CaliFornia

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.

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?

Thank you for the reply. These are my MRI results. Do you believe the “abutment” in C5-C6 can cause the symptoms I described in my earlier post?

FINDINGS: There is normal alignment of the cervical spine. The vertebral bodies are of normal height. There is no compression fracture identified.

C2-C3: Disc desiccation. There is no disc protrusion.

C3-C4: Disc desiccation. There is a 1-mm midline disc bulge resulting in effacement of the anterior thecal sac with no central canal narrowing.

C4-C5: Disc desiccation. Endplate degenerative changes are noted. There is mild biforaminal uncovertebral bony hy pert rophy .

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.

C6-C7: 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.

C7-T1: Disc desiccation. Endplate degenerative changes are noted. There is a 2-mm midline and right paracentral disc protrusion resulting in some flattening of the thecal sac with mild narrowing of the right lateral recess.

There is no cord compression.

IMPRESSION:

1. At C5-C6 and C6-C7, there are 2-mm midline disc protrusions with mild degree of central canal narrowing.

2. At C5-C6, there is a 3-mm right foraminal disc osteophyte complex resulting in abutment of the exiting right cervical nerve root with narrowing of the right neural foramina. There is also left-sided uncovertebral bony hypertrophy with abutment of the exiting left cervical nerve root.