complex with an eccentric right foraminal component contributes to severe right foraminal stenosis and mild canal stenosis.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Your problem seems to be a C6 nerve compression (“C5-C6: There is a disc osteophyte complex, with an eccentric right foraminal component consisting of both a disc protrusion and associated osteophytic ridging. There is severe right foraminal stenosis”. This means the C6 nerve is severely compressed. Look here to understand how a C6 nerve problem presents (https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/).

    This diagnosis would probably fit with your current symptoms.

    I personally think you should see an orthopaedic spine surgeon but a capable neurosurgeon should be OK. An ACDF generally is much better than a foraminotomy (remember Peyton Manning?) but there are occasions that a foraminotomy would work. Based upon your symptoms including weakness, you should see out a surgeon sooner than later.

    It’s alway possible to have two different disorders at the same time but this is rare. There is generally only one problem that is causing symptoms.

    Yes, it is possible to regain grip strength and the neck is more forgiving of nerve compression than the lumbar spine. Nonetheless, see a surgeon soon.

    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.
    jr999
    Participant
    Post count: 5

    Thank you very much Dr. Corenman. That is quickest, most detailed response I have got from anyone till date including my NYC physiatrist whom I like and respect. I will bear your advice in mind as I conduct my search.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Please keep in touch with the Forum to let us know how you progress.

    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.
    jr999
    Participant
    Post count: 5

    1. I am considering 3 NYC doctors who are all in network. All three are 40-something year old neurosurgeons who specialize in spinal surgery including ACDF, foraminectomy and even minimally invasive surgery. Unfortunately I could not find older (i.e. more experienced) doctors who take my insurance. Two of these surgeons come highly recommended by my physiatrist and the third was a Castle Connoly Top Doctor a few years ago.

    2. The other question for me is: autograft or allograft.

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