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    Old 11-11-2013, 09:10 PM   #1
    VTFox34
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    Help: Multi-level Cervical Disc Disease & Herniations

    Iíve been reading and researching on this message board for a few days now and have found all sorts of useful information. I was hoping to get some opinions on my neck issues. I am 29 years old and am in good physical shape. I am becoming frustrated with the different opinions I am getting and the fact that it is not getting better on its own.

    I was dropped/slammed on my head while training in mixed martial arts (kickboxing/wrestling) way back in 2006, which led to a loss of range of motion and pain in my neck and some numbness down my right arm.

    I had an MRI performed with the following results on 9/30/2006:
    Foramen magnum is widely patent
    Cervical potion of spinal canal has an average diameter of 12 mm

    C4-C5 : Broad-based central disc bulge associated with a rightward protrusion of disc material into right C4-C5 neural foramen. Focal rightward disc protrusions narrows at right C4-C5 formamen and raises concern for mild impingement of the exiting right C5 nerve root.

    C5-C6: Broad-based disc bulge. Small protrusion of disc material both right and left into inferior aspect of the C5-C6 neural foramen bilaterally. Partial neuroforaminal narrowing bilaterally at this level, greater on right side. Potential mild irritation or impingement of exiting right C6 nerve root.

    C6-C7: Small broad-based disc bulge with mild protrusion of disc material into the interior aspect of the neural foramina bilaterally, right greater than left. Possible impingement of the exiting right C7 nerve root.

    Impression: No spinal cord impingement and partial effacement of ventral CSF space at C4-C5 through C6-C7. Multilevel spondylosis with protrusions of disc material into the neural foramen on the right side at C4C5, C5C6, & C6C7 and impingement of the exiting right C4, C5, & C6 nerve roots.

    The neurologist and neurosurgeon that I saw told me to give it time and it would heal on its own. Over time, I did get much better. The only problem that did not go away completely was being able to tilt my head back. I did have spasms from time to time, which led to a lack of range of motion in my neck and pain in the back of my deltoid and trapezius area. Over the next 6 or 7 years, I was able to work out and play sports at a pretty high level, including training MMA, playing football and basketball, and doing P90X and Insanity on a daily basis. I did have some issues with the spasms and went through 3 rounds of cortisone injections and a round of physical therapy. Eventually, in 2012, I started seeing a chiropractor and had no significant spasms for a year.

    In late July of 2013, I went to the beach and woke up one morning not being able to turn my head at all without severe pain. I was not able to put any weight on my right arm. I visited my chiropractor twice a week and began to feel better and started to get back into my regular workout routine.

    In mid-September of 2013, I was doing chin ups (wide grip, palms facing me) and felt a pop. I am not sure where the pop occurred in my body, but my right arm gave out. Since then, I have had a new sensation of numbness that creeps down my right bicep, forearm, and index finger & thumb depending on how I am sitting or standing. I have also lost a significant amount of strength in my right bicep. I was doing dumbbell curls at 45 pounds and now struggle to do repetitions at 25 pounds. I had a new MRI performed and had a series of cervical nerve root injections, which did not help.

    The new MRI from 10/3/2013 stated the following:
    Straightening of the cervical spine potentially due to muscle spasm
    C4-C5, C5-C6, C6-C7: Degenerative disc disease, annular bulging, small herniations, and spondylosis

    C4-C5: Minimal degree of intrinsic degenerative change. Small broad-based right posterolateral hernation superimposed on a minimal posterior annular bulge. Hernation contacts and very slightly flattens the right ventrolateral aspect of the spinal cord. A good volume of CSF remains present dorsal to the cord at this disc level. Osteophytes arising from the joints of Luschka create mild bony encroachment of the right foramen and minimal encroachment of the left foramen.

    C5-C6: Same statement as C4-C6 except mild intrinsic degenerative change.

    C6-C7: Mild instrinsic degenerative change and mild posterior annular bulging without mass effect upon the spinal cord or significant canal encroachment. Osteophytes arising from the joints of Luschka create moderate bony encroachment of the right foramen and mild to moderate curvature of the left foramen.

    C4-C5 disc herniation is less prominent than shown on my 2011 MRI

    I have seen several doctors with different opinions on how to deal with this problem:

    Neurosurgeon: Recommended posterior discectomy via laminotomy at C5-C6 and right C5, C6, C7 foraminotomy . She said that there was a slight chance (6% I think) that I may need a fusion if it fails. The fusion would be a three level fusion due to the instability in the three discs. She recommended I work out with lighter weights but no jumping/plyometrics or lifting above my head.

    Neurosurgeon/Orthopedic Surgeon: Do not have the above procedure done because it will just lead to reherniation and a spinal fusion soon after. He recommended that I deal with it and continue to do what I can as far as work outs go or I should go ahead and get the fusion surgery.

