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Old 12-29-2012, 04:56 PM   #1
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Cervical Stenosis, received opposite medical recommendations

I am a 46 years old male, six months ago I have been diagnosed (MRI report) with cervical spondylosis and stenosis at C5-C6 and C6-C7 level. The discs and osteophites are causing compression to spinal cord, AP diameter reduced to 8mm at one level. My normal lordosys is reversed. My symptoms are-
Neck and shoulder pain, occasional numbness in hands, right hand finger tips
sensitive to pressure (typing).

I can function without medication but ability to work has reduced. To be able to sleep is a challenge because of neck pain and occasional numbness.

Following are opinions from three different Surgeons I visited-

Neurosurgeon 1: He thinks it is pretty bad. It will only get worse. Itís not urgent but itís safe to do surgery. He will replace three discs (C4-C5 is also slightly degenerated) and two vertebrae because the vertebrae are also too close to the spinal cord. He thinks I can defer surgery as long as the pain is tolerable, I can do it now as well as precaution against accident and fall.

Orthopedic Surgeon 1: He thinks it is not bad. I need surgery after 10 years, in my mid 50s. He gave me PT, recommended injection but strongly warned against surgery. It will be two discs replacement. His recommendation is to do nothing and watch, visit doctor once a year, perform MRI once in every 2 years.

Orthopedic Surgeon 2: He thinks my MRI report is bad but I do not have corresponding or matching symptoms. Reports tells him I need surgery right now, my symptoms (no weakness in hands or legs) tells him opposite. But like the first surgeon, he thinks nothing wrong to perform a surgery right now. He is not in favor of injection because he thinks the space is too tight. He would perform ADCF with alloe graft on three levels which will restore my normal lordosys.


So, I am confused and worried as to where I stand and what is safe and wise to do next.

Any suggestions or sharing of similar experience will be much appreciated.

Last edited by restonguy; 12-31-2012 at 05:57 PM.

 
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Old 01-02-2013, 10:50 AM   #2
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Re: Cervical Stenosis, received opposite medical recommendations

Dear reston guy, If Im understanding you right all 3 drs are not recommending surgery at this time, nor injections, nor PT. Which dr is treating your symptoms & what medical treatment are you receiving?

 
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Old 01-02-2013, 05:32 PM   #3
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Re: Cervical Stenosis, received opposite medical recommendations

gmak, thank you for your time in reading and replying my post. Main dr is Orthopedic 1, because I visited him twice and went for PT according to his advice. He gave me Tramadol HCL for pain which I have not started to take. He also asked me if I want injection. He thinks I need surgery after 10 years. Other-2 is against injection, he is in favor of quick surgery, but not urging for it.

At present, I am only doing neck stretches at home, no other medical treatment. My neck pain reduced after PT, but recently I am getting more and more occasional numbness in my hands.

Here is my MRI report taken 5 months ago.

Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Just to recap my dilemma, the Ortho 1 said- do not let any one scare you to surgery. While the Ortho-2 said you need surgery, you can do it now as a precaution, otherwise after sometime when your symptoms will advance and you will give in. It sounded like 10 months max, not 10 years. I cannot go back to Ortho-1 before one year because that's when he will see me next. I have symptoms that are scary but not disabling yet.

Should I wait, should I do a surgery or see more doctors?

 
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Old 01-02-2013, 05:41 PM   #4
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Re: Cervical Stenosis, received opposite medical recommendations

gmak, thank you for your time in reading and replying my post. Main dr is Orthopedic 1, because I visited him twice and went for PT according to his advice. He gave me Tramadol HCL for pain which I have not started to take. He also asked me if I want injection. He thinks I need surgery after 10 years. Other-2 is against injection, he is in favor of quick surgery, but not urging for it.

At present, I am only doing neck stretches at home, no other medical treatment. My neck pain reduced after PT, but recently I am getting more and more occasional numbness in my hands.

Here is my MRI report taken 5 months ago.

Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Just to recap my dilemma, the Ortho 1 said- do not let any one scare you to surgery. While the Ortho-2 said you need surgery, you can do it now as a precaution, otherwise after sometime when your symptoms will advance and you will give in. It sounded like 10 months max, not 10 years. I cannot go back to Ortho-1 before one year because that's when he will see me next. His office will not take appointment until it is one year from my last visit. I have symptoms that are scary but not disabling yet.

Should I do surgery so there is no permanent nerve damage, should I wait, or see more doctors?

 
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Old 01-03-2013, 07:27 AM   #5
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Re: Cervical Stenosis, received opposite medical recommendations

#1 and #3 seem to be proposing very different surgeries. Replace two VERTEBRAE? Are you sure he's proposing that?

You do not mention what each guy said about the other two's recommendations, so should I assume you didn't ask them? I think it is critical that you do so. Don't beat around the bush. Lay it out for each one. If they won't explain their positions, kiss them goodbye.

