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Old 01-07-2013, 04:49 AM   #1
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Question Spondylolisthesis, facet disease, cervical spine

The radiologist who read my flexion/extension films of the neck stated there was moderate posterior subluxation at right C3-C6 (he did not mention the degree of spondylolisthesis in terms of millimeters). The neurosurgeon could not appreciate the subluxation.
The same radiologist stated I had marked posterior apophyseal degenerative joint disease at the left C3-C5 with marked neuroforaminal narrowing most marked on the left. The neurosurgeon again stated he would describe it in lesser terms, possibly mild.
I am trying to get a second opinion. In the meanwhile, it there any point to trying to clarify the severity of both the degree of spondylolisthesis or facet disease if the neurosurgeon does not want to take me to surgery because of a lack of significant disk herniation or spinal stenosis on MRI?

Thanks.

 
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Old 01-07-2013, 06:17 AM   #2
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Re: Spondylolisthesis, facet disease, cervical spine

Welcome to the board.

The MRI is just one piece of the diagnostic puzzle. The spine specialist will correlate information found on the MRI to what he/she finds upon physical exam, a basic neurologic exam and after listening to the patient's history and symptoms. It is common to have a bulging disc that looks awful on imaging but in reality is causing no symptoms. If one treated based only on what is found on MRI that is something derivating from "normal," almost everyone would end up with spine surgery.

Beyond our twenties, most people begin to show signs of "wear and tear" in the spine. ("wear and tear" as shown by degenerative disc disease). This is not significant. It is a normal part of the aging process, which, for the spine, begins in our twenties. What is important is whether there is nerve compression and whether the patient is in pain, what is causing the pain, and then what can be done about it.

What symptoms are you experiencing that took you to a neurosurgeon?
You might want to get a second opinion with an orthopedic spine surgeon from a different medical practice.

Last edited by teteri66; 01-07-2013 at 06:19 AM.

 
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Old 01-07-2013, 01:11 PM   #3
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Re: Spondylolisthesis, facet disease, cervical spine

Thanks for your review of my comments. I have a very complicated history that began a decade ago with a whiplash injury from being rear-ended by a truck. I have had progressive deterioration of both my thoracic and cervical spine and ended up having three endoscopic surgeries through Laser Spine Institute. I had a cervical radiculopathy manifested with pain into the hand that abated with surgery. Additionally, my neck pain improved. It definitely also helped my back as I went from not being able to sit at my computer for more than twenty minutes due to severe back pain to being able to sit for several hours.
Now, unfortunately I am not able to cook a meal before developing severe thoracic radicular symptoms wrapping around to both sides. I have two herniations that correlate with my symptoms. Epidurals are very helpful but for only about a month. As far as my neck, it is much less straightforward. I have onset of severe pain within twenty minutes of laying down. My neck becomes quite hardened. I develop terrible headache pain accompanied frequently with nausea. I have very poor sleep. The biggest problem is I used to lay down to give rest for my thoracic spine after I had been active like cooking a meal. But now, when I lie down within 20 minutes my neck becomes rock hard. What helps the back aggravates the neck-- terrible. My life is miserable.
I just found out that I will get to speak with an orthopedic surgeon at Laser SPine Institute to discuss procedures for both the thoracic and cervical spine. I think they will definitely help my back. I do have more concerns though about the neck. They do not perform fusions and yet I'm concerned that a fusion might ultimately be what would more definitely help me with my cervical problems. I am wandering if I could have an instability related to the subluxations that is someway worsened by laying down? Or could this pain brought on by the supine position be related to the facet disease? If I have facet problems bilaterally at multiple levels I have concerns that undergoing rhizotomies or doing something comparable where the nerves would be de-enervated at multiple sites, over time do I run the risk of doing more harm to the joints with the ongoing movement of the joints? What are the best ways to better define the pathology and sort through the options? I hear what you are saying that clarifying the severity of the facet joints may not clarify if it ultimately is the source of the problem. Then how do you sort through what is causing my terrible neck and back problems? Can EMG's or NCV's ever help clarify the neck problems? I'm interested in getting a CT scan to better visualize the facet joints. What do you recommend? Thanks very much.