    Chiropractor: Continue to do decompression treatment with him which includes traction, light manipulation, and electodes to relax muscles in neck and shoulders. Surgery might be considered down the road, but told me to stay away from the fusion.

    Neurologist: Saw significant weakness in my right arm compared to my left arm. Said that the laminotomy/foraminotomy surgery may be something I need. I will be going in for further testing on Friday and will consult with him about the possibility of needing corrective surgery. He told me not to do any upperbody exercises.

    I do plan to get a third opinion about surgery. I am most concerned about losing muscle mass and strength in my right bicep. I also do not want to make the injury worse. My ultimate goal would be to be able to compete at a high athletic level once again and resume the activities I have had to give up. I do not want to get the fusion surgery at such a young age, but I am afraid the other surgery could lead to me reherniating the disc and needing the fusion soon after. I am also afraid that I will not be able to workout at all after getting this type of surgery. I am sorry for being so wordy, but that is pretty much my whole story. Any feedback would be greatly appreciated. Thanks!

     
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    Old 11-22-2013, 11:17 PM   #2
    VTFox34
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    I had an EMG performed on Nov. 15th. When the testing was over, the neurologist told me that it was my C6 nerve root causing the issues. He also mentioned that I could have crushed something into the nerve in my shoulder area, but couldn’t give me much detail without sitting down and reviewing the results. My neurologist gave me a call today and told me that the EMG results matched up to my MRI results. He said that a surgical procedure would be my call, but that if it hasn’t gotten better yet, he would trust the neurosurgeon who wants to perform the discectomy via laminotomy and the three level foraminotomy. He did mention that I have weakness in my forearm, but they were not able to explain it using the EMG results.

    I am concerned that I might have the neck surgery, as I have been advised, but still encounter problems because of a pinched nerve elsewhere in my shoulder/upper arm area. Is this something I should be concerned about? Most of the doctors I have seen have not brought up that possibility.

    Right now, I am still having numbness in my right arm and the weakness is at about the same level. I can’t tell if it’s getting worse, but it’s not getting better. Luckily, I am not in pain. I have noticed that the muscle on my right arm (brachioradialis maybe?) is quite a bit smaller than on my left side. When I flex my right bicep, it looks like the elbow is concave on that side, unlike the left where muscle pops out.

    I am planning to visit two more neurosurgeons to get their opinions before I decide, but as of now, the laminotomy and foraminotomy are looking like the best bet for me.

     
    Old 11-23-2013, 09:20 AM   #3
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Hi VT.... You have a very interesting story, and I must say that for an obvious muscle-head, you're quite articulate

    Let me get one thing out of the way, first. I certainly hope that the sports you want to return to do NOT include MMA. That's a bad idea at 21, a worse idea at 29, and a really really bad idea for someone who's already been damaged somewhat. Given your obvious dedication to sports and conditioning, I'm sure there will be LOTS of things you can do where you're not inviting your opponents to inflict permanent spinal damage.

    Let me soften that somewhat by congratulating you on your diligence in dealing with your problems, particularly in getting so many opinions. Of course, you see the downside of getting so many opinions, that is, that you may get so many DIFFERENT opinions.

    The differences in your seven-years-apart MRI's are also intriguing. I'd guess - from some differences of wording - that we're dealing with two different radiologists here. Two guys may look at the same thing and see it differently, or may see it the same way and describe it differently. (To complicate matters more, I would assume that neurologists and neurosurgeons will ignore the radiologist, look at the images themselves, and develop their own opinions.)

    For example, at C4-5...

    one sees " Broad-based central disc bulge associated with a rightward protrusion of disc material"

    the other sees " Small broad-based right posterolateral hernation superimposed on a minimal posterior annular bulge"

    Are they really describing the same thing? Certainly possible. One, though, concentrates on the possibility of impingement of the foramen, while the other talks of a small impingement of the spinal cord.

    Oddly, it's the 2006 guy who talks about the foramen, which is where your CURRENT problem seems to be. (symptoms in your thumb and forefinger are C6 impingement, you don't need a neurologist to tell you that)

    Your description of your right bicep sure is familiar to me. I had the same problem with my left bicep. Actually, one day I noticed that I had quite suddenly lost most of the strength in my left bicep AND deltoid. Just gone, without any sensation that might otherwise indicate damage. My left bicep, which usually bulged quite a bit (let me add that I am a large, muscular male, in spite of the gender designation that HB has seen fit to inflict on me) was completely flat. In my case, I believe the C5 nerve was blamed. A simple outpatient foraminotomy cleared that up. I should add, though, that my problem was facet hypertrophy, which, because it occurs BEHIND the foramen, does not require as intrusive an operation as you would, as your problems come from IN FRONT of the foramen. I believe that due to the brachioplexus, both the C5 and C6 affect the biceps. Because to your thumb symptoms, you clearly have a C6 problem, but you might want to clear up whether you may also have a C5 problem.

