@rdflash0788 Rick, thank you for your update from Dr. Fox. I don't think it is possible to predict exactly when symptoms like numbness and tingling should be a concern and a lot of that comes down to how you feel about it. This can be generated from spinal problems, and these symptoms can also be caused by other conditions that pinch the same nerves as they travel into your arm. I have had that situation in having carpal tunnel syndrome and thoracic outlet syndrome in addition to a herniated cervical disc. I've had numbness and tingling as well as diffuse pain in my left arm for several years associated with these problems. My herniated C5/C6 was replaced with a fusion, and I had carpal tunnel surgery on my wrist. I have done a lot of physical therapy and myofascial release to work on the TOS which helps a lot, but I can also aggravate it and it kicks up again, so I stretch a lot on my own to try to prevent it from getting worse. If nerves are damaged or dying from compression, it may cause wasting and loss of muscle mass in muscles connected to those nerves. I had some of that on the back of my arm and shoulder, and a lot of muscle came back after my spine surgery during rehab.

TOS can be common in spine patients because it can be caused by injuries or repetitive stress. Unfortunately, finding a doctor who understands TOS is difficult and many patients with TOS are misdiagnosed or it is missed like mine was for several years. My spine issues were caused by a whiplash years earlier, and the thoracic outlet containing the brachial plexus of nerves and vessels exists right next to the spine and connected to it, and it can be injured as well. It may be worth asking your spine doctor about TOS and being evaluated for it. If you have this, cervical surgery will likely aggravate it for a bit after spine surgery because of the proximity of swelling and inflammation. When surgical scar tissue tightens up, it can also tighten other areas such as scar tissue from TOS and this is where myofascial release helps to loosen that. I had to wait for about 4 months after my fusion before I could resume therapy for TOS. I was evaluated at Mayo Rochester for TOS in the vascular lab prior to spine surgery.

It might also be worth asking if the posterior surgical approach would be better if you do have TOS. TOS does involve the scalene muscles at the side of the neck just above the collar bone and more in the front, although with neck spinal muscles also connecting to the shoulder blade, if can create tension there too, and for me TOS does cause my cervical vertebrae to rotate a bit because I have more tension on one side of my neck. If you have a multilevel fusion, that won't be possible for you to have that rotation, and when that happens for me, I do get some occipital headaches on the back of my head.

C1 & C2 do most of the head turning, with some help from C3 & C4. If you are fused from C3 to T1, you would loose a bit of head turning range. That would also be a good question to ask if your surgeon hasn't mentioned it so you have a better understanding of what to expect. Slipping vertebrae and osteophyte complexes could be contacting and compressing the spinal cord, and your surgeon should have showed this to you on your imaging and explained how that can cause your symptoms. With the recommendation for multiple level fusion, I'm guessing you gave some of this gong on. If you do have concerns, you may want to send a message on the patient portal to your surgeon.

Jennifer