Ulnar Nerve Compression

Tagged: Motor weakness from cervical nerve root compression- treatment considerations

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CaliFornia
Participant

March 1, 2018 at 8:36 pm

Post count: 12

#27776

My doctor believes the C6 abutment is causing my symptoms, even if those symptoms seem to point to ulnar nerve compression. He gave me gabapentin (300mg/day) and said to check with him in few weeks if symptoms do not improve. He will consider an EMG at that time.

My symptoms started on Feb 11 and I began gabapentin on Feb 21. The pain has largely subsided, though I still feel discomfort occasionally. My neck and right shoulder are also less stiff. But I still have numbness and weakness in my hand. The weakness has improved but the numbness seems unchanged.

Can you please opine if 300mg/day gabapentin is sufficient treatment for the C6 abutment-even if that’s the cause of my symptoms? And is it reasonable for the weakness/numbness to recover more slowly?

Donald Corenman, MD, DC
Moderator

March 2, 2018 at 1:58 pm

Post count: 8660

#27778

It would be unusual for your symptoms to originate from a C5-6 root compression but not impossible. An EMG would be a good test in your circumstances to determine origin of the pain and paresthesias.

Gabapentin dosages can range from 100mg at night to 1800mg/day. There is not one dose that is standard for any patient. The patient normally titrates up to the therapeutic dose slowly and stops either with success (relief of some symptoms) or with side effects that require dosage reduction (or failure of relief).

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.

CaliFornia
Participant

March 5, 2018 at 1:45 pm

Post count: 12

#27802

Thanks for your continued feedback.

1. Can the bone spur regrow after a Posterior Foraminotomy? If so, is meaningful to manage the spur conservatively and resort to surgery only when the abutment has advanced to entrapment or compression?

2. How does gabapentin work to relieve numbness and weakness caused by a bone spur? Can gabapentin work even if the spur is still abutting the nerve?

Donald Corenman, MD, DC
Moderator

March 18, 2018 at 9:48 am

Post count: 8660

#27895

Posterior foraminotomy can allow the bone spur to continue to grow as these spurs grow with motion and the surgery does not stop motion and motion is what causes spur formation.

Gabapentin works by “slowing nerves down”. This means that this medication will work in most situations. It is the potential side effects that patients may not like.

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.

CaliFornia
Participant

November 24, 2018 at 10:41 pm

Post count: 12

#29824

Dr. Corenman:

Recall, my thread stemmed from symptoms on my right arm and hands. And my Feb 2018 MRI showed a bone spur on right C5-C6 level. Since then, pain in my right side has disappeared. But I’m still experiencing weakness in my right grip and problems with dexterity involving my right index finger. I did a fresh MRI and CT scan, and the results (together with those of the Feb 2018 MRI) are below for C5-C6 level.

These are my questions:

1. How can one explain ongoing abutment of C6 nerve root with the lack of pain on my right hand side? Can the nerve adapt to the abutment, which might explain why the pain has subsided?

2. Similarly, how can one explain weak grip/poor dexterity in my right hand with lack of pain on that side? Is it possible pain fibers are no longer being compressed but mortar fibers are being compressed?

3. In your experience, is it likely I will recover my right hand grip/dexterity without foraminotomy at my right C5-C6 level?

MRI AND CT SCAN FOR RIGHT C5-C6 LEVEL

February 2018 MRI
C5-C6: Disc desiccation. Endplate degenerative changes are noted. There is a 2-mm midline disc protrusion resulting in flattening of the thecal sac with a mild degree of central canal narrowing. There is a 3-mm right foraminal disc osteophyte complex resulting in abutment of the exiting right cervical nerve root with moderate narrowing of the right neural foramina. There is also left-sided uncovertebral bony hypertrophy with abutment of the exiting left cervical nerve root.

October 2018 MRI
C5-C6: Anterior osteophyte formation is associated with mild to moderate loss of disc height asymmetric towards the left. Uncovertebral osteophyte formation contributes to severe right neural foraminal stenosis. Mild left neural foraminal stenosis is present. Central spinal canal are normal.

October 2018 CT Scan
C5-C6: Moderate to severe loss of disc height is associated with right greater than left uncovertebral osteophyte formation. This results in moderate to severe right and moderate left neural foraminal stenosis. Broad-based disc-osteophyte complex is asymmetric towards the right and measures up to 4 mm in the right paracentral region. Central spinal canal and facet joints are normal.

Donald Corenman, MD, DC
Moderator

November 25, 2018 at 10:27 am

Post count: 8660

#29827

We talked about a neurological consult and an EMG/NCV test to determine if it is the nerve root in your neck or a compression of the nerve in the elbow or wrist. Did that test occur and if so, what were the results?

Weakness of the hand can derive occasionally from the C6 nerve but more commonly from the C8 or T1 nerves. You do have C6 nerve compression (“severe right neural foraminal stenosis”) but without pain or paresthesias (pins and needles), I worry that your C6 nerve is either significantly injured or not symptomatic. If this nerve was injured, you would have biceps weakness (difficulty lifting with your arm by bending at the elbow).

If you don’t have a nerve test, you should consider one now.

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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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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