    As for your possible shoulder impingement, I would note that the doc simply said you MIGHT have a problem there. I had docs telling me that radiculopathy was causing problems in my hand, even though I repeatedly told them that it only happened when I bent my elbow. Finally, I got a guy to do a nerve test and he said that my problem was elbow impingement (which has since gotten better on its own). It could be, in your case, that the shoulder and the spine are too close for a nerve test to determine if an impingement is in one or the other. Given your history, I'd say anything is possible.

    Back to your two MRI's. Did you notice that, in the first one, he's primarily talking about protrusions (herniated or otherwise), while in the second, he's primarily talking about osteophytes growing off your uncovertebral (Luschka) joints? It would seem that over seven years that part of your spine has been under a lot of stress and has responded by laying on extra bone. Uncovertebral osteophytes are extremely common, but not in 29-year-olds. I have to think that the disk protrusions and the osteophytes are related, perhaps because those herniated disks are not doing their natural job as well as they might and stress is transferring to the vertebrae (the uncovertebral "joints" are protrusions from the vertebrae). Seven years of additional stress has resulted in bone overgrowth.

    So... to the proposed operations. I'd really like to understand what a "discectomy via laminotomy and the three level foraminotomy" is. "Laminotomy" means to remove part of the lamina. Usually, this is done by shaving some off the inside to the lamina so that the spinal cord has more room. It's often done in conjunction with a laminoplasty, where several levels of lamina may be cut through and then swung open, with the levels immediately above and/or below given laminotomies. I don't see, in your case, what the laminotomy would be doing. As you say "via" laminotomy, I suppose that cutting out part of the lamina is not an end in itself, but is done to enable the other parts of the operation.

    A "diskectomy", though, means the removal of the disk. Does he really intend to do that? What does he propose to put in place of the disk? How will that insert be secured? If it's secured by plates that are screwed into the vertebrae, then that should be pretty secure. If he just wants you to wear a collar until the bones fuse together on their own, that's another. For one thing, you'd be in a collar for a while. For another there's some failure rate of fusions done without plates, and for someone as active as you, the chance of failure may be greater (though being so young would help, I'm sure).

    As for the three-level foraminotomy... if that operation is done to remove impingements coming from IN FRONT of the foramen, then the facet bones must be partially removed to provide access. This CAN create instability, I guess depending on the number of levels done and the amount of the facets removed. Just something to consider.

    OK, enough rambling. You seem to be handling all this very well on your own, and you probably don't need to be talking about it to amateurs like me. If you want to continue, though, that's fine. I'd particularly like to get an understanding of how this proposed "discectomy via laminotomy and the three level foraminotomy" would work.

    Last edited by WebDozer; 11-23-2013 at 09:51 AM.

     
    Old 11-24-2013, 11:23 AM   #4
    VTFox34
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Thanks so much for the reply. I appreciate that you took the time to read my posts and give me some very thoughtful feedback. I am already trying to figure out what sports/activities I will focus on once I get all of this neck trouble behind me. If I have any type of procedure done, I’m sure I will have plenty of time to think about it.

    I am definitely one to get as many opinions as possible. I’d rather have many different choices and then be able to weigh the pros and cons of each rather than jumping at the first option that may or may not be what is necessary to help with my troubles. The neurosurgeons are more or less looking at the MRIs themselves and not really reading the reports… at least not in front of me. Maybe they are doing this on their own before or after my consultation.

    The proposed procedure by my first neurosurgeon was written down as discectomy via laminotomy at C56 and right C5, C6, C7 foraminotomy. She said the laminotomy would be the method used to get to the herniated disc. I don’t know if the laminotomy would actually provide any decompression itself. The discectomy is actually a micro-discectomy (I think) where only the herniated portion of the disc will be removed. She wrote down discectomy on the sheet she gave to me, but told me just a potion would be removed and she definitely said she did not want to do a fusion of any type. I will clarify this when I go back to see her and make sure I know exactly what I am getting myself in to. The only thing I worry about with this procedure is reherniating the disc after the portion of it has been removed. She said there was a possibility of this and that if a reherniation occurred, I would possibly need a fusion at that point.

    She only described the foraminotomy as opening up the hole that the nerves run though. She did not mention having to remove other bones like the facet bones and said it would be a minimally invasive surgery. I asked if there would be any instability and she said no. I think my specific example I asked about was playing basketball and taking an elbow or shoulder to the face or neck and she said that there was no risk for damage due to instability. I am not sure how I know if the problems are coming from in front or behind the foramen. She didn’t mention it, so I am not sure where she would be going to get to open up the foramen.

