Complex Case: Adjacent Segment Disease - C5/6
I would value opinions on the following case. Patient, aged 55, had a ACDF in 1992 at C5/6 for a prolapsed disc, at which time a minor protrusion at C6/7 was observed. Surgery cured the left sided brachaligia. In 1999 she was referred back to the Neurosurgeons for right sided brachaligia and cerivcalgia. Pain in the right middle, ring and little fingers. This indicated C7 nerve injury. MRI displayed a bulge at the C6/7 level which was encroaching the thea anteriorly. Treated with physiotherapy and conservatively until Jan 08 when she reported back with unbearable pain. MRI (2007) displayed an ankolysed C5/6 with 'prominent degenerative changes' at C6/7, disc space narrowing and a posterior osteopytic bar in the canal which was not compressing the cord of the nerves. Foramen magnum normal. Treated with facet joint injection. Further MRI (2008) and EMG studies ordered. MRI (2008) showed no root compression. EMG to investigate ulna nerve, Tinels and Phalens positive. EMG reported likely right C7 motor root involvement. Further course of two facet joint injections ordered. MRI (2009) displays no exit foramen stenosis, which is confimed by CT (2009). Primary first opinion is that as there is no imaging of exit foramen stenosis, then surgery would not be supported. Further treatment likely to be down the line of C7 root injections. Does anyone know whether a Bryon disc would be suitable and whether a case could be made for surgery without imaging, as EMG and pain locations indicate C7 nerve as the source of the problem ?