katt178ParticipantJuly 17, 2019 at 11:49 amPost count: 1
My neurosurgeon says I need surgery but refuses to do it. He said to live with the pain as long as possible, and to wait another 10 years or so. He said I am too young for surgery and that the rest of my life will be never ending surgery after surgery and by the time I am 80 years old my entire spine will be fused and I will have 0 mobility. This is a very scary thought but with the pain I am in now, I do not see how I can wait years more to fix the problem. Does this sound right to you?
History: 36 yo female, C5/C6 ACDF in 2010 with no complications. This was an emergency surgery due to a large herniated disc that was compressing my spinal cord.
Pain/symptoms returned about 1 year ago. Pain from neck into back of shoulder and radiating down left arm to my 3 middle fingers. Numbness and tingling in hand/fingers. Noted weakness 4/5 in left wrist extension.
In this past year I have tried physical therapy, acupuncture and cervical ESI 3 months ago with no relief from anything.
C1-2: Normal atlanto-occipital and atlantoaxial articulation.
C2-3: Normal disc height and hydration. Mild bilateral facet joint arthropathy. The central canal and foramina are adequately patent.
C3-4: Disc desiccation loss of disc height. No disk bulge or protrusion. The central canal and foramina are adequately patent.
C4-5: Disc desiccation loss of disc height with anterior endplate spurring and 1-2 mm central disc protrusion. Mild bilateral facet arthropathy greater on the right. Minimal bilateral uncovertebraljoint spurring . Mild central canal stenosis of 9 mm. Mild bilateral foraminal stenosis right greater than left.
C5-6: Intact ACDF with anatomic alignment. Left prominent uncovertebral joint spurring resulting in moderate to severe left foraminal stenosis. Correlate clinically for left C6 radiculopathy. No central canal or right foraminal stenosis.
C6-7: Disc desiccation with preservation of disc height with anterior endplate spurring. 4 mm broad-based central disc extrusion with minimal caudal extension mild hypertrophy of ligamentum flavum . Bilateral uncovertebral joint spurring and mild facet joint arthropathy resulting in moderate to severe bilateral foraminal stenosis left greater than right. Moderate central canal stenosis of 7 mm in AP dimension
C7-T1: The disk is normal in heights. Minimal 1 mm posterior disc bulging. The central canal and foramina are adequately patent.
No paravertebral soft tissue abnormality.Donald Corenman, MD, DCModeratorJuly 26, 2019 at 10:37 amPost count: 7255
I think your surgeon is being a bit dramatic. It sounds like you have a significant radiculopathy of the C6 nerve root (“Pain from neck into back of shoulder and radiating down left arm to my 3 middle fingers. Numbness and tingling in hand/fingers. Noted weakness 4/5 in left wrist extension”).
You sound like you still have continued nerve compression of the fused C5-6 level on the left (“Intact ACDF with anatomic alignment. Left prominent uncovertebral joint spurring resulting in moderate to severe left foraminal stenosis”). I am unclear what “intact ACDF” means-whether it means you have a solid fusion or just that the ACDF is “intact”-whatever that really means. If you have a solid fusion, there should not be motion of that level and even with foraminal stenosis, the nerve should not be too reactive. I have however seen fused levels with foraminal stenosis still cause nerve root pain.
The other question is what can the level down cause (C6-7).(“Bilateral uncovertebral joint spurring and mild facet joint arthropathy resulting in moderate to severe bilateral foraminal stenosis left greater than right”). You do have severe foraminal stenosis and your symptoms could be from a C7 radiculopathy. The radiation of pain fits somewhat more with a C7 pattern (“Pain from neck into back of shoulder and radiating down left arm to my 3 middle fingers. Numbness and tingling in hand/fingers”).
However weakness of the wrist extensor is a C6 nerve. It could be you have had that even prior to the C5-6 ACDF and it is an old finding or still related to your continued C6 nerve compression.
I would say a diagnostic block (SNRB) with a pain diary would be helpful to differentiate these two potential pain generators.
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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