    The second neurosurgeon gave a totally different opinion. He said either suck it up (my words, not his) because I’m not in pain and haven’t lost complete use of my arm or get the fusion surgery. He said the other procedure would just lead to a fusion shortly down the road. I think the fusion surgery is his thing though. He made sure to tell me he does about 8 fusions a week and talked about Peyton Manning’s fusion surgery.

    No doctor has actually mentioned the osteophytes to me. I didn’t know what they were until I saw a picture of them online a week or two ago. It is definitely something I plan on asking about. What types of procedures are done to clear those up? I have read online about conservative measures that can be taken, but then it will say surgery may be necessary without really describing what type.

    I do know that I have big time issues with my neck and it is probably best to get them resolved, especially if they aren’t able to tell if I have shoulder impingement. I am more worried that I might be getting an unnecessary neck surgery, only to need a shoulder/arm surgery to clear up my weakness. I feel like that would be a huge regret for me, especially if I have complications regarding a neck surgery that I wouldn’t have needed.

    I do have my 2006 results from my visit with the neurologist for an NCS and EMG:
    Right median nerve showed prolonged latency and decreased velocity.
    Motor conduction of right ulnar nerve showed an 8 m/s drop in velocity across the elbow.
    Sensory conductions of the right transcarpal median and ulnar nerves showed prolonged latency and decreased velocity.
    Conclusion- Right moderately severe carpal tunnel syndrome. Right ulnar nerve slowing across the elbow.

    I don’t know exactly what this all means and if it could have an impact on the weakness I have developed. Could this nerve issues be causing problems in the brachioplexus? I am picking up the results of my newest EMG test on Monday. Hopefully that will give me some helpful information I can use to come to a better decision.

    Thanks again for the reply. I feel like your message has provided me with a great deal of good information and thoughts that will help me to ask better questions when meeting with my doctors. I have seen your responses to other members and, I have to say, that I am glad there are such understanding and helpful people out there who take the time to give thoughtful feedback.

     
    Old 11-24-2013, 12:24 PM   #5
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    << The proposed procedure by my first neurosurgeon was written down as discectomy via laminotomy at C56 and right C5, C6, C7 foraminotomy. She said the laminotomy would be the method used to get to the herniated disc. I don’t know if the laminotomy would actually provide any decompression itself. The discectomy is actually a micro-discectomy (I think) where only the herniated portion of the disc will be removed. >>

    I guess you can describe an operation by what gets cleared (foraminotomy) or by what gets cut out (discectomy). I wonder if your proposed operation might not be called a "foraminotomy via the lamina". That is, it's essentially foraminotomy, but going thru the lamina rather than the facet. I'd like to see it diagrammed.

    << She wrote down discectomy on the sheet she gave to me, but told me just a potion would be removed and she definitely said she did not want to do a fusion of any type. I will clarify this when I go back to see her and make sure I know exactly what I am getting myself in to. >>

    Yeah, I would want to know the why of that "definitely" part.

    << The only thing I worry about with this procedure is reherniating the disc after the portion of it has been removed. She said there was a possibility of this and that if a reherniation occurred, I would possibly need a fusion at that point. >>

    Might be some online studies of the incidence of reherniation, although the surgeon should certainly know.

    << She only described the foraminotomy as opening up the hole that the nerves run though. She did not mention having to remove other bones like the facet bones and said it would be a minimally invasive surgery. I asked if there would be any instability and she said no. >>

    My mention of potential instability is because the NIH site mentions it. if your cervical lordosis (backward bend) is what it should be, that would lessen the potential for instability. Kyphosis (forward bend) is definitely a contraindication for any surgery that removes part of the spine. Anyway, if she's going thru the lamina, then instability induced by removing part of the facets is not a problem.

    << I think my specific example I asked about was playing basketball and taking an elbow or shoulder to the face or neck and she said that there was no risk for damage due to instability. I am not sure how I know if the problems are coming from in front or behind the foramen. She didn’t mention it, so I am not sure where she would be going to get to open up the foramen. >>

    The osteophytes are growing off the uncovertebral (Luschka) joints, from in front of the foramen. As for how she gets at them, I'd sure like to know.

    << The second neurosurgeon gave a totally different opinion. He said either suck it up (my words, not his) because I’m not in pain and haven’t lost complete use of my arm or get the fusion surgery. >>

    That's why you always take baseball bats with you to these confr... I mean, consultations. Drastically reduces the incidence of take-it-or-leave-it arrogance. You could whack him with the bat once, and then tell him that because he hasn't lost complete use of his brain he should just suck it up. (yes, Admin, I am kidding)

    << He said the other procedure would just lead to a fusion shortly down the road. I think the fusion surgery is his thing though. He made sure to tell me he does about 8 fusions a week and talked about Peyton Manning’s fusion surgery. >>

    I dunno... probably something online, as I said. It's good, though, that you're aware that there are spinal surgeons who would prescribe fusion for a toothache.