 
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Old 01-03-2013, 06:08 PM   #6
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Re: Cervical Stenosis, received opposite medical recommendations

Hello webdozer, thank you for your response. the first doctor indeed mentioned about replacing two vertebrae, I kind of ruled out his recommendations.

I told second one about the first doctor, he was upset and said don't let anyone scare you to surgery.

I told third doctor about second one and his strong words against surgery. Third surgeon kind of toned down after hearing it and started saying my report doesn't match with my symptoms.

Here is my MRI report-
Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Any comments/suggestion will be much appreciated.

 
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Old 01-04-2013, 07:14 PM   #7
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Re: Cervical Stenosis, received opposite medical recommendations

Thank you webdozer and gmak for your time to read and respond to my posting. I have been replying to your responses but don't see them posted. So I thought I will try again.

Currently I am only doing some neck stretch that Therapist gave me. Ortho-1 prescribed me Tramadol HCLfor pain which I haven't taken yet.

for webdozer- yes, the first surgeon, who is a nureo surgeon of age 46, told me he will replace three discs and two vertebrae, which is strange. The second surgeon is an orthopedic spine surgeon age 54 said don't let anyone scare you to surgery, you need surgery after 10 years. I told his remark to the third surgeon, orthopedic- 41, he toned down his surgery recommendation after hearing that. He said he don't see weakness in my hands or legs, so I can wait but MRI report is pretty bad. To dig what is in his mind, I said do you think it is a good idea to go for a surgery now, he said yes. He also mentioned my symptoms will definitely progress and I will give in. It sounded like I have one year time.


With stenosis ( 8mm AP diameter) can I take injection and will it reduce my numbing and tingling symptoms?

I would rather believe the Ortho-1 who said 10 years, but I am getting more and more numbness in hands and legs in last 2/3 weeks. So, I am confused.

 
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Old 01-05-2013, 11:21 AM   #8
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Re: Cervical Stenosis, received opposite medical recommendations

Injection will not reduce numbing and tingling. Might reduce pain, inflammation ans stiffness, esp. that coming from C6-C7.

Have you tried cervical traction? If your surgeon says it is safe, that could help with numbing and tingling. It helps my shoulder and arm pain and numbness. It can. Be done at home after a qualified PT. shows you how and sets limits.

 
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Old 01-05-2013, 12:44 PM   #9
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Re: Cervical Stenosis, received opposite medical recommendations

Daffydolphin, thank you for your response. About four months ago I got PT, and part of it was cervical traction. It help reduced my shoulder pain. I think it is a good option to try. Can I buy some avail device from Orthopedic store and start doing it at home following user manual? Thanks!

 
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Old 01-05-2013, 01:56 PM   #10
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Re: Cervical Stenosis, received opposite medical recommendations

Many medical device stores will require a prescription to sell it. They can be bought online without. If you get the Rx, your insurance might pay 70 to 80% of it.

You want the lay on the floor, pneumatic (bike pump) trac type (the sit chair, mount over door type can screw your jaw joint up). Mine was retail priced at $1,000 in the medical equip store, sold on Amazon for around $600, my insurance approved price was $525 of which I only paid the equipment store about $160. And it looks like something that should not retail more than $125 with the case. The manual mine had only told me how to care for it, clean it, store it etc. For use, it told me to see my doctor or physical therapist.

My PT told me to set it at between 15 to 30 pounds of pressure, and to clear it with Dr. before going over 30. I set it at 25. Use for at least 15 to max 30 minutes per session, at least 3 times a week, but can use daily or even twice a day. Release pressure slowly and remain stretched out on floor for at least a minute before standing up, and then get up slowly.

 
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Old 01-05-2013, 03:11 PM   #11
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Re: Cervical Stenosis, received opposite medical recommendations

Thank you Daffydolphin for giving detail about traction device. During my PT I took 25 pounds for 10 minutes session, and felt good immediately after. I think I will go for it. Will talk to doctor about it. Thanks again!

 
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Old 01-05-2013, 09:41 PM   #12
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Re: Cervical Stenosis, received opposite medical recommendations

We can't really tell if laminoplasty might be called for w/o seeing the MRI radiologist's report. Laminoplasties are for people with congenitally narrow spinal canals, where the intrusions into the canals (disks, bone spurs, swollen ligaments) may not be particularly big. The idea is that, instead of treating the intrusions directly, you treat the narrowness of the canal.

Just something to know, also, is that kyphosis is a counterindicator for laminoplasty. You have "reversed lordosis", which may or may not rise to the level of actual kyphosis (the two are opposites).

