[Doloressan]

#24994

I’m scheduled to have C4-6 ACDF on June 12th. I went for a 2cnd opinion yesterday. He basically recomended I either have C-3-7 acdf or wait it out as long as I can tolerate the left arm pain n dysfunction and ongoing left side neck n shoulder pain. He said I have impinged nerves at multiple levels and a ‘Swan neck deformity’ at C3-4 creating an S curve then at c4-5 two ruptured discs w bone spurs posteriorly n c6-7 is nearly bone on bone. My foraminal canals up n down bilaterally are severely stenosis n impinging nerves. So that’s my pain in da neck going on, ? I’m scheduled to meet with my current surgeon tomorrow to ask questions and sign the consent form. I have concerns now after the 2cnd opinion as what he explained makes sense about my most probably needing further surgery very soon if I proceed with just c4-6. Any suggestions on how to brooch this discussion with my Dr in a way that I will be heard but also effective and respectful would be a big help. I don’t want to tell her how to do her job. At one point she had suggested c3-7 but posterior approach. I’m not keen on that. Thank you in advance.

[Doloressan]

#25027

My MRI findings: 4/13/2017 MRI
The visualized elements of the posterior fossa and craniocervical junction are unremarkable. There is loss of the normal cervical lordosis. The vertebral body heights are preserved. There are extensive Modic type 1 endplate degenerative changes with severe loss of disc height at C6-7, similar to the prior examination.
At C2-3, level there is mild uncovertebral hypertrophy and left articular joint facet hypertrophy resulting in mild to moderate narrowing of the left neural foramina (image 9, series 5) moderate narrowing of the left neural foramina. At C3-4, there is bilateral uncovertebral hypertrophy and mild spondylosis,causing anterior thecal sac deformity and moderate bilateral neural foraminal narrowing, articular joint facet hypertrophy bilaterally, slightly more pronounced on the left (image 14, series 5).At C4-5, posterior disc protrusion and prominent uncovertebral osteophytes,right greater than left result in mild-to-moderate narrowing of the spinalcanal. The disc and osteophytes mildly indent the right anterior cord. Thereis moderate bilateral neural foraminal narrowing (image 20, series 5)..At C5-6, there is spondylosis, diffuse disc bulge and bilateral uncovertebralhypertrophy resulting in moderate right and moderate to severe left-sidedneural foraminal narrowing (image 24, series 5). There is no evidence ofsignificant spinal canal narrowing..At C6-7, mildly heterogeneous signal is noted at the endplates consistent withbone marrow replacement for fat, narrowing of the intervertebral disc spaceand disc bulging, causing mild anterior thecal sac deformity and mildbilateral neural foramina narrowing associated with mild bilateraluncovertebral hypertrophy (image 28, series 5). There is no evidence ofsignificant spinal canal stenosis.The visualized spinal cord is normal in caliber and signal intensity. The cervicomedullary junction and visualized portion of the posterior fossa areunremarkable. There is no paraspinal soft tissue abnormality. IMPRESSION: 1. Multilevel degenerative changes throughout the cervical spine overall unchanged compared to the prior examination of 20 May 2. There is persistent mild-to-moderate narrowing of the spinal canal at C4-5 as a result of prominent posterior disc protrusion, and accompanying osteophytes, right greater than left. 3. There is moderate to severe multilevel bilateral neural foraminal stenosis as described above.

[Donald Corenman, MD, DC]

#25097

You do have genetically induced multilevel degenerative changes of your neck. There are a number of unanswered questions. What are your symptoms? See the section https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/ to understand how to describe your symptoms. On your physical examination, do you have any neurological findings (motor weakness, sensory loss, reflex loss, myelopathy)? What is the alignment of your neck (found on the X-rays-not the MRI). Did you have flexion-extension X-rays and was there noted a degenerative spondylolisthesis, instability or kyphosis? Do you have a slip at C7_T1 (noted on X-ray)?

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.

