<3 weeks symptoms so far but worsening motor weakness - what are my options?
 

Thanks so much every1 who has contributed to the wealth of information here on this forum. I have been on this website for last 8 hours.
I am a new victim of disc herniation, 35 yr old male, 2.5 weeks h/o neck pain with rt arm pain, with weakness at Rt wrist extensors (4-/5) and biceps(4/5), MRI - C5-6 Right parasaggital disc herniation, protrusion type, extending into neural foramina. Pain is adequately controlled with meds at this time, but weakness worsened from initial power of 4+/5 at the said muscles. How much more can I wait to continue trying conservatively at this time? This is the first time I developed this, no prior history of disc disease. other cervical discs appear fine, no DDD reported on MRI.
I am scared, confused and sad after having learnt many of the pros and cons of every approach and the experiences of many with good and others with no so good outcomes.

!
 

poonav,

Welcome to the site. There is a ton of information on here and it can be very confusing. You first have to decide what you are willing to live with then find out what option is best for you. There are other procedures that can help you in the short run but will probably just delay the inevitable. The ultimate, at least here in the states that they still teach is fusion which has something like 60-65% chance of sucess initially but could lead to further disc deterioration or ADR which so far in the short run has a much better success rate and is thought to prevent further adjacent disc problems. So, what is your tolerance to risk? For me and others on here, fusion was not the answer and we went with ADR. Talk to people and read and research. Ask your doctors tough questions.

Good luck

Mark

Thanks Mark for beautifully summarising on the current state of treatment choices. My main concern at this point of time though is that are there good examples of people with C5-6 disease who have worsening motor weakness in the dominant arm and hand, who opted for conservative approach in the acute phase and actually did make good recovery?(like it is said that many disc herniations resolve/ improve without needing surgery.)

Of course I understand that my case is in the grayer zone since i have possible progression of my neurological symptom ie weakness of my right arm - I am not sure till what level of weakness should I wait hoping to recover before i really decide on getting it fixed surgically?

Nerve compression pain or disc pain?
 

Poonay,

I think the big question here is what is your pain generator---the nerve that is being compressed by the herniated disc, or the disc itself?? If it is just nerve pain (which is suggested by the arm pain & weakness), then a simple Microdiscectomy (outpatient procedure that takes about 30 minutes, you go home that day) could do the trick. They make a small (1 cm) incision, use a small endoscope to get to the disc, and then remove the bulging portion that is pressing on your nerve and causing the symptoms. However, if the disc is degenerated as well as bulging and the pain is coming from the disc itself, a Microdiscectomy will not work. The disc needs to be removed, and as Mark said you then have a choice between fusion or artificial disc replacement.

Rather than worry and fret, why not go see a spine surgeon or neurologist and get a professional opinion? Your first step is to find out the exact cause of your pain, then you can determine how to treat it. Until you do that, everything else is just conjecture.

Good luck,

Welcome!
 

Welcome to our humble global forum. You’ve received some thoughtful, succinct replies from Mark and Charles, so I hope this motivates you to keep going; researching, seeing different doctors, asking questions and sharing. It is a journey, as many here can attest.

When you can, please:

- see this topic, a very important one: ADR Risks, Complications, Disqualifications;
- add a signature, as in mine or others in this topic, that describe your spinal situation;
- tell us a bit more about your spinal health, e.g. traumas or disease;
- research other options for non-surgical options – have you started yet?

Thanks for posting. And don’t forget that even though you are going through a tough time, you are helping others by asking and sharing. So don’t be shy!

:wiggle:

Sorry that you're in such pain.

I agree w/Charles that you must determine your pain generator(s). If you feel pain on your cervical spine/back of neck, then maybe (and I don't know cervical stuff at all) a discogram is warranted, along w/facet injections to rule out the facets as pain drivers which means that an ADR wouldn't help you vs. fusion (if you have a positive/painful discogram). Hopefully you can get away w/a disectomy. My best, Allan

all of u guys r awesome, i am really greatful to everyone here with all the valuable suggestions, i will be posting in detail soon about my visits with ortho-spine doc and other details of my case. and Rich - will add my signature soon - i have to run now. thank ya all, keep ur suggestions coming.
god bless every1!