    << No doctor has actually mentioned the osteophytes to me. I didn’t know what they were until I saw a picture of them online a week or two ago. It is definitely something I plan on asking about. What types of procedures are done to clear those up? >>

    The foraminotomies should get rid of those, but I certainly would ask, and get a demonstration on one of their spine-props. A discectomy-and-fusion should be able to get the osteophytes at the level of the fusion, but I'm not at all sure it could get the other two levels.

    << I have read online about conservative measures that can be taken, but then it will say surgery may be necessary without really describing what type. >>

    Some people really want to avoid surgery, and some have avoided it and cleared up their problems. Your call....

    << I do know that I have big time issues with my neck and it is probably best to get them resolved, especially if they aren’t able to tell if I have shoulder impingement. I am more worried that I might be getting an unnecessary neck surgery, only to need a shoulder/arm surgery to clear up my weakness. I feel like that would be a huge regret for me, especially if I have complications regarding a neck surgery that I wouldn’t have needed. >>

    Well, the doc only said that you MIGHT have shoulder impingement, which was only logical. As far as I know, though, you do not have clinical evidence that you do, while you certainly have clinical evidence of cervical impingement. I'd also note that one or two people on these boards have reported shoulder surgeries that later seemed unnecessary, so it works both ways. If would be good if you could find some way of narrowing your odds, though.

    << I do have my 2006 results from my visit with the neurologist for an NCS and EMG: Right median nerve showed prolonged latency and decreased velocity.
    Motor conduction of right ulnar nerve showed an 8 m/s drop in velocity across the elbow. >>

    I'm really surprised that someone of your level of physical activity would have lived with a substandard arm for all that time. You said earlier that your right arm is smaller. To the extent that you can fix the nerves, the size of the arm will recover. The muscle fibers that are fired by those nerves that can't be fixed will have atrophied and will stay that way. Unfortunately.

    << Conclusion- Right moderately severe carpal tunnel syndrome. Right ulnar nerve slowing across the elbow. >>

    Elbow and wrist problems, too. What have you been doing with that right arm? I suspect that some of those problems are cervical-spinal, but that's just an amateur's guess.

    If you can find an online depiction of your proposed surgery, I'd like to see it.

    Last edited by WebDozer; 11-24-2013 at 12:31 PM.

     
    Old 11-24-2013, 03:03 PM   #6
    WhistleDixie
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Hello VT and WebDozer,

    I don't mean to intrude on your conversation, but as I await my Tuesday appointment with neurosurgeon...I could use some of your wisdom, or at least ask you to loan me your bat=)

    VT...Your quandary makes me feel even less informed about my issues. I have a LONG history of spinal injury dating back to a near fatal accident as I began my junior year in HS. I am now 52. I've been told by at least 2 neurosurgeons since 2005 that surgery will not correct my issues.

    Again, I don't wish to hijack your thread, but I need Web Dozer's opinion on my MRI results that I posted several days ago. Can I get my name on the short list for a consult, please? My thread is titled "Tumors on Spine?" or maybe "Vertebral Hemangiomas". My story, like most, is never-ending so I don't want to projectile vomit my issues. However, if you would be so kind as to take a look at the posted MRI thread...I would totally appreciate your input.

    VT...I certainly wish for you healing resolution. I, personally, am swinging for (or from) the fence since late August early September. Thank y'all for listening.

     
    Old 11-25-2013, 09:15 PM   #7
    VTFox34
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Wow WhistleDixie, that is quite a long time to go with having spinal problems. I read your thread “Tumors on Spine” and I wish I had some insight to your problems. In my experience so far, the best bet has been to gather as much data as you can in order to find the solution that will work best for you. I am sorry that you seem limited in your options for doctors… having to drive two hours just to see one can be stressful I’m sure. Again, I would try to gain as much data on your symptoms as you can and try to find yourself a knowledgeable doctor who can explain things to you. In my case, my chiropractor does a good job of reading through my different tests in order to help me understand what is going on. He doesn’t have all of the answers, but can at least point me in the right direction. I would also write down the questions you want to ask. I generally get nervous when I go to any doctor and end up missing out on questions that I want to ask and end up going home wishing that I hadn’t forgotten during the consultation.

    WebDozer: Thanks again for your replay. It gives me so much to think about (in a good way) and will help me to ask better questions when I consult with my doctors. I will update you on the actual process of the procedure when I go back to see my neurosurgeon. I think she may have kept it as simple as possible for me because she didn’t really talk about other bones she would have to go through or remove in order to perform the foraminotomy. Now I am really interested to see what bones would need to be drilled through to perform the foraminotomy and how much stability I would lose.