[Doloressan]

#25132

Dear Dr Corenman,
Thank you for your time, energy and expertise in providing insight for me. I deeply appreciate it.

My symptoms began when I was age 38 (I’m 55 now) with lower left side neck pain close to the spine that felt/feels like a metallic sticky-burr or thumb tack pushing into the joint n bone area around c5-7 (my perception). On a 1-10 scale this pain ranges from a 4-7. The left side muscles in my neck and shoulder spasm n were also painful. Trigger point injections have helped those. Methocarbomal helps maintain comfortable level of tolerable discomfort. In the past 1 1/2 years my left arm began having tricep/bicep and upper forarm into my thumb-ring finger numbness n pain that feels like a burning deep ache. Other times it feels tingling. The pin needle test shows loss of sensation at my bicep, tricep and a cpl of fingers. My pointer, middle and inside of my ring finger. When I lift things w my left arm, they feel heavier. A bottle of water that weighs 1lb feels like it weighs 3lbs. I have increasing difficulty buttoning, clasping jewelry etc. My neurosurgeon says weakness is 4/5 in the left arm. I do stumble over my left toes when I do a lot of walking and my left leg feels heavy and aches. I feel a burn stop my quaracep that differs from a work out feeling.
I’m told I have severe kyphosis and my 2cnd opinion Dr is quite concerned about the instability of C3-4 in particular. The flexion-extension movement X-ray was unfortunately not done until after my last appt w my neurosurgeon (next time I see her will be on the day of surgery). The X-ray did not mention anything below my cervical spine levels. Showed level C6-7 are the most degenerative with moderate to severe osteophytes.
My fear is that I will need further surgery for C6-7 since my scheduled Sufism for C4-6. I asked about c6/7 and was told my major issues are at C4-6 and that’s what’s being done. So I do not feel satisfied.

[Donald Corenman, MD, DC]

#25133

You have done well to describe your symptoms. The C7 nerve (which exits between C6-7) seems to be involved by your description. The C7 nerve innervates (connects) the middle, long and index fingers with the brain. The C6 nerve connects with the thumb and index (but there is some crossover between C6 and C7 making just the sensory and pain symptoms not perfectly reliable). The biceps muscle generally is supplied by the C6 nerve and triceps (along with wrist flexors and finger extensors) is supplied by C7.

If one (or both) of your surgeons have performed a meticulous physical examination, you would know if you have triceps weakness and by that finding, implication of a C7 nerve involvement. This is one criteria to include the C6-7 level. The next criteria is the amount of narrowing of the disc space. This is a common level to degenerate and if you load a C4-6 fusion on a very degenerative level (C6-7), especially with the significant complaints you note of neck pain (some individuals have degenerative changes with only nerve (arm) pain and not neck pain), I think you are asking for some future problems.

Your statement “I’m told I have severe kyphosis and my 2cnd opinion Dr is quite concerned about the instability of C3-4 in particular” also worries me. How did this physician diagnose instability? Was it from a forward slip of the vertebra above, too much motion on flexion-extension X-rays or some other finding undisclosed? If you have instability at C3-4 and undergo a two (or three) level fusion, this level will wear out faster.

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.

[Doloressan]

#25184

Thank you again for your insights. The second opinion Dr said levels 3-4 are unstable due to the swan neck deformity and kyphosis. He said having just 4-6 done concerned him that C3 would slip further over than it already has bc of the fusion.
When I met with my surgeon for the final appt to sign consent and ask questions, I addressed these concerns and she said she thinks there is only a 10% chance of future surgery. And disagrees about C3 slipping. When I asked about C6-7 she said my main areas of concern are c4-6 and this surgery will address those. I then went for the flexion extension exray which says C6-7 has the least disc space and most bone spurring.
So it is now the 11th hour. I know the areas C4-6 definitely need to be done and I’m hoping the surgeon I’m going with is right. I believe I’m pursuing this bc I am hoping to get away with a less extensive surgery than the 3-7 proposed by the second opinion Dr.

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