Donald Corenman, MD, DC
Moderator
Post count: 8436

Deltoid weakness is a C5 nerve root problem and C6 innervates the biceps muscle. You have significant C4-5 compression (C5 root-“tight right foramen stenosis”) and C5-6 compression (C6 root-“moderated left and more severe right foramen narrowing by uncovertebral joint hypertrophy”).

This requires some thought process to go through the various scenarios to understand what to do.

C6-7 is not wonderful as there is both foraminal and central stenosis. Unfortunately, your C3-4 level is very degenerative too.

Sometimes surgery is necessary even though we don’t want to consider it. Nerve compression that causes motor weakness is serious and might not be recoverable even with surgery. It is this situation that surgery needs to be considered to allow the best chance for recovery of motor strength.

Based upon your report, the two levels at C4-5 and C5-6 have to be incorporated in the ACDF as these levels cause your current motor weakness (C5 and C6 roots). It is important to free up the nerve roots to have the best chance to allow them to recover, especially with your occupation being a chiropractor.

The level at C6-7 is very degenerative and includes central stenosis as well as severe foraminal stenosis. I don’t think you can “park” a fusion on top of this level (C4-6 ACDF) without causing this level to become symptomatic. Therefore this level needs to be part of the surgery.

The flexion-extension x-rays would be important to know how much range of motion you have in C3-C7. If these levels are as degenerative on X-ray as on the MRI, there should be very limited range of motion. This is important as you are probably looking at an ACDF (fusion) of at least three levels and probably four.

The question is what to do about C3-4. This level does not contribute any motor nerves to the upper extremities so this level is not contributing to your weakness. Depending upon this level’s contribution to your current pain, it may or may not need to be addressed surgically. C3-4 can contribute to neck pain, especially due to the root compression (“Moderate to severe bilateral foramen narrowing by uncovertebral hypertrophy”). This can be determined by a selective nerve root block of C4 and a pain diary (see website).

If the C3-4 level is very stiff based upon the motion x-rays, surgically including it might not cause any significant problem to you in loss of range of motion. This does however mean a four level ACDF which will make your neck stiffer somewhat. You could continue your career but you might not want to consider a change in career to boxing or long distance running.

Dr. Corenman