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Old 12-03-2011, 08:52 PM   #1
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rayp HB User
confused about diagnosis and treatment

Hi Folks,

The nice folks on the spinal forums suggested I post this here as well.


I' a 44 year old male with a long history of RA and joint pain. Went to see the doctor as my mid and lower back were very sore, right leg completely numb. She ordered a MRI and what appears to be the main results are:

T1-T2: Normal disc height and T2 signal. Bilateral paracentral through far lateral shallow protrusions partially efface ventral CSF. Left ligamentum flavum calcificaion with a minimal extradural mass effect upon the thecal sac. Bilateral moderate foraminal narrowing. Mild facet degenerative degenerative change.

T3-T4: Normal disc height and T2 signal. Bilateral paracentral through far lateral shallow protrusions partially efface ventral CSF. Right moderate and left mild foraminal narrowing. Right moerate and left mild to moderate facet degenerative change. Prominent ligamentum flavum calcification bilaterally indents teh dorsal aspect of teh cord and deviates the cord anteriorly. There is near complete effacement of CSF surrounding the cord. Subtle increased T2 signal within the cord at the interspace level is poorly circumscribed.

T6-T7: Normal disc height and T2 signal. Right paracentral tiny protrusion just abuts the ventral cord. Bilateral moderate facet degenerative change. Mild foraminal narrowing. Bilateral ligamentum flavum calcification indents the posterior aspect of the cord and deviates teh cord anteriorly at the mid T6 level.

She referred me to a neurosurgeon, who took a look at my MRI and report and is recommending T3 and T6 laminectomy. Based on some research, it seems like laminectomy in the thoracic region is much less common than elsewhere.

I plan on getting a second opinion (heck, maybe even a third!). I guess what I am asking is whether the laminectomy is the best course of action, and what is the urgency of getting this taken care of - I can deal with the pain, etc. but I do not want to risk causing more damage!

Also - if anyone can recommend a good neuro in the Seattle area it would be appreciated.

Thanks!

Ray

 
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Old 12-04-2011, 09:38 AM   #2
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teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: confused about diagnosis and treatment

First, please get several opinions before proceeding. I don't feel comfortable telling you how severe the cord compression is. It's not that having a laminectomy in the thoracic level is less common. All surgery in the thoracic level is done less often than either cervical or lumbar surgery.

Fewer problems arise in the thoracic area due to the fact that it is not subject to a lot of movement. And, it is much more difficult to operate on due to the ribs, etc.

I would normally suggest that a patient needs to be careful having multiple laminectomies as the lamina is needed to provide support. When too much bone is cut away, the spine can become unstable and there is more room for a nerve to get "pinched." Sometimes a patient can get away with having two adjoining levels surgically altered, but more than that can be problematic.

However, this may not hold true in the thoracic spine as it is designed to be fairly stationary anyway.

Until you know that the cord compression is not severe, if I were in your position I would consider it something that needs attention as quickly as you can arrange appointments. I would get an opinion from at least one orthopedic spine surgeon. Their training (with a spine fellowship) is similar to a neurosurgeon's and sometimes will approach things slightly differently.

I can give you two names of ortho spine surgeons to check out. You have many to choose from in the Seattle area, what with the UW faculty and their spine clinic and I believe there is another large orthopedic clinic there, too. It depends what you like. Anyway, the names are Andelle Teng and ...I'll have to get back to you with another name. I can't think of it at the moment!

In case you are not familiar, an ortho spine surgeon is not the same as a sports medicine doc or a regular orthopedic doctor...so be sure you are choosing a fellowship-trained orthopedic spine doctor...someone who limits his practice to the neck and back.

 
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rayp (12-04-2011)
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