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Old 09-13-2012, 09:01 AM   #1
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Surgey not proven to improve nerve pain from nerve pain impingement?

Edit-sorry title sposed to say "...pain from nerve root impingement" am not sure how to edit.

I have a compromised nerve root with impingement at c6 (originally thought it was c7 based on mri as a bulge more visible at c7 level but smaller bulge at c6 the culprit) the result of a traumatic fall in football 2 and a bit yrs ago, the pain pattern matches the nerve conduction study etc etc, it took me a long time to get this even diagnosed. I only have nerve pain but it is near the pain threshold for me 24/7, so for me this is a serious serious problem. Ive tried physical therapy, anti depressants, epidural steroid injection (no success unfortunately), am now on lyrica (near max dose provides maybe 30-40% relief for some hours which if great for me but the deep pain remains). I am now seekign a surgical opinion, cause well simply no surgeon has examined my pictures after the nerve conduction study findings. But my neurologist and the pain clinic I have attended all tell me surgery is a 50/50, has no proven clinical findings and some ppl can get better but others worse for a case like mine. They say the success rates the surgeons publish are just marketing so american doctors can make their millions buy a bigger house etc. In fact my neurologist was jumping to conclusions about how no surgeon will touch me cause theres no functional nerve deficits.

Anyway my qs is does anyone know about the general surgical success rates for treating pain in similar scenarios where theres a detectable nerve root iritation but the only symptom is pain (for me it goes down left shoulder and arm and it is crippling, i cant hold my head back with my neck straight or shoulder back where its sposed to be its too painful) or have any personal experience with this they can add? Im just seeking guidance, i dont know if i can live with this the rest of my life, i would have to get into some heavy narcotics + lyrica i think if i want to have any reasonable standard of living, but with the heavy narcotics I can lose my natural defense mechanisms to the chronic pain which can induce the worst episodes of pain where i have no control and its so overwhelming i feel like im about to die or something (i generally have this persistent feelign of doom anyways caue of the pain, but it gets terribly amplified). Can anyone relate to this, it sounds weird but never underestimate your body's ability to adapt...

Last edited by skeletor3; 09-13-2012 at 10:20 AM.

 
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Old 09-13-2012, 01:55 PM   #2
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

<< They say the success rates the surgeons publish are just marketing so american doctors can make their millions buy a bigger house >>

Yeah, you should be spending your money on Physical Therapists and Pain Management docs instead. Don't they deserve to have bigger houses, too?

Let's see what the surgeon says....

Do you, perchance, have the radiologist's report from your cervical MRI?

 
Old 09-13-2012, 07:51 PM   #3
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Well to be fair the dr who told me that at the pain clinic wasn't actually charging me personally anything as it was all coveredby government subsidies, neurologist on the other hand not so much. Yeh i can type up the MRI report, i think its lacking sufficient detail about the disc at the corresponding level though (go figure):

Sagittal T1, T2, STIR and transverse T2 images were performed.
Alignment: Slight loss of the cervical lordosis noted. Diffuse kyphosis
Bone Marrow: no focal bony lesion
Cord/Conus: no altered signal intensity
Transverse images were performed from the C2 to the T1 level
C2/3 disc level: no disc herniation
C3/4 disc level: Diffuse broad based disc bulge associated with minimal to moderate canal stenosis with some right foraminl narrowing and nerve root abutment
C4/5: Minor disc bulge. Minimal canal narrowing. Uncoverterbal degenerative features, minor associated with some foraminal narrowing
C5/6 disc level: Disc osteophytic spurring associated with moderate canal stenosis. Trace of CSF fluid anterior and posterior to the cord.
C6/7 disc level: Disc osteophytic spurring associated with focal disc herniation to the left of midline associated with left foraminal narrowing. Moderate canal stenosis.
C7/t1: disc bulge to the left of midline associated with minimal narrowing. No overt nerve root impingement. From the sagittal images, no focal disc herniation. Minor bulges.
Conclusion
Multilevel disc ostephytic spurring as described with moderate canal stenosis c5/6 and focal disc herniation c6/7 level to left of midline.