    She did say that she wouldn’t want me to get a fusion because I am young and could end up having trouble for the rest of my life as I get older. She said that if I only had a one level fusion, the two surrounding discs are already deteriorating and would need to be replaced soon after. If I had a three level fusion, it would put significant pressure on the surrounding discs and could lead to even further complications. She said the best bet was to stay away from fusions for as long as possible.

    As far as my right arm being smaller, possibly due to the problems in my median and ulnar nerves and having carpal tunnel syndrome… my right bicep is still bigger than my left. The muscles in the forearm right below the elbow only recently started to deteriorate and become smaller on my right side. I haven’t had any issues working out, lifting weights, or playing sports since the pop I heard doing pull-ups in mid-September.

    I did receive my results from my neurologist today. I included them on this post.

    Nov 18, 2013
    Nerve Conduction Studies: Both lateral antebrachial, right median, radial and ulnar sensory nerve action potential amplitudes and distal latencies were normal except borderline asymmetry in lateral antebrachial responses (10 uV on the right versus 19 uV on the left). The right median and ulnar distal motor latencies, compound muscle action potential amplitudes, and conduction were normal.

    EMG: Right biceps, pronator teres and brachioradialis showed polyphasic motor unit action potentials of normal duration with reduced recruitment; insertional positive waves and occasional fibrillation potentials were seen in these muscles. Right deltoid, triceps, flexor carpi radialis, and first dorsal interosseous muscles showed normal insertional activity, no spontaneous activity, normal motor unit action potential form, and normal recruitment.

    Interpretation: This is an abnormal study. It is most compatible with acute-subacute moderate right C6 radiculopathy. A musculocutaneous neuropathy cannot be excluded in addition to cervical radiculopathy, but this would not explain the abnormalities in pronator teres and brachioradialis.

    Repeat study in several months is recommended, and correlation with cervical MRI would be helpful.

    So it again shows problems with the C6. This again confirms there is a problem there. I don’t quite understand what they mean about the abnormailities in the pronator teres and brachioradialis. These are the muscles that appear to be shrinking on my right arm. My right bicep is still bigger than my left though, but the numbness runs from bicep to fingers. So they are saying it could be emanating from my neck, but could also be a pinch somewhere else between anywhere between the chest muscle and the arm? How would one go about finding out if there is a pinch there? Again, I guess it comes down to me not wanting to do a neck surgery if it is a pinch somewhere else that can be taken care of without opening up my neck. I am reading about musculocutaneous neuropathy online, and it seems like I have the symptoms described. It says it’s an isolated injury, which it was… I didn’t have issues with my arm until doing pull ups when I felt a pop. I’m just not sure where the pop came from. It also lists a cause as weight lifting. I just wish I could take some sort of test to rule out the cause of weakness coming from the musculocutaneous nerve.

     
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    WhistleDixie (11-26-2013)
    Old 11-25-2013, 10:14 PM   #8
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Thanks for your thoughts, VT...Oh, not to misrepresent my situation...I have had several series of epidurals and facet/trigger point injections over the years, but they've not relieved any pain at all. I've been put into 16 or 18 lbs. of cervical traction (many years ago), seen chiropractors and PT specialists. I've tried various meds over the years, but I have little to no tolerance of oral meds due to gastric/digestive issues.

    Forgive me if I repeated anything. It's been a long, worrisome, frustrating day. As you can see, I'm not sleeping tonight. I'm so stressed over my appointment tomorrow for neurosurgeon consult on MRI. It's started sleeting again tonight to continue through tomorrow morning. I freak out when I have to drive in bad weather. I will be a bundle of nerves by the time I see the Dr. Then I'll fall completely to pieces convincing him I need Psych consult=)

    I, too, hope that you find answers soon.

     
    Old 11-26-2013, 04:42 AM   #9
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    VT, I certainly see your conundrum. The doc just can't exactly pinpoint a problem like yours, and to some extent he has to make inference based on your symptoms. I'd want a better understanding of ""but this would not explain the abnormalities in pronator teres and brachioradialis"".

    As for ""correlation with cervical MRI would be helpful"", I don't know. I guess I'd want him to NOT know what the MRI says, so he doesn't have something to latch onto.

    VT, I have to wonder if maybe just getting a nice recliner and watching TV for six months might not clear up this problem...

     
    Old 12-07-2013, 10:43 AM   #10
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    I wish I could relax in a recliner. From what I have heard, I do need to make some sort of decision in order to prevent any permanent muscle atrophy. Iím also pretty OCD about working out, but that another story.

    I saw a third neurosurgeon yesterday in order to get another opinion about my condition. This neurosurgeon gave me the same answer as the neuro/orthopedic surgeon. He said that my best bet was to get a fusion surgery. He did a much better job describing it that the last doctor though. He said there was no chance it was anything but the neck causing the weakness and deterioration in my brachioradious and pronator teres.