Title: Re-Introduction

Hello Mark,Charles, Rich, 'ans' and the forum

I really appreciate all the valuable and important suggestions - enabling me better understand my situation and making me smarter in my questions to my doctors to help them help me.
I have already seen a neurologist, a neurosurgeon and today I met an Ortho-spine as well. I have seen these 3 specialists in that sequence.
To again put it in perspective, my symptoms of right sided neck pain (back of neck) started 3 weeks ago, initially mild pain for 4 days with sudden worsening to 10/10 pain on 5th day, with myokymia of right arm muscles and minimal weakness of the arm. (The pain in my arm has never been as bad as the 'spasms' in the back of my neck.)
Neurologist - seen on 6th day of symptom onset - MRI done - C5-6 disc herniation - suggested conservative Rx with steroids/ anti-inflammatories/ vicodin/ heat - helped in pain, did not notice much difference in weakness.
Neurosurgeon - seen after 2 weeks of onset - I was a little weaker in my right arm than before - agreed with conservative Rx - suggested gentle cervical traction - tried for 2 days - I am unsure whether the traction made it worse or it had to get worse any ways - the weakness of right arm/hand appeared to increase - reconsulted Neurosurgeon - suggested - if weakness worsens - will need surgery - ACDF - likely because he does not do ADRs or MICF.
- saw Ortho-spine today - in NYC - recommended MICF since I have motor weakness which seems to be getting worse and it has been 3 weeks since symptoms started.
- I am considering MICF seriously at this time, but as suggested by all of you - I need to ask him - whether I should get a discogram before the surgery?
Question I still have - I noticed very subtle, short lasting (few seconds) pain on left side of my neck for last 2-3 days - with some myokymia in left sided muscles as well - very transient though - Does that warrant a repeat MRI before the surgery?

Thanks to all
God bless

Navneet

Hi Navneet, Thanks for keeping in touch. How much did you tell the doctor today...did you mention the new pain on the left side? Your MRI is very recent, is it not? I think you need to ask all these questions to the doctor you saw today, and hopefully he can get back to you very soon, since things are progressing quickly.

Do you have his email? He is normally very good about answering quickly, especially if he is concerned about your symptoms.

I'm sorry things are getting worse instead of better, but you are very lucky to be getting some good advice so early in your experience with this pain. So many of us let it go far too long before finding help with doctors as good as you have found already.

Please continue your fight...you are doing a great job, even if it doesn't feel like it right now.

Hi Sue,
I was quite satisfied after meeting this OS doc. He did answer most of my concerns. yes. i did tell him about my new left side symptoms, however subtle or fleeting they are. he did say that he might repeat my MRI prior to the MICF, yes my MRI is just 2 weeks old at this time and my pain is 3 weeks old - grrrrrrr -

Like Mark, Allan, Chalres and Rich have suggested - I really need to ask my doc whether the pain in the back of my neck is from the disc? and would I need a discogram. Though for sure the weakness is from nerve compression and I hope that this pain in the back of neck - is actually from the annulus tear - and resolve in 6-12 weeks like they say - they usually do.

I hope all goes well
Wishing luk

Guys, I am awake so late! I just hit upon some info in older threads regarding the EMG - can having an EMG exacerbate my already bad neck spasms? - reason i am asking this is, I am scheduled for my first EMG in 3 days and might actually plan for the cervical formainotomy a couple of days after that - so I have a baseline EMG. Should I reconsider not having an EMG so close to my planned procedure? Gurus pl advise.

Hi Navneet,

How are you doing with the spasms?

My EMG didn't make things worse, pain wise, but I didn't have the same spasms that you do. I wish I could be of more help. It was a pretty benign test, actually, at least for me. I don't remember much discomfort at all, and my back pain is pretty significant without medication.

Are you checking with the last doctor about your concerns?

Navnett,

I am a lumbar chick so excuse me as I don't know too much about cervical. But i just had a lumbar discogram and read up a lot on it prior to procedure, even though I have had one before. I did see where they don't think cervical discogram is as necessary or as accurate as lumbar discogram.
My advice to you INMHO is to try conservative care first unless there is an emergency to jump into surgery.
Do a lot of research and ask pointed questions of your doc.

Kimmers

Hi every1!
I underwent Post cervical foraminotomy with removal of the disk fragment 2 days ago. so far so good, arm pain appears to have resolved, weakness i guess will take few weeks( 6-12 ?). The pain at the incision site ofcourse was pretty severe to begin with, seems to be getting better. I just hope that everything turns out well.
I am really thankful to every1 here for their precious advice and words of wisdom.
God bless all!

Best Luck- sounds like you took a treat the symptoms approach. Just remember that no matter how good you feel - to be careful with your injury. Your disc is still trashed And when you need to get your disc fixed, avoid ACDF at all costs. Most surgeons recommend it as they've been doin it for years, it's their specialty and they haven't invested in to modernize their skills and practice.

Thx!
ThomasL

Foraminotomy
 

Hey there I just had a foraminotomy on C6-C7 on May1 and was wondering if yous till have residual pain. My pain was minimal before surgery due to cortisone epidural injections however I had weakness and decided to go ahead with surgery. Two weeks post of and i still have pain in arm and numbness, on a level of 0-10 it is below 5.
How is your pain?
Thanks
Rob

Hey Rob
your case appears to be similar to mine. I am about 9 days post-op now, my neck and arm pain is definitely much better, i am now needing about 6-8 tylenol ES in a day, off vicodin almost. I have a cold for last few days and whenever i sneeze, i get pain in my neck, around the site of surgery. I hope it will disappear soon. The weakness in my arm does not seem to have improved yet, I understand its going to take few weeks may be 6-12? what's ur take on this?
Just wanted to clarify, I had a minimally invasive procedure, endoscopically, with 2 cm incision on back of my neck, if u also had similar procedure, then we definitely would be comparable, as the non-endoscopic procedure probably have longer recovery times.
wishing u pain free life