 
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Old 01-05-2013, 10:55 PM   #13
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Re: Cervical Stenosis, received opposite medical recommendations

Jen, I like northern Virginia too. Thank you for your response and valuable advice. I didn't count the first doctor's opinion, and I probably heard it wrong. No one of these three advised laminoplasty. One reason could be that it is not their expertise. The second surgeon said no surgery because he told me my 8mm AP diameter and symptoms are acceptable. BTW, So far I did not feel weakness in hands or legs, I feel numbness several times a day and during sleep. He said I have 10 years and surgery is needed when it will show red on the MRI (being naive I didn't ask many follow up questions). The third surgeon is listed as one of the nation's top 50 spine surgeon according to a website and he is with NIH (Dr. Jay Khanna). He leaned towards immediate surgery. I made appointment with another surgeon who supposed to be very good too (Dr. Abraham Kader) but I agree with you, I probably haven't found the right surgeon yet. I am not settling until I am fully satisfied and until I can bear my symptoms. I have done XRAY besides MRI. What other kind of tests are there?

webdozer, thank you for your comments. Here is the full MRI report taken 6 months ago. I will appreciate your comment, and anyone else's who may have similar situation or know about this condition.

Open MRI

Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flattening of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.

IMPRESSION:

1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Last edited by restonguy; 01-05-2013 at 11:05 PM.

 
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Old 01-06-2013, 07:12 AM   #14
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Re: Cervical Stenosis, received opposite medical recommendations

Your MRI report does not looks particularly alarming to me. I'm a little surprised that two out of three surgeons recommend immediate surgery. I would say, though, that surgeons should always read the images themselves, and many just ignore the radiologist's report. It's entirely possible that the radiologist is missing something, or he's understating what he does see.

Radiologists use a progression of adjectives to describe anomalies...

minimal - I can just barely see it

mild - I can clearly see it, but don't think it's problematic

moderate - bordering on problematic, bears watching

severe - probably needs to be fixed

Your radiologist is, unfortunately, a little light on the adjectives, but you will note that he never says "severe". You do have disk protrusions touching the cord at three levels, though, and mild encroachment on both foramina at C6-7.

I'm curious about the right-hand finger tingling.... Is it the tips of all the fingers that are sensitive, or just one or two (and which ones)? Any other symptoms in the hands (weakness, tightness, shocks, slowness)? The reason I ask is because sensitivity at the tips of all fingers does not sound like a cervical problem to me.

Anyway, from your report, one can't really say if laminoplasty is called for. Laminoplasties are meant to treat congenitally narrow spinal canals (by swinging open the lamina bones at the back of the spine). The radiologist does not give any indication that your canal started out too narrow, and he doesn't mention "short pedicles", which may be the main reason for narrow canals. Still, if you do have congenital narrowing - and at three levels - then a laminoplasty is a reasonable approach. To repeat, though, kyphosis is a counterindication, and your "reversed lordosis" leaves it open to question that you may be considered kyphotic.

Normally, I would say that seeing three surgeons is a sufficient effort at getting a full range of opinions. I'm afraid, though, that you need to get one or two more. You might also get a second radiologist's report. I know there are radiologists who advertise online for second-opinion reports. I can also give you the name of a pretty good radiologist who did a couple of reports for me.

 
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Old 01-06-2013, 08:57 AM   #15
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Re: Cervical Stenosis, received opposite medical recommendations

Back in 1996-1997 I had really severe lumbar issues. I had a condition known as "Flatback syndome" that cause me to bend forward and unable to maintain a normal posture.

Prior to that I had lumbar surgery for herniated discs and cervical surgery for stenosis. Both surgeries were done by the same doctor a neurosurgeon. So I went back again to be evaluated.

His recommendation was to lose weight and take some aspirin. BAD ADVICE. So here I see someone else and went thru the medication route and physical therapy. NOTHING worked.

I ended up seeing an orthopedist in NY at one of the top orthopedic hospitals in the country. The recommendation was surgery with Harrington Rods. So taht is why I said bad advice by the original surgeon that I saw.

But with anything I always get a second or third opinion if necessary. after my initial consult with the orthopedist I in my heart felt that was great advise but did get another opinion.


I usually like to get another opinion from a different doctor at a different hospital So I proceeded uptown to another hospital and saw a neurosurgeon this time. I liked the doctor, he was thorough. But his recommendation was not to do surgery and go back to work. I totally disagreed with his opinion.

Here it was almost a year since I could walk upright. Medication did NOT help; physical therapy did NOT help. I could not function in my normal daily routines.

So here I was with 2 separate opinions.

I decided on a 3rd opinion. This time I headed to lower NYC to yet another hospital and another doctor. Back to an orthopedist.

When I told him the 1st doctors opinion, then the 2nd doctors opinion (neurosurgeon) his comment was that the Neurosurgeon was *&% of )^$^
(BLEEP BLEEP). Bottom line I needed surgery.

In my heart and soul and from what I researched on my own I knew that the original doctors opinion was right.

Sometimes we need to be proactive, look at all the evidence; all the opinions and come to an answer that makes the most sense to us. None of us want surgeries, but you were the one at the doctors office not us. Look at the doctors that gave you the opinions. I tend to look at who did I trust the most? I never regretted going thru any of the surgeries I went thru because I took the time to evaluate the situation and think what made the most sense. I knew in my heart what the answer was. Good luck in whatever you decide.

 
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