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  • Injections, Surgery or Do Nothing dilemma please make your comment

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    Old 01-06-2014, 10:26 AM   #1
    Grazia636
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    Injections, Surgery or Do Nothing dilemma please make your comment

    I'm 40 and very active person. I still play soccer in open division. I play violin also practice every day but this is just my hobby. My work is stinting 8h at the front of the computer and using my hands to type. Two small kids and a lot of activities. Now going back to the point. Why I got to the doctor 1 year ago. First of all I started having dizzy moments. There are very short just seconds but I feel it like somebody hit you in your head with something hard and you feel this impact wave but not actual pain. It is very annoying just annoying nothing else. Then I started having chest pain going straight to my back. This chest, back pain is hard but still not so bad to make me not to do my stuff. And at the and I was starting having right arm pain and numbness and my neck got stiff but it is not painful. Arm pain kind of disappeared but my hand got numbed and clumsy. It is hard to put makeup on ;-) I had all kardio checkup bc my doc though it is my heart but no my heart is perfect. She finally ordered neck MRI and EMG/NCV. Reports:

    MRI
    C1-2 Normal
    C2-3 Normal appearance the disc. Posterior spondylosis. Small T2 hyperintensity most suspicious for small atypical 5 mm hemangioma left side C3
    C3-4 Normal
    C4-5 Normal
    C5-6 Normal
    C6-7 Normal
    C7-T1 Small 3mm AP diameter right uncovertebral spurring with moderate narrowing inferior margin of the right C7-T1 foramen suspicious for mild mass effect on the exiting right C8 nerve root. No other posterior spondylosis or disc protrusion. No left uncovertebral spurring. No left foraminal narrowing. No central canal stenosis. Small 4mm T2 hyperintensity most suspicious for small atypical hemangioma right anterolateral margin C7 vertebral body.
    T1-T2: Normal appearance ofthe disc. No posterlor sponciyiosis. Partial imaging of the T1-2 foramina appear patent. No central canal stenosis.
    Incomplete imaging of the peripheral inferior margins of both T1-T2 foramina.

    Impression:
    1. Small 3 mm AP diameter C7-T1 right uncovertebral spurring with mild to
    moderate narrowing inferior margin right C7-T1 foramen suspicious for mild mass effect on the exiting right C8 nerve root in the foramen. No C7-T1 central canal or left foraminal narrowing.

    2. Small 5 mm T2 hypwintensity in the left side C3 vertebral body and small 4
    mm T2 hyparintansity in the right anterior inferior lateral margin C7 vertebral
    body most suspicious for small atypical hemangiomas.

    3. Incomplete imaging inferior peripheral margins of the T1 -2 foramina but no
    T1-2 central canal stenosis or evidence foraminal stenosis at the medial margins of the T1-2 foramina.

    4. Thin section CT though the C3 vertebral body and thin section CT from the
    lower C6 to the lower T2 level would be advised for further evaluation to
    confirm atypical hemangioma in the C3 and C7 vertebral bodies and further
    evaluation of the bony foraminal stenosis in the right C7-T1 foramen and
    exclusion of any stenosis in the T1-2 foraminaa.

    EMG/NCV

    all the numbers and charts and

    IMFRESSION:
    1. Moderate to severe right C8-T1 radiculopathy.
    2. Mild right carpal tunnel syndrome.
    3. Mild right cubital tunnel syndrome.

    I do not understand this at all and have such a mixed feelings.
    My doctor sent me to pain management doctor for injections. She told me like this "You do not want mess up with your nerves". She wants to do injections before surgery, what kind of surgery?. I do not have a lot of pain. I do not have a neck pain just stiffness. I had though numb arm. I wish I could leave it alone but now I'm not so sure. Please any thoughts, ideas advises what to ask the doctors. Please board members?

    Last edited by Grazia636; 01-06-2014 at 10:28 AM.

     
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    Old 01-06-2014, 11:26 AM   #2
    WebDozer
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    Can you be more specific about the clumsiness in your right hand? Do some digits work fine and others not?