Foraminotomy
 

Hey yes mine was also endoscopic minimally envasive procedure, called laminoforaminotomy using METRXII tubes by Medtronic. My incision is small less than an inch and was outpatient. Doc said I also had some arthritic spurs that he cleared up as well. I had it on Friday 5/1 and back at my desk on monday. Doc said don't lift anything over 10lbs for 2 weeks which I already violated twice and I am upset about that. I have also been taking tylenol during the day as needed and at night sometime a percocet especially yesterday after carrying my laptop bag and a small bag or grocery up 3 flights of stairs :(
I called doc and asked can you do a new MRI but he said not until 6 weeks post op when i see him again. My symptoms now are getting better from the incision, neck was sore and painful for 10 days and starting to feel better today. I wear a soft collar as needed and have been driving also.
My arm pain and numbness persist not like when it first happened but they are there and bother me.

Hi rcphx, could you tell me where you got your surgery done with the METRXII system? I thought that it was hard to find a doctor who uses it. I'm glad to hear that you have great success with it....much better to have a tiny incision than a much larger one. Improvements are coming, slowly but surely! Just think of where we'll be in ten years or so.

Please try to comply with doctor's orders ;) I know it is tough though.

foraminotomy
 

Hi ThomasL,
I did it in Minneapolis at a doctor with the twin cities spine center Dr. Kevin Mullaney. I have to say, as with all of us, we have seen our share of ortho's and Neurosurgeons while dealing with our pain issues. Prior to that I was in Phoenix where I saw Dr Christopher Yeung who also would have done that endoscopically. Dr Mullaney uses the METRXII whereas Dr Yeung said he doesnt use it but the incision would be slightly bigger than the METRX all under an inch. But i was very Impressed and happy with Dr Mullaney's work as far as knowledge, personality, and surgical skills. However, the jury is still out as far as the results I have not done an MRI and I did violate his orders twice. So if for some reason it doesn't work it will not be his fault as I am completely convinced he is an excellent surgeon and did a phenomenal job with me. So if yo live near those two areas or would like more info on Phoenix docs I have seen many from Mayo clinic, to Barrow's neurological insitiute to all the adr docs in phx area.
Hope this helps

Hi Rob
wish you a speedy recovery too. can you please tell how bad was your weakness to begin with and have you noticed any change/ improvement so far in last 2 weeks? what have you been told about the recovery of muscle strength by your doc? how many weeks/ months have you had your symptoms before you underwent surgery?
You can actually add information about your diagnosis under your signature as many of us have done, you need to go to the "UserCP" tab on left side of screen at the top.

foraminotomy
 

My weakness was noticeable but did not prohibit me from doing my job. I have atrophy in left trap, tricep, and forearm. Back in Oct 2007 I regained strength after physical therapy and doc at time said since the pain is gone lets not do surgery. But my problem returned in Feb 2009 after startign rock climbing and lifting weights again. I did not do a new EMG but I can tell it is weaker and my arm is about an inch smaller than the right side.

Hey Rob,
my first symptoms of pain happened on 4/10/09, with pain in neck and rt arm, over next few days pain was worse and then slight weakness in right arm at wrist and abduction at shoulder and some weakness at biceps. Got the surgery done on 5/6/09, which was 20 days after my first MRI. the radiating pain of the right arm has almost disappeared, but the weakness is still there and I do expect it to take some time as every1 says it takes at least 6-12 weeks to recover. I have not noticed any appreciable atrophy of the muscles so far - may be its early, but this is just such a frustrating feeling to know that your dominant hand is weaker than it used to be, it fatigues so easily, unable to do many things which it could do without having to rest and besides that not knowing whether or not and if it will - how much will recover?
I do understand you have had similar problems and I wanted to ask you that :
1) Since your surgery, have you noticed any improvement in the muscle power.
2) What kind of expectations have been set by your doctor for the recovery of muscle power - I did notice that your doctor said - the weakness is not noticeable easily - Ya I know - to him it is not - but to you, it is since its your hand.
3) Have you thought of or Do you know of any other means (exercise, PT, Supplements etc.) to help improve the chances of gaining back the muscle power we have lost, besides the fact that we underwent surgery to give it the best shot at recovery? I have not been suggested any PT by my doctor and I do believe he is a terrific spine surgeon. What's your take on this?

awaiting some insight from you
BTW, I am an internist in training, planning to go back to work next week. ( I have been on leave for last 5 weeks)

foramnitomy
 

to answer questions:
1) since surgery I have been told not to lift anything over 10lbs so i have been avoiding anything that violates that, except for a few times lol. so NO I cannot say either way if there is improvement yet.
2)Doc has not addressed to me course of action, I do nto see him until June 11 (6 weeks post op).
3) PT in the past helped me, no supplements, hitting the gym hard helped hypertrophy muscles that do receive the signals from uncompressed portions of the nerve. But as a bio-medical engineer i know if the electrical signal is interrupted to the affected muscles how in the heck are these muscles going to improve if they do not receive any signals from the nerve. I have no idea if the injured nerve is permanently damaged or not, how do we know?
I have wishful thinking that over time the nerve will recover but I will never know if my C7 nerve root is fully funtional or not as of now.