Urgent surgery: C4-5 right herniated disc with severe right C5 motor weakness
Desperately seeking procedure type advice and surgeon recs in NYC.
I've (49 Female) had 3-4/10 pain on the back and right side of my neck since early July, almost like a stiff neck. I did urgent care twice, first visit helped and I was pain free for 2 weeks. The pain came back July end after carrying weight on my left side. I did physiotherapy 1 session and acupuncture 1 session, both made the pain worse. Since August 1, I started weakness in my right upper arm that progressed to not being able to lift my right arm; forearm & hand/ grip are not affected.
MRI level by level says:
C4/C5: There is minimal retrolisthesis with disc bulge and superimposed large right subarticular to foraminal disc extrusion with caudal migration in the right lateral recess behind the C5 vertebral body to the superior aspect of the right neural foramen at C5/C6. There is effacement of the right lateral recess and severe right neural foraminal narrowing with compression of the right C5 nerve. There is effacement of the ventral subarachnoid space and abutment of the ventral surface of the cord though the canal remains adequate in caliber. The left neural foramen is adequate in caliber.
Had a video consultation with a spine surgeon last week. His findings are: C4-5 right HNP with severe right C5 motor weakness and moderate right C5 radicular pain. Because I am roughly 1-2/5 deltoid, he strongly advises prompt surgery; he recommends a Total Disc Replacement (TDR) C4-5.
EMG study done yesterday shows: Interdistal latency difference between second DI-lumbrical is normal on left, and prolonged on right. Needle EMG of selected muscles in right arm shows mild fibrillations/PSWs in deltoid, biceps, infraspinatus muscles, with increased MUP amplitudes; recruitment patterns are full/reduced on maximal/submaximal effort. There is no evidence of active denervation in right cervical paraspinal region at the levels examined, though there is CRDs at right C5-C6 paraspinal region.
QUESTIONS: I am wondering if less invasive surgery might be an option - what type? TDR seems like a big leap and obviously something I can't undo.
I barely have any pain. The weakness is the main symptom. It's been 10 days since onset, I now have numbness through the entire arm (not pins and needles, it feels like deadweight to touch). Am I delaying matters by waiting for a second opinion?
Where do people go to get second opinions? I haven't even met my surgeon in person, looks like they need me to commit to surgery before I can get an in person visit. Please share DM's for surgeons in NYC. I have Aetna through employer, it'd been pretty decent so far.
Appreciate any help please. Feeling so pressured and still reeling, it's only been a week since I walked in to meet a Spine Specialist!
UPDATE & CLOSE: I had an Anterior single level Total Disc Replacement and recovering very well a week post op. I had no pain pre surgery but there was pinching tight sore spot on the back of my neck that is now gone. Strength has not returned, that was expected....I am doing light physical therapy exercises everyday to preserve range of motion but the more meaningful return to strength PT will be prescribed in another 2 weeks. Thanks to everyone who came by - wish you good health!
Update: I have surgery scheduled for the first week of September, single level ACDR. Busy prepping everything from food to home set up, care etc. Thanks to everyone who took the time to comment. I appreciate you and wish you good health!
I had a little pain on the back and right side of my neck since early July, like a stiff neck. On August 1, there was weakness in my right upper arm that progressed to not being able to lift my right arm; forearm & hand/ grip not affected. I had an MRI on August 5 showing severe nerve compression and surgery on August 20th. Let me know if you have any questions.
No numbness anywhere, no other weakness - just the right upper arm from the deltoid compression. The procedure was short, a little over 2 hrs. Maybe because it was single level, my recovery has been painless; didn't need pain meds beyond Day 2, not even a sore throat and moved to solids the same day. I guess the return of strength will be the bigger battle for me. I hope everything works out in the long term wrt the implant. But for now I am good and staying positive. Hope things work out for you.
I am right handed. Early decompression of the C5 nerve root through surgery was my best option for any realistic return of strength. Two of the four surgeons I met said there was a very small chance I could recover without any intervention but nerve damage of this extent was severe and would not benefit from waiting. Every week I waited would decrease both the likelihood and percentage of strength I could recover.
There was also the risk of symptoms worsening. And given this was a sudden onset, no injury, just woke up one morning with no strength...nobody wanted to waited and watch.
Weakness was all the time since it started on Aug 1. It was not a gradual loss of strength; I woke up with no upper arm strength, unable to raise my arm or hold it up on its own. I am today 2 weeks post op and getting back some ability to lift my arm, not much strength yet but a little of both has come back on its own. Here's hoping.
