Cervical disc prolapse in a surgeon, causing hand muscle weakness: A treatment dilemma!

A few months ago, a well accomplished busy surgeon walked into my clinic with severe radicular pain in her left arm associated with numbness in the thumb and index finger. The symptoms were troubling her for a couple of weeks and symptoms had made it difficult for her to operate. She is an ardent runner and was obsessive about her fitness activities. She had to stop all the fitness activities due to this pain.

On examination, it was clear that she had a cervical nerve root compression, most likely due to a cervical disc prolapse. There was sensory loss in the index finger and thumb and  weakness in triceps muscle. An MRI of the cervical spine was done and it revealed a C5-C6 disc extrusion causing significant C6 root compression on the left side.

Cervical disc prolapse causing nerve root compression.

She recieved pain medications and physiotherapy and advised on some activity limitations and asked her to stop operating for a while. We hoped that it would start improving in a few weeks as it usually does in most cases. Though the pain was getting better with medication, the dense numbness in the index finger and thumb persisted even after four weeks, with no sign of improvement. It was time to decide whether to wait further or to consider surgical treatment to give her the best chance of full recovery of nerve function.

A persistent numbness in the index finger and thumb and triceps weakness could affect her work as a surgeon. Waiting for too long could lead to a some persistent neurological deficit that may affect her function as a surgeon.

After a discussion with her about the pros and cons of non-surgical and surgical options, we decided to wait for a couple of weeks. In the mean time, I allowed her to scrub in a couple of cases and assist other surgeons, to see if the numbness and triceps weakness affected her function. She came back saying that she was able to do it quite well and it was not affecting her ability to operate. As the pain settled, she gradually increased her activities. Triceps strengthening and isometric neck exercises were advocated. She started running few minutes a day and gradually increased her fitness activities including swimming and jogging. Her numbness also started getting better gradually and she was back to operating over the next three weeks.

Although we know cervical disc prolapse with nerve root compression has a good chance of recovery, apprehension of permanent neurological deficit affecting hand function that can put a career at stake could push us towards an aggressive treatment approach which involved a surgical procedure. Loosing the hand function is the most dreadful thing for a surgeon and an aggressive approach to treat may be chosen in such situations to ensure full functional recovery. But a close observation and a wait and watch approach with a gradual rehabilitation program helped her to get back to normal eventually, avoiding a surgery, luckily.

But not everyone may be able to recover so well and a surgical option needs to be considered in certain situations to achieve the best functional outcome.

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Dr Phani Kiran S

Experience and Professionalism

With years of experience in spine surgery, Dr Phani Kiran SSenior Consultant Spine Surgeon will assess you and suggest the treatment option that is right for you.

We at Medspine clinics, understand the importance of educating all our patients about the spinal problems and the most effective ways to take care of their spine.

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