    He said he would perform an Anterior Cervical Diskectomy and Fusion with an Intervertebral Spacer. He would be removing the disc material from C4-5 and C5-6 and fusing them together. He would be using a cage with a plate to hold the fusion together.

    I did not ask at the time, but his website says he uses a PEEK spacer for spinal fusions. I know there are pros and cons of any type of material used in the fusion, but is this generally seen as a better material than using a bone graft?

    He said that he used to perform the same micro-diskectomy via laminotomy and foraminitomy that my first neurosurgeon had advised. He said that this would not be a long term solution, much like the second surgeon I saw. He said that it would eventually wear down and I would need a fusion due to a disc reherniation and instability.

    He said the fusion would be very stable and I would be able to play flag football and basketball between 6 months to a year after the fusion, box (including sparring) after a year, and be able to lift weights. He said the only thing he would not recommend would be wrestling/submission grappling due to the stress it places on the neck. This made me very happy, as it seemed like the laminotomy/foraminotomy procedure would leave me a bit more limited in the physical activities I would be able to participate in.

    I guess besides surgical complications, he said there is a possibility that the discs above and below could deteriorate due to the stress from the fusion and need to be fused themselves. He did say that this might happen anyway, as my C6-7 is not in the best shape as it is.

    He said that there is a time limit on when the nerve damage would become permanent. It has been 3 months so far that I have been having these symptoms. He said I should take the rest of December to see if it gets any better with chiropractic care, but would like to do the procedure in early January. He said after 4 or 5 months, the nerves may not be able to reconnect to the muscle.

    I am seeing one more neurosurgeon on Tuesday in order to get one more opinion. Right now, I have three options. One, do nothing and learn how to live with a restricted lifestyle in terms of physical activity and permanently lose the muscle below the biceps. I am not in pain, which is why I consider it a possibility. Two, get the laminotomy/foraminotomy procedure knowing that it may deteriorate and I still would have to limit my physical activity. Three, get the fusion, resume my physical activities, but know that I may have to have more procedures if other discs deteriorate. I like having options and will be discussing these with the last neurosurgeon I will see and with my chiropractor. As much as I like having options, I donít want to have to make a decision that I may have to live with for the rest of my life, especially if itís the wrong oneÖ

     
    Old 12-09-2013, 06:31 AM   #11
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Looks good, at least to my amateur's eyes. A C4-5 C5-6 ACDF should not cause very great loss of range-of-motion (1/4?). At your age, recovery should be pretty quick. I don't know about the PEEK. There have been questions and posts about it here before, which you could look up. I really don't know why to not just use donor bone, but I guess some think PEEK is an improvement on that.

    It's interesting that your 2011 MRI report had a herniation at C6-7 while your 2013 report did not. I suppose it could have resorbed? I certainly hope that two radiologists were not looking at the same thing, with one calling it bone overgrowth and the other calling it a disk herniation. Anyway, I would want to know about that. As your problems do not (yet) seem to be coming from cord impingement, but rather from foraminal narrowing, I would want to know what the proposed operation will do about that. If the narrowing is from disk material, then at least C4-5 and C5-6 should be cleared up. What about the bone overgrowth, though, particularly at C6-7?

    Also, you might want to ask this new surgeon what he thinks about a 3-level ACDF (that is, assuming he also thinks that at least a 2-level is appropriate).

    Last edited by WebDozer; 12-09-2013 at 06:34 AM.

     
    Old 12-11-2013, 04:24 PM   #12
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Thanks again for the reply WebDozer!

    My neurosurgeon appointment was cancelled yesterday due to snow. I will have to wait until Tuesday to get my final (I hope) opinion.

    I looked back over my 2006, 2011, and 2013 MRIs and it actually doesnít say there is a herniation at the C6-7 level (or explicitly use the word herniation). My 2011 & 2013 MRIs just mention osteophytes and foraminal narrowing. The 2006 MRI says that there is a small disc bulge.

    I think I am leaning more towards the micro-discectomy via laminotomy at C5-6 and the three level foraminotomy if I had to choose today. I feel as this is less invasive than actually pulling out two discs when only one is causing me problems at this point. If the procedure fails and the disc reherniates, there would be the possibility to do the fusion. I may have to get multiple surgeries with a fusion anyway, due to the additional stress on the discs.

    I guess I am also looking at the future as well. The group that the last neurosurgeon I am seeing is working on disc regeneration using stem cells (they have 5 patients undergoing trials) and injecting platlet-rich plasma into the disc to promote healing. I have also seen a video on Thrombin injections that Dr. Kevin Pauza is working on in Texas to help regenerate and seal discs. Now, I have no idea if these treatments will work, and if so, how long it will take for them to be available. I guess Iím just being an optimist. From what I understand, my disc degeneration is mild and not the cause of the weakness and numbness, but these may be viable options down the road if the degeneration continues. If I donít have my natural discs anymore, then these options become closed off to me. I will be doing some more research about these new treatments to see what I can find out.