    Last edited by WebDozer; 01-06-2014 at 11:26 AM.

     
    Old 01-06-2014, 11:55 AM   #3
    Grazia636
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    Yes I can. I can feel this in my whole hand/arm. The feeling is like you want to do something but your hand/arm doesn't want to listen. And being more specific. Arm, you are lifting your arm for example scratch your nose and do makeup and you are staying I have a trouble to lift my arm form elbow above. I can band it in my elbow but have trouble with lifting. Hand, the most affected fingers are pinkie and ring. With pinkie I cannot fully extend at all. With others is a little better. But I have a problem with holding objects like coffee, iron the most annoying one is driving I cannot hold steering wheel and drive using this hand. I have problem with just writing on the paper using pencil. I just kind of don't feel it. Hard to describe. And one more I do not feel when something is hot I feel sensation and I know it is worm but how if I do not check it with my left one I can burn myself. I did it few times already. What is most questionable to me I do not have pain. There is no pain in my neck. There is some in my arm but I can deal with this. Maybe it is just something which will go away by itself?

     
    Old 01-06-2014, 01:36 PM   #4
    WebDozer
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    It seems pretty clear from your symptoms and from your report that you have right-side C8 radiculopathy. Your have a bone spur coming off the uncovertebral joint (part of the vertebra where it interfaces with the disk) and pushing on the C8 nerve root.

    This would cause symptoms in the pinkie, and to some extent the ring finger. The C8 also innervates part of the arm, but I'm not sure what effect that would have on arm movement. You can do a search of C8 + dermatome and see for yourself.

    What I don't know about injections would fill volumes, but I don't really see how an injection would help. (maybe others can chime in). Your problem is BONE overgrowth, and I don't see how an injection helps that.

    The standard "fix" for radiculopathy such as yours would be a foraminotomy, which is a low-invasive posterior operation where the uncovertebral bone spur is cut away. I think you'd lose a little of your facet bone on that side also (to provide access).

    I'm in no way qualified to comment on your hemangiomas, I'm afraid....

    Last edited by WebDozer; 01-06-2014 at 01:37 PM.

     
    Old 01-07-2014, 03:48 AM   #5
    CT06405
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    Webdozer, when you had your foraminotomy(s), was the recovery easier than with surgery through the front of the neck? Did you have any lasting pain in the back of the neck from the incision?

    Last edited by CT06405; 01-07-2014 at 03:53 AM.

     
    Old 01-07-2014, 03:52 AM   #6
    WebDozer
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    For my foraminotomy (left C5), I was released from the hospital 4-5 hours after the operation, and never even filled my pain meds prescription. So no lasting pain, and not much initial pain, either.

     
    Old 01-07-2014, 04:01 AM   #7
    CT06405
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    Quote:
    Originally Posted by WebDozer View Post
    For my foraminotomy (left C5), I was released from the hospital 4-5 hours after the operation, and never even filled my pain meds prescription. So no lasting pain, and not much initial pain, either.
    In that case, I think Grazia would be better off having a foraminotomy than injections, which have their own risks and are, at best, a temporary pain reliever. If she can find a doctor to do one - it's not always easy.

    I have been looking for a doctor to do a foraminotomy at two levels, since my disc bulges are not substantial but my foraminal stenosis is. However, most doctors are pushing surgery in front of the neck, where they would also remove a disc or two, clean out the bone spurs in some facet joints and fuse the area. One of their reasons is that the incision in back of the neck is more painful. However, a two-level fusion is, to me, a bigger and riskier operation.

    Did your foraminotomy work?

    Last edited by CT06405; 01-07-2014 at 04:02 AM.

     
    Old 01-15-2014, 02:34 PM   #8
    Sreynold
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    Re: Injections, Surgery or Do Nothing dilemma please make your comment

    My cat scan showed an hemangioma which is a benign collection of capillaries. Many people have them. Thought I was dying until my doctor said what it was

     
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