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Old 10-05-2012, 11:06 AM   #5
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Re: Need Help decided what to do and understanding results

Smokey - The 2012 MRI does not seem a whole lot worse than the 2008. I think that many surgeons would have operated back in 2008, actually, at least to do something about the apparent impingement of the left C6 nerve, which would have caused symptoms (tingling, numbness, weakness, pain) from the shoulder down to the thumb.

some terms...

REVERSAL OF LORDOSIS - Lordosis just means a backward curve of the ascending spine. Some areas should be lordotic, and the neck is one. Reversal of lordosis in the neck is pretty common. It just means that the neck is not as curved back as it ought to be, the head is more likely to point down, and increasing pressure is put on the spinal column. It's the severity that's important, though, and your radiologist hasn't been much help there.

RETROLISTHESIS - One vertebrae being displaced BACKWARD compared to another. So your C4 is displaced backward over the C5, and the C5 is displaced backward over the C6.

LIGAMENTUM FLAVUM - the ligament that holds the lamina at each level to the lamina at adjacent levels. It runs down the BACK of the spinal canal, so if it is hypertrophied, it is squeezing the canal from BEHIND.

FACET - In the back/side of the spine, where the different levels meet. There is some limited freedom of movement here, one level upon another, so it's called a "joint". Osteoarthritis can cause hypertrophy over time, with osteophytes (bone spurs) growing off the facets and either pushing on the spinal canal from the SIDE, or pushing into the neural foramina.

NEURAL FORAMINA - These are openings in the front/side of the spinal structure, one on each side at each level. The spinal nerves leave the spinal cord, pass through the foramina, then head down to your shoulders and arms.

UNCARTHROSIS - Osteoarthritis of the uncinate process, which is a ridge that grows off the sides and back of the cervical vertebrae (the disks fit into it, and are stabilized by it). Osteophytes can grow off the uncinate processes and either into the spinal canal (from in FRONT) or into the neural foramina.

DISK OSTEOPHYTE COMPLEX - Multiple osteophytes (bone spurs) growing off the vertebrae where they interace with the disks. These are growing BACKWARD into either the spinal canal or the neural foramina. They may be associated with bulging disks.

Your problem levels are C5-6 (advanced), C4-5 (getting there) and C3-4 (starting).

I would expect worse problems in your right shoulder/arm (than in the left) because of the multi-level moderate-to-severe narrowing. While the left side could be bad at C5-6, it seems to have gotten better at C6-7, which I can't explain. BTW, the C7 nerve would show symptoms mostly in the middle fingers.

The radiologist would have been a lot more helpful if he'd included measurements of the growths and stenosis at various levels. I guess he's counting on the surgeons to view the images themselves and ignore his report, which I'm told is not uncommon.

As for surgeries, I'm sure the surgeon who wants to operate wants to take out the C5-6. He may well want to do the C4-5 while he's at it. If he took out both levels, your neck's range-of-motion MIGHT be reduced to 50% of normal (maybe as high as 70%), although from what you say it's so bad now that this might be an improvement. I would hope that the surgery can deal with the uncarthrosis and the disk osteophyte complexes. Something to ask. Another thing to ask is, if the surgeon only wants to do the C5-6, then what can be done about the foraminal narrowing at C4-5, which just MIGHT be the cause of many/most of your symptoms. Can they do a separate surgery (a "foraminotomy") from behind to clear out the foramina? (foraminotomies are minimally invasive, usually with brief and easy recoveries).

There's another surgery that some surgeons would suggest, which is the laminoplasty. This does not come in from the front, and does not remove disks and fuse vertebrae. Instead, it "decompresses" the spinal canal by cutting the lamina on one side, then swinging that lamina open and propping it with a titanium brace. It's not unusual to do three or four levels in one operation. The hypertrophied ligamentum flavum is thus pulled away from the spinal canal, and the cord is given more room to "escape" backward from the uncarthrosis and disc osteophytes encroaching from in front. Range of motion is preserved.

I've had all three operations mentioned - single-level fusion in 1996, left C5 foraminotomy in 2004, and C4,5,6 laminoplasty in 2011. Many docs do not know how to do laminoplasties (or don't know how to avoid neck muscle damage when doing them), and so will only suggest fusions.

Of course, I'm just a slightly educated amateur with a little too much personal experience, who's trying to give you a little better understanding of your situation, and the options for dealing with it.

Last edited by WebDozer; 10-05-2012 at 11:12 AM.

 
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Smokey2065 (10-06-2012)