    Also, Monday night, I was looking at the muscles below the bicep at the elbow and I swore they looked bigger than they had. I went downstairs and tried to curl the 45 pound weight, and for the first time since September, I was able to. I set it down, picked it up and did it again. I couldnít do it a third time, nor could I do two in a row without setting it down, but it makes me wonder if I am getting better naturallyÖ or if my body is just using other muscles to compensate for my muscle deterioration in that area.

     
    Old 12-12-2013, 12:26 AM   #13
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    I said herniation because the radiologist noted protrusions of "disk material", which would be an accurate description of a herniation. He could have meant that the entire disk was protruding, although still intact, but it just seems that "disk protrusion" (the usual wording) and "protrusion of disk material" imply different situations. Perhaps not necessarily, I guess.

    As for the disk regeneration via stem cells... that MAY work someday, and it MAY be of benefit to you some day, but I wouldn't recommend waiting on it.

    As for going with the microdiscectomy, that's reasonable, as long as you're aware of the possibly temporary nature of the fix. Also, did one surgeon say that might promote instability? Maybe that was just me. Still a question I'd have for that surgeon, and something I'd want to see demonstrated.

    Your seeming recovery of arm strength is certainly encouraging. That atrophy was always the strongest argument against a wait-and-see approach, in my mind. It would be nice if you could evaluate that with some certainty, but I guess the dumbbell is the best you can do. And I'm sure you're aware of how easy it is to cheat when doing curls....

     
    Old 12-17-2013, 05:08 PM   #14
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    I think the big difference is that I was trying to cheat as much as I could to do a bicep curl with 45 and couldn’t do it, but now I can. The right arm is still weaker than the left and fatigues at a quick rate, even when using 25 pounds or less.

    I did see the fourth neurosurgeon for a final opinion. He spent the most time talking to me out of any of the other neurosurgeons I have seen. He was also the first to do x-rays.

    He went through several options for me in order to get down to the one he thought would be best for me. He said that getting a one level C5-6 fusion would be best, even though the C4-5 and C6-7 show deterioration as well. He said that because I don’t have neck pain, the goal would be to just get rid of the arm numbness and weakness. He said if there was neck pain, he would want to fuse two or three of the levels. He also said he would hesitate because the bulges from the other discs are not putting the pressure on the nerve like C5-6 is. He said that the one level fusion would give my cervical spine the “C” shape again and reduce pressure on the discs throughout my cervical spine. There would still be a possibility that the discs adjacent may need to be fused at some point down the line due to deterioration. He said he hoped that by that time, advancements would have been made so that there would be an alternative to fusion and went on to talk about what they are doing with stem cells and such.

    He said the foraminotomy & laminotomy would be a definite quick fix but not a viable long term solution. He said that my cervical spine would not regain the “C” curve and the discs would continue to do most of the work in holding up my head, adding to their deterioration. He also said that the C5-6 disc had deteriorated to the point that if some of it were removed, it was much more likely to collapse. He said that a fusion would need to be done and this would buy very little time. WebDozer, I do think that it was you who mentioned instability from this procedure, but none of the doctors mentioned it, so I guess that wasn’t the main concern of the procedure.

    He also explained that an artificial disc was not an option because it would not lead to giving me back the “C” curve and that it would cause the adjacent discs to deteriorate quicker.

    He said he would be using a cadaver bone. He said the bone will cause a better rate of a successful fusion and explained why the plastic piece is not the best option. He said that he actually has had to extract the plastic portion and re-do fusions from other surgeons. He said that the cadaver bone would not give me the risk of any disease or anything like that. He would be securing my fusion with a titanium plate and screws.

    He said he has a 97% success rate and spends a lot of his time fixing “botched” procedures from other surgeons. He has even worked on the President of their practice, first doing the foraminotomy before having to do a fusion two years later. He said that he has also repaired a patient of a doctor of one of my other opinions, but would not comment as to who it was.

    I guess that puts things at 3-1 against having the laminotomy/foraminotomy, because it looks like fusion is inevitable. I really like this doctor. He made things clear, seemed confident in his abilities, and really explained why he came to the conclusion as to what the best solution would be. He is also an athlete, so he knew where I was coming from and knows how much I want to continue to be active throughout my life. His practice is also the official specialists of a professional sports team, which makes me feel like I will be getting the same type of care. Of course, this is the only practice that is out of network for my insurance, but that will not be a deciding factor.

    Last edited by VTFox34; 12-20-2013 at 04:10 AM.

     
    Old 12-20-2013, 03:10 AM   #15
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    Re: Help: Multi-level Cervical Disc Disease & Herniations

    Not doing anything about the herniation at C4-5?

     
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