There you go, now keep in mind the bone spurring is probably not relevant causation wise cause the nerve pain was instant after the injury, probably just indicative of a nerve problem.

 
Old 09-13-2012, 08:10 PM   #4
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Your MRI report does indeed seem rather innocuous. I guess if one were to expect anything to be symtomatic, it would be whatever is governed by that left C7 nerve. (the radiologist just says there is "foraminal narrowing" there, but says nothing of the severity of the narrowing... unfortunately, too many radiologists can't be bothered to do even a half-decent job)

Why do you think it's the C6 nerve, when the C7 is the only level at which the radiologist says there is a foraminal problem? The nerve conduction study, I suppose? Does the pain get down into your hand and, if so, which fingers?

As for not operating when the only symptom is pain, I'd say that attitude is specious, at best. You should ask one of these clowns if they could hold their hand in a pot of boiling water. If they can't do it, isn't that a FUNCTIONAL problem, even though their only SYMPTOM is pain? The simple fact is that most of these docs are comfortably shielded from what it's like to have these problems.

BTW, has anyone suggested your problem is muscular in nature? The fact that it came on instantly with the trauma would lead one to suspect that....

Last edited by WebDozer; 09-13-2012 at 08:11 PM.

 
Old 09-13-2012, 09:39 PM   #5
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Nah it was instant from the impact to the spine, my skeleton took a big impact from a fall, my rib was also damaged.

C6 because yeh the nerve root impingement was found to be at c6 from the irritation in the signal of that nerve, and yeh it matches the pain pattern down through thumb and index and middle finger, the thumb being the worst (i was a bit confused about thumb for a little while thinking that it hurt so much it might be muscular, but no it makes sense now if its c6). Also there is a bulge at c6 apparent on the mri its just smaller and as you say more innocuous looking the specialists i had review them basically said. And for some reason completely not described in the radiologists report even though its quite visible (the neurologist showed me herself on the sagittal view).

Last edited by skeletor3; 09-13-2012 at 10:59 PM.

 
Old 09-14-2012, 07:03 AM   #6
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

OK, I suppose your problem MIGHT be alleviated by a simple Left-C6 foraminotomy. (I had a Left-C5 foraminotomy a few years ago, and it was an outpatient procedure with almost no recovery period)

The question would be, can a foraminotomy (coming from behind) access the disk (or osteophyte) which is impinging on that nerve?

 
Old 09-14-2012, 08:09 PM   #7
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Hmm ok thx, did your foraminotomy resolve the nerve pain (did u have any pre op?)? If so was it resolved instantly or took time to heal? Did it resolve all of the pain or only a %? Was it a good op for you? Would you do it again?

Last edited by skeletor3; 09-14-2012 at 08:10 PM.

 
Old 09-14-2012, 08:25 PM   #8
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Before that particular operation, I had no pain at all. The symptoms were 3/4 loss of strength in left deltoid and biceps (this was the C5 nerve).

Most of the lost strength came back immediately, and that was it.

I'd say it was a good op. I went in expecting to spend one night, but was raring to go by early afternoon and got released late afternoon. Never filled my pain pill prescription.

Maybe I was lucky and maybe I had a good surgeon. I don't know. I also don't know if foraminotomies (coming diagonally from the back/side) can get at a disk bulging into a foramen from in front. My problem was osteophytes, but I don't recall what they were growing off of.

I have read of "partial diskectomies" (maybe they should be called "diskotomies"), which is what you'd need. I suppose a surgeon might argue that a bulging disk will just bulge again when you cut part off but, like I said, I have read of it being done.

Last edited by WebDozer; 09-14-2012 at 08:28 PM.

 
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Old 09-14-2012, 09:32 PM   #9
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

So essentially they have to take off part of the disc thats pressing on the nerve root? Are they able to successfully take disc material off a nerve without injuring the nerve? How precise are their instruments? Im not sure as to the texture of the material of a bulging disc and the interaction it makes when bulging onto a nerve root, but if their self reported success rates are anythign to go by it seems they can pry material from the nerve leaving the nerve intact. Makes me wonder when in cases that were unsuccessful with a foraminotomy then they ultimately perform a fusion, if the disc material couldnt be successfully removed from the nerve in a foraminotomy how will removing the whole disc achieve this result... sorry just thinking out loud.

