Hi,

I have been in considerable pain for the past couple of weeks with left radiculopathy. My doctor sent me for an MRI and I got the results back today. I am Male, 37 and with a couple of young kids absolutely terrified about the prospect of surgery . Currently, the pain is severe through my left shoulder and left arm and I have had pins and needles in my left index and middle finger for the past week.

Any feedback really would be much appreciated, because I am really scared about this:

C2-3: Negative

C3-4: Negative

C4-5: Negative

C5-6: Posterior osteophyte disc complex is demonstrated. Mild central stenosis is noted. Severe bilateral foraminal narrowing is present, greater on the left.

C6-7: Spondylitic changes are present. Posterior osteophyte-disc complex is noted. A left paramedian disc protrustion is present.

C7:T1: Negative

IMPRESSION:

1. Spondylitic change at C5-6. Mild central stenosis is noted. Severe bilateral foraminal narrowing is present.

2. Posterior osteophyte disc complex at C6-7 with small left paramedian protrusion noted.


Thanks everyone. I am going with the assumption that surgery is going to be necessary, but is it as scary as I imagine it to be and might these problems be resolved with it?

Cheers

Hello and I am sorry you are in pain!

I can give you advice based on my personal experience with "severe bilateral foraminal stenosis" which will cause radicular pain in the shoulders and arms due to the pressure on the nerves passing through that space. I had it at C3/4 and C6/7 bilaterally and severe like yours. I consulted with 4 Neurosurgeons 3 wanted to fuse me at both levels but being that I am only 45 and spend my life mountaineering and skiing I wasn't comfortable with that after talking to many people and doing research on my own. What I learned was that if you fuse the levels below will deteriorate much more quickly and it will limit your range of motion permanently. So I went back to my physiatrist and got a name of a 4th NS who was highly rated and recommended by several other doctors. She was quite adamant that fusing now given my activity level, age etc., that I would be happier with what is called a 'foraminotomy and laminectomy'. This would not impair my ROM nor would it cause the lower levels to degenerate like with fusion. Basically they go in through the back side of the neck and drill the bone back open so that the nerves are no longer being compressed. It is a more invasive procedure and more painful (from what my doctor said) but is much better in the long run if it works. When I say 'if it works' .. She (my NS) explained to me that usually if it fails it is within the first year and then the only option is the fusion. I was ecstatic to say the least and went for it. Mine was 100% successful and I'm doing great 1 year and 4 months later. I didn't think the surgery was that bad but.. I had gone through 9 major surgeries just before that because my injury was caused by a head on collision where multiple body parts were affected so in comparison it was a piece of cake. All of my symptoms were immediately gone and the only regret I had was that in staging surgeries that this wasn't done sooner. In addition to arm symtoms I had headaches everyday and it was hard to turn my neck to the side.. haven't had a headache from neck pain since the day I went in to surgery - Praise God!!

My NS is in Seattle if you want her contact information please email me or PM me through this board. I learned that many doctors won't do this surgery as it seems they all want to fuse as fusion is easier for them but worse for us.. sad... so you might have to seek out several opinions if that is something you consider.

The good news based on your MRI is that you only have one level to deal with.. that is good!! Be good to your neck and to your body!! A physiatrist (a good one) is worth more than gold!!

Hi,

Your findings and symptoms were very close, but not the same, as mine. I had a C5-6 fusion and anterior plate in January 2008. Post-op pain was not all that bad....certainly only annoying at 1 month post op. All symptoms directly from that injury and resultant surgery did well for me and I am happy with it. I have no regrets!

Well, thanks guys for responding I have an appointment with the neurosurgeon on Thursday, so fingers crossed! Did either of you give steroid shots and PT a go? I am rather hoping that trying that will take care of the problem.

To be honest, I am petrified of surgery! Zookester, after reading your report I am certainly in two minds. The neuro surgeon I am going to see is apparently one of the best here in Lincoln, Nebraska and on the conservative site. I will ask him about the long term risks of fusion.

Dubious, you said that fusion surgery worked out ok for you? Can I ask how scary it is to go under for surgery and how long does it take afterwards for the pain to dissipate? I am hoping to not lose any time off work. I would at a desk (which is probably why I am in this mess to begin with!).

Admittedly, on my course of Hydrocodone, the pain is a little more manageable now, but I do still have the weakness in my left arm and the numbness in my middle and index finger in my left hand.

