1/1/2 year of conservative treatment.. 2 level cervical fusion discectomy recommended
After 1 1/2 year of physical therapy, 3 cervical epidurals and pain, anti-inflammatory and anti-spasmodic medications, I continue to suffer with neck, shoulder and bilateral arm pain and parasthesias to the fingers and also left shoulder blade.
I was in Pt 3 days a week, but couldn't advance beyond a beginner in terms of strengthening exercises. Any increase always aggravated my symptoms and made me feel worse. My upper extremity pain would increase and worsen into the neck and left shoulder region. I have been off PT for over a month now, and some of my symptoms have improved....because I am only laying around, avoiding everything that increases symptoms. Any activity or pt exercises makes my upper extremities shake all the time. I develop more parasthesias down both arms into the fingers with nerve pain, also.
I cannot tolerate the pain medications as I get such adverse reactions. I have tried a combination of Tramadol 100 mg. 3 times a day with Flexeril 10 mg. 3 times a day and Celebrex 100 mg. 2 times a day. I felt horrible! I started weaning off the meds to see what was causing the reactions, and slowly started Tramadol again. I cannot stomach it though! When I take it, I have 24 hour nausea, dizziness with vomiting and a severe headache and shallow breathing. Flexeril makes me real drowsy and lethargic, gives me a dry mouth hoarse voice. Prior to this combination, I have tried Naproxen 550 mg. 2x day, but I had severe reactions when I took it with Flexeril.
I am desperate to get better, but wonder if there is another procedure that can alleviate my symptoms and improve my lifestyle. I am frightened, because it is open surgery (right sided anterior surgical approach with a 3 inch incision) The procedure that has been recommended to alleviate my symptoms is a 2 level fusion to C5-6-7 with discectomy (using artificial discs, titanium hardware...plate, screws, bolts). If I choose to proceed, 3 surgeons will be doing the procedure, my spine surgeon, neurosurgeon and physician's Assistant.
By looking at the CT report below, can you help me understand this more clearly. I see that I have an abnormal disc at C4-5, too. That abnormal disc didn't show up on the MRI w/o contrast a year ago. What happens if they fuse the C5-6-7, but leave C4-5? This CT image was taken immediately following my Discogram. The discogram confirmed that C5-6 and C 6-7 were my pain generators. C4-5 was my control disc that didn't show significant pain like the typical pain confirmed at the C5-6 and C6-7 levels
I would appreciate any suggestions or advice and help in understanding my case. Does anyone suggest or know anything about a less invasive endoscopic surgery with the Laser Spine Institue in Florida?
CT SPINE WO CONTRAST
Technique: CT of the cerical spine was performed in the axial plane Coronal and sagital reformats were reviewed
Findings: There postprocedural changes related to recent discogram cervical curvature and alignment are anatomic Vertabral body and intervertebral disc heights are preserved. There is no evidence of fracture
At C2-3 and C3-4, there is no significant spinal canal or foraminal stenosis
At C4-5, there is right asymmetrical uncovertebral spurring. There is resultant mild right spinal canal stenosis. There is opacification of the interverebral disc without evidence of annular fissure.
At C5-6, there is a mild shallow left paracentral disc protrusion and uncovertebral spurring. There is no significant foraminal stenosis. There is extension of contrast material from the nucleus pulposus into the periphery of the left posterior aspect of the disc, approximately 90 degrees, consisitent with Dallas grade 4 annular fissure. Contrast material does not extend beyond the annulus.
At C6-7, there is a mild, broad posterior disc osteophyte complex. There is flattening of the ventral thecal sac without significant spinal canal stenosis. There is no significant foraminal stenosis. There is extension of contrast maternal nucleus pulposus into the periphery of the posterior aspect of the disc, approximately 180 degrees, consistent with the Dallas grade 4 annular fissure. Contrast does not extend beyond the annulus.
At C7-T1, there is no significant spinal canal or foraminal stenosis.
There is no abnormal paraspinal soft tissue mass.
Visualized lung apices are unremarkable.
Mild degenerative changes in the cervical spine, most prominent at C5-6 and C6-7 levels.
At C5-6, there is a mild shallow left paracentral disc protrusion with resultant mild left-sided spinal canal stenosis. At the left posterior aspect of the disc, there are findings of Dallas grad 4 annular fissure.
At C6-7, there is a mild broad posterior disc osteophyte complex with flattening of the ventral thecal sac, but no significant spinal canal stenosis. At the posterior aspect of the disc and other findings of Dallas grade 4 fissure.
Last edited by Lazlouz; 06-21-2012 at 06:30 PM.