Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Three days back, I had an MRI scan of my brain and spine. The brain report was normal; however, the spine had some issues. The reports said I have two types of stenosis, canal and foraminal. The canal stenosis is mild to moderate involving C5 and C6, whereas the foraminal stenosis is severe involving C5 and C6. I have pain in both my hands, cramps in the legs when I stand or drive for a long period, a sharp pain in my chest that radiates down to my arm when hunched over for long periods, fasciculations, minor myoclonic jerks, brisk reflexes, and a minor tingling in my pinky area.
Kindly advise.
Hello,
Welcome to icliniq.com.
I have seen your reports (attachments removed to protect patient's identity), and your MRI (magnetic resonance imaging) scan shows severe foraminal stenosis at C 5/6 and left side of C 6/7. You do not have any cord changes, and it is borne by the fact that the central canal is not very tight. The foraminal stenosis well explains your upper limb symptoms. I suspect that directed root injections may not be helpful in your case as there are structural issues in uncovertebral joints, and you may need surgery sooner or later.
I hope this helps.
Do revert in case of further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
How soon will I need surgery? And, is the surgery inevitable?
Kindly advise.
Hello,
Welcome back to icliniq.com.
Surgery is a clinical decision based on detailed clinical examination, assessment of functional limitations, your needs and demands, and your response to treatment. A CT (computerized tomography) guided steroid injection is warranted; however, it may or may not work. Did you have any physiotherapy sessions? I suggest you discuss the options with your doctor and get their opinion.
I hope this helps.
Do get back in case of further questions.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
My neurologist suggested that I get treatment done only if the symptoms worsen. However, I do not have significant pain, and my hand pain and cramps are mild. Does a surgery mean I will be potentially disabled or reduced to a wheelchair? Will my quality of life be affected indefinitely due to the intense pain? What can I expect? What will be the prognosis? I am only 40, and I am concerned.
Kindly help.
Hello,
Welcome back to icliniq.com.
You must consult a neurosurgeon and not a neurologist. The decision also depends on the clinical findings; hence I suggest you take a surgeon's opinion with whom you can discuss your concerns, the options, and details of the surgery. The diagnosis is cervical radiculopathy with foraminal stenosis and active functional limitations. This is a diagnosis based only on your reports, and I have not included the clinical findings. Though surgery is risky, you will be asked to weigh the pros and cons of surgical options with your current and expected symptoms, the effect of the symptoms, and how they would impact your working ability and income. As it is a progressive condition and you are just 40, the decision would be coming; however, it will be difficult to tell how soon. ACDF (Anterior cervical discectomy and fusion) is the first option when the disc is completely worn out and narrowed. However, age is a factor that is in your favor.
Meanwhile, I suggest you use nerve stabilization agents like capsule Pregabalin (Pregabalin, Lactose monohydrate, Cornstarch, and Talc).and Duloxetine (Serotonin-norepinephrine reuptake inhibitors (SNRIs)).
I hope you found this helpful.
Patient's Query
Hello doctor,
Thank you for your response.
As of now, I do not have any limitations. Also, I have an appointment with an orthopedic next week. From what I understood, having a foraminal endoscopic surgery can have a good outcome. However, I want to lead a normal life. Is it possible, or am I looking into a future with constant pain and distress?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I suggest you wait for the orthopedic surgeon to give an opinion. However, surgical procedures improve symptoms which would be evident straight away. Also, the pain reduces gradually, and you will be able to lead a pain-free life. I suggest you have a favorable view of the future.
I hope you found this helpful.
Patient's Query
Hello doctor,
Thank you for your insight. It is greatly appreciated.
Hello,
Welcome back to icliniq.com.
You are welcome. I hope I have helped you out.
Regards.
Take care.
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Orthopedician and Traumatology
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