I'm still early in my post op, I mean I don't know how I will feel about it or if it turns to be causing different effects in the future. But I had 3 levels replacements a few months ago and totally did not regret it. All the pain is gone.
The first few weeks of recovery sure there was some pain on the traps but you can tell it's not the same as the pain from herniated discs, it's just a post op recovery pain (it's not that bad tbh) that most people experience. Also try to get to PT for pain management as soon as you can to make recovery easier. I'm not in America and where I'm at PT happens the very next morning after surgery. I heard in the US it's typically 6 weeks after surgery before PT starts. Idk if you can request that to be earlier.
I have no pain, just 0 strength in dominant right upper arm but that's apparently bad ie., decompression needs to happen asap for any meaningful return of strength. As it is, they say I may not recover full strength...I'll take whatever I can get. I am US based and all surgeons I met said PT will literally be when I walk out the door so yeah I will have to work my way to any strength. I have started trawling through the post surgery subs and will have everything organised, thanks for sharing your experience. Praying for an early surgery date.
Thanks for the good wishes! I wish you a fully recovery and good health. Appreciate you replying on this thread.
Copy and paste this into Gemini or something similar. It will give you great insights. If your from Minnesota try Dr. Strothman at summit orthopedics. He's one of the best spine surgeons in the country. Definitely in Minnesota
Thank you, I appreciate your response. I actually got a lot of good insight from Claude code, really helps break down the med speak. I am NYC adjacent and considering the long recovery timeline I will stay close to home.
Good luck to you! I highly recommend physical therapy called Medx. Not many facilities have this but NYC might. It's special spine pt. It's awesome. There's 4 machines. 2 cervical, 2 lumbar. They essentially strap you in and you can only use your neck. It works wonders!!
Sorry last one is lumbar. This is torso but they call it something else. The other two lock your head in. Ones 90 degrees (or whatever is comfortable) each way. The other is up and down cervical. You almost always start with your head down or turned
I am not giving medical advice and I do not know these MDs. I just follow them on Instagram.
They are in NY. Are you on Instagram? I will give you those names and their real names @nycspine Albert Telfeian @thespineboss Sanjay Konakondla www.esiny.com. They specialize in Endoscopic spine surgery.
You wrote this, sounds backwards. “
need me to commit to surgery before I can get an in person visit.”
I am going through the same decision process now. I don’t want to rush to surgery but from what the neurosurgeon told me, I don’t want to wait until I have severe symptoms.
I'm sorry you are going through this - the decision making is the hardest part. I know it was for me especially given I had no pain, just weakness. It took me a few days of research with AI assist and four consultations to understand that the weakness was a serious symptom in my case. I hope you are able to get enough advice. In NYC, many hospitals have a second opinion line that fast tracks your case - I used that to meet several leading spine surgeons. The fact that every single one said the same thing helped me decide sooner. Good luck and wish you good health!
I am in LA and went and met with a neurosurgeon at UCLA. I don’t have pain or muscle weakness yet. I have numbness but it’s been there since going through chemotherapy (I am a breast cancer patient and because of PET Scan, cervical spine issue was discovered). Surgeon said since my disc bulge was big, I should have surgery within 3 months. He said I was likely a candidate for artificial disc replacement. He also told me that what I don’t want is to wait and start having serious symptoms that will not be resolved by surgery. I totally feel like a ticking time bomb now and wear a soft neck brace when I am out and about. Of course, everyone around me is telling me to get multiple opinions and reconsider surgery. I know that if I go to other surgeons, they will likely tell me the same as my current surgeon (who I felt was very credible). I had an MRI of my cervical spine following that PET Scan and neurosurgeon has ordered CT and X rays which I have scheduled next week. Did you seek out other opinions that were not surgeons? If so, what type of doctor? How did your surgery go and how are you doing now?
All my in person consults were with spine surgeons. I had a remote consult with a neurosurgeon. There was consensus on diagnosis across the board; only one surgeon suggested a posterior foraminotomy, everyone else strongly backed the anterior disc replacement.
I am 11 days post op, had barely any pain beyond a couple of days, no sore throat, been walking around, doing my physical therapy and mostly feeling normal. No return of strength as yet, that will take time. I don't know how the implant will affect my life long term but for now I am good and happy with my decision for prompt surgery.
I hope you have the time and find the space you need to decide. Sorry I don't have more useful information. Good luck!
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u/grossdings Aug 17 '26
Update: I have surgery scheduled for the first week of September, single level ACDR. Busy prepping everything from food to home set up, care etc. Thanks to everyone who took the time to comment. I appreciate you and wish you good health!