Cheers all

Yes, I highly recommend 'transforaminal injection' and at least it was my understanding that they actually do these injections for two reasons. One to help you get relief from the pain but most importantly to determine if surgery would likely be a success. What I mean by that is if they inject the steroid at the foraminal opening at the damaged level and you get relief then it confirms that is what is causing your symptoms and that surgery is likely to be successful. I also highly recommend massage therapy and PT/Chiro (as long as the Chiro has all chartnotes and MRI/Xray reports) because the muscles along your neck and shoulder will invariably be tightened and need to be released or relaxed so that this isn't worsening your symptoms. This is especially true if you sit at a desk like you mentioned. I would also recommend checking the ergonomics of your desk, keyboard and monitor height and using a proper headset if you are on the phone often. Sometimes just adjusting the monitor height can do wonders for relieving pain in the neck and numbness in the arms or at the very least keep the pain symptoms from returning after you finally get relief. All to often people seek help of PT/Chiro/Massage etc., and get relief and then spend hours on the couch watcing TV with poor posture or return to work and do the same only to undue what was just done and then wonder why they aren't improving. I ended up getting a sit/stand desk for work and changed my TV and sitting arrangement in our home to prevent as best I could any additional strain I was inadvertently placing on my neck.

If you do go to PT be sure to be diligent about doing the home routine if they give you one.. it takes commitment but, is well worth it if you can get away from the pain instead of living with lifelong neck/back problems. Which is all to common.

I also recommend what is called a "tiger tail" which you can get from amazon or REI they make it really easy to relax tight muscles throughout the body.

Lastly.. yes it is always better not to undergo surgery but, once the nerves are causing symptoms and the opening are closed enough to cause the radiologist to comment that it is "severe foraminal stenosis" then most likely the least aggressive surgical fix is warranted. When I say least aggressive that is the foraminotomy not fusion. The surgery for the foraminotomy is more invasive but, less aggressive if that makes sense.

Here is a link to more information about a foraminotomy and the amazing surgeon that performed my surgery. http://seattleneuro.com/patient-educ...-foraminotomy/

I hope that helps,
Tessa

It was a little weird, but not really scary. I remember having referred pain to my chest immediately afterwards but was controlled with pain meds. I think I spent 3 days in the hospital including the day of surgery and off to home to be rendered incredibly bored for 1 month (I don't recall being allowed to drive for 1 month). The pain was really not that bad and certainly controlled with meds. I was just happy to be done with the pinched nerve-related arm pain, numbness, tingling and weakness as well as the headaches!

Thanks guys I have the appointment with the neuro surgeon tomorrow and will certainly ask about PT. I would do whatever they ask if it meant alleviating this pain! Admittedly, with the hydrocodone, the pain is manageable.

Quick question, did either of you try a chiro? I tried one immediately after I had initial pain and unfortunately it made things much worse. I am tempted to try it again though. Isn't it supposed to get worse before it improves?

Cheers

Chiropractic makes sense IMHO to manipulate above and below the levels of involvement, not thru it, supplemented with mechanical traction (both in office and at home several times per day). In addition to that, I am not opposed to interlaminer or transforaminal epidurals if a Medrol dose pack failed. If 1 month (this time frame is variable dependant upon your clinical findings) of a protocol such as mentioned failed, then surgery makes sense. Just thinking out loud...

Oh yes, I saw my trusted Chiro along with a massage therapist 2-3 times per week prior to giving in to the idea of surgery. But.. they need to have your complete imaging file, chart notes available prior to touching you. And then only very gentle traction or use of what I call the "clicker" (not the technical name). And they should provide you with massage to that area and moist heat prior to any adjustments including traction because the muscles are likely tightened and pulling on your neck/head. KT taping can also be helpful and many good Chiro's can apply it properly.

Moist heat and epsom salt baths are also really good for relaxing the strained neck muscles and can lessen pain levels.

Good luck, eat healthy and stay positive!
Tessa

Zookester, I actually stopped seeing my chiropractor b/c I feel like he made things worse. To be honest, I'm not quite sure how I have ended up in this state at 37, I am just really fearful and scared about what to do next. I have the appointment with the neuro surgeon tomorrow and just filling out the paperwork makes me nervous. I have insurance etc through work, but I was born and raised in the UK and seeing so many questions about finances and stuff about certain things not being covered by insurance just makes me nervous. I am used to the NHS where it takes 6 months for anything to get done, but at least you know it is paid for

Although, I have been in the US for 14 years now..just nothing more serious than an appendectomy in that time

Anyways...my chiropractor saw my MRI results and said to me that he still thinks that he can fix things. My posture is pretty awful and he said with adjustments etc, he can free up the nerve.

A lady at work told me she had the same injury and was able to fix it through steroid injections and PT.

I'm not sure who to believe at this point, b/c I feel like the neuro surgeon will probably want to just do the fusion surgery thing, but then doesn't that leave me open to all sorts of problems down the road? A couple of people have told me that fusion surgery on c6 and c7 means the other discs will have issues later on?

Sorry for blabbering so much, but a few weeks ago I couldn't have even imagined being in a situation like this and suddenly it feels like I am falling apart.

Cheers guys.