advrider

Dr. Corenman,

Thank you again for all the information you provide on this forum. I think I’m going to go forward with surgery at this point after trying PT, multiple ESIs, the RFA, the suprascapular nerve release surgery and still having intractable neck pain and arm weakness and pins and needles in my arm. Definitely have concerns about having surgery at 33, but at this point I’m already forced to change careers from the military and have had to stop pursuing nearly all my hobbies. Will discuss my concerns about facet pain with the doctor when I see him next week and discuss the ADR vs ACDF again.

Dr. Corenman,

I wanted to reach out to you as I’m still dealing with this issue. I had a suprascapular nerve release surgery in January 2019 which significantly relieved some of the pain I had in my right shoulder blade, however I’m still continuing to deal with bilateral neck and trap pain and weakness in my right arm.

I took your advice and saw a neuromusclar neurologist and had an EMG, results below:

“This abnormal study provides electrodiagnostic evidence of
subchronic reinnervation that was most pronounced in the right
extensor digitorum communis muscle with more subtle findings in
the right triceps brachii and pronator teres muscles. No findings
of active or ongoing denervation were observed. The findings
could owe to a subchronic right C7 radiculopathy, though
confirmatory findings were not seen in the mid-cervical
paraspinal muscles. Despite the clinical history raising concern
for an upper trunk plexus lesion, no significant neurogenic
findings were seen in upper brachial plexus muscles. Clinical
correlation is advised.”

The neurologist wrote that “on examination today, he has weakness in predominantly C7 innervated muscles, consistent with the EMG results of today showing chronic reinnervation changes in C7 distributing muscles. We discussed that this is all consistent with a chronic right C7 radiculopathy. Although he still has weakness on examination, there was no evidence of ongoing denervation, which is reassuring. It is possible that the more proximal pain was due to suprascapular nerve entrapment, so we agreed that continuing to monitor for postoperative improvement would be reasonable at this point rather than pursuing the possibility of cervical spine decompression.”

That was 6 months ago and I’m continuing to have neck pain and right arm weakness, I also saw a thoracic outlet specialist who said that I have symptoms that correspond to neurogenic TOS, but that is impossible to differentiate between neurogenic TOS and cervical spine issues in many cases and recommended pursuing a cervical spine operation as c-spine issues are much more common than neurogenic TOS.

I met with a spine surgeon and he seemed ambivalent about whether an ACDF or ADR would help because the majority of my pain is my neck and I only have occasional tingling and triceps spasms in my right arm and the fact that this is now chronic.

FINDINGS: Anatomic alignment of the cervical spine. The vertebral body heights are maintained and the marrow signal is normal. The craniocervical junction is within normal limits. Normal signal and caliber of the spinal cord.

Segmental analysis as follows:

C2-C3: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C3-C4: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C4-C5: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C5-C6: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

C6-C7: Mild broad-based disc bulge with superimposed moderate right paracentral to foraminal disc protrusion. There is mild narrowing of the spinal canal with flattening of the ventral cord. Mild to moderate narrowing in the right neural foramen and mild narrowing of the left neural foramen.

C7-T1: No significant posterior disc displacement. No spinal canal or neuralforaminal narrowing.

IMPRESSION: Moderate degenerative disc disease at C6-C7.

Any thoughts on whether you think this supports a cervical operation and would there be any evidence that predisposes you to an ACDF vs an ADR?

Thank you for any advice.