About why the question is whether it can be reached via the beck of the neck, is this because entry through the back is a lot less intrusive compared to what they have to go through via the front?

 
Old 09-15-2012, 05:41 AM   #10
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

<< So essentially they have to take off part of the disc thats pressing on the nerve root? >>

Yes

<< Are they able to successfully take disc material off a nerve without injuring the nerve? How precise are their instruments? Im not sure as to the texture of the material of a bulging disc and the interaction it makes when bulging onto a nerve root, but if their self reported success rates are anythign to go by it seems they can pry material from the nerve leaving the nerve intact. >>

I would think that depends on what's happened to the disk. If it's just a BULGING disk, then what's hitting the nerve is the disk annulus (the tough, cartilaginous outer ring). If it's a HERNIATED disk, then the disk NUCLEUS (soft inner material) might also be hitting the disk. It would seem the former situation would be preferable in a foraminotomy, but I suppose that with a herniated disk, if you could remove all/most of the nuclear material you might even be better off.

<< Makes me wonder when in cases that were unsuccessful with a foraminotomy then they ultimately perform a fusion >>

That makes sense, although I haven't read of any cases

<< if the disc material couldnt be successfully removed from the nerve in a foraminotomy how will removing the whole disc achieve this result >>

What I'm GUESSING is that, in a foraminotomy, the disk material could be removed from the nerve root (that's ASSUMING they can access that spot from behind), but that it's always POSSIBLE that what's left of the disk would just bulge back into that spot eventually. With a frontal diskectomy, the whole disk is cut/pulled out. With a frontal operation, access should not be a problem.

<< About why the question is whether it can be reached via the beck of the neck, is this because entry through the back is a lot less intrusive compared to what they have to go through via the front? >>

Intrusive in a different way. A major posterior operation (laminectomy, laminoplasty, posterior fusion) has to move/cut a lot of muscle, which could well be more intrusive than coming from in front. A foraminotomy, however, is more of a microsurgery, where the surgical cutting implement can be insinuated between the muscles.

To repeat, the potential success of a foraminotomy depends on (1) accessibility of the problem area to posterior entry and (2) the permanance of the remediation.

Let me just add that when you talk to surgeons, make sure they have done - and continue to do - foraminotomies. I get the impression that more than a few surgeons want to perform ACDF's in every case.

Last edited by WebDozer; 09-15-2012 at 05:56 AM.

 
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Old 09-15-2012, 08:39 AM   #11
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Thanks for addressing the qs, as for a case of failed foraminotomy into a fusion i was just thinkign about the NFL quarterback Peyton Manning who had I think a few microdisectomies (I believe), that temporarily resolved the problem but ultimately symptoms came back and he went with a fusion surgery. Im not entirely sure the specifics of the case and the differences between a foraminotomy and microdisectomy, but based on his ops from what I understand might be a little similar. But yeh still assuming a bit here, just raises a few interesting questions im not sure about though too.

Last edited by skeletor3; 09-15-2012 at 08:40 AM.

 
Old 09-15-2012, 09:36 AM   #12
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Re: Surgey not proven to improve nerve pain from nerve pain impingement?

Good point about Manning (our local quarterback). He had one microdiscectomy. I don't see why a "microdiscectomy" could not also be a "foraminotomy". One refers to what's being cut (disk) while the other refers to the location that's being cleared (foramen). My foraminotomy was also called an "osteophytectomy", because it was osteophytes which were being cut out.

I would note that Manning had that microdiscectomy in late May, which is less than three months before he would have to be ready for the American football season. So clearly, they considered that to be a minor operation with very little recovery period. They also thought that it was worth trying, that it might be a long-term fix, even if not permanent.

I know that if I had that choice, I wouldn't hesitate to go with the microdiscectomy and hope for the best.

 
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