 
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Old 01-07-2013, 01:13 PM   #4
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Re: Spondylolisthesis, facet disease, cervical spine

Thanks for your review of my comments. I have a very complicated history that began a decade ago with a whiplash injury from being rear-ended by a truck. I have had progressive deterioration of both my thoracic and cervical spine and ended up having three endoscopic surgeries through Laser Spine Institute. I had a cervical radiculopathy manifested with pain into the hand that abated with surgery. Additionally, my neck pain improved. It definitely also helped my back as I went from not being able to sit at my computer for more than twenty minutes due to severe back pain to being able to sit for several hours.
Now, unfortunately I am not able to cook a meal before developing severe thoracic radicular symptoms wrapping around to both sides. I have two herniations that correlate with my symptoms. Epidurals are very helpful but for only about a month. As far as my neck, it is much less straightforward. I have onset of severe pain within twenty minutes of laying down. My neck becomes quite hardened. I develop terrible headache pain accompanied frequently with nausea. I have very poor sleep. The biggest problem is I used to lay down to give rest for my thoracic spine after I had been active like cooking a meal. But now, when I lie down within 20 minutes my neck becomes rock hard. What helps the back aggravates the neck-- terrible. My life is miserable.
I just found out that I will get to speak with an orthopedic surgeon at Laser SPine Institute to discuss procedures for both the thoracic and cervical spine. I think they will definitely help my back. I do have more concerns though about the neck. They do not perform fusions and yet I'm concerned that a fusion might ultimately be what would more definitely help me with my cervical problems. I am wandering if I could have an instability related to the subluxations that is someway worsened by laying down? Or could this pain brought on by the supine position be related to the facet disease? If I have facet problems bilaterally at multiple levels I have concerns that undergoing rhizotomies or doing something comparable where the nerves would be de-enervated at multiple sites, over time do I run the risk of doing more harm to the joints with the ongoing movement of the joints? What are the best ways to better define the pathology and sort through the options? I hear what you are saying that clarifying the severity of the facet joints may not clarify if it ultimately is the source of the problem. Then how do you sort through what is causing my terrible neck and back problems? Can EMG's or NCV's ever help clarify the neck problems? I'm interested in getting a CT scan to better visualize the facet joints. What do you recommend? Thanks very much.

 
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Old 01-07-2013, 02:20 PM   #5
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Re: Spondylolisthesis, facet disease, cervical spine

You might want to get an opinion from an orthopedic spine surgeon or a neurosurgeon at a more "traditional" medical practice, too. I'm not sure Laser Spine can help you at this point.

I have to run right now but will try to answer your questions when I get home....

Last edited by teteri66; 01-07-2013 at 02:23 PM.

 
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Old 01-08-2013, 09:53 AM   #6
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Re: Spondylolisthesis, facet disease, cervical spine

Thank you very much for your interest. I am an internist so have some knowledge but still have many questions. My neurosurgeon doesn't think he can help me; but, maybe going to an orthopedic surgeon outside of LSI would be a good idea. I do appreciate your comment and certainly will welcome all of your thoughts.
Sincerely,
drmva

 
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Old 01-08-2013, 10:50 AM   #7
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Re: Spondylolisthesis, facet disease, cervical spine

As I hope you realize members do not have formal medical training and are sharing information based on experiences....that being said, I think some of us have a wide variety of experiences with various spinal procedures, treatments, etc. and can offer some information for consideration.

I consulted with eight different spine specialists from three different states, and practices ranging from a large teaching university program, to a one man practice (the one I chose!) so I had an interesting variety of opinions. I have known my surgeon, who was originally a trauma surgeon and then did a fellowship in spine surgery, for 18 years and have asked him about clinics such as the one you went to...and it is a very specific "approach" to a surgery.

I think it would be worth your while to meet with a well-trained, experienced ortho spine surgeon for an opinion.

Unfortunately the onset of arthritis seems to happen sooner and more extensively in people who have been involved in a high impact accident. My problems have been lumbar...and I learned the hard way how much facet joint deterioration can contribute to a patient's pain. I would assume it is the same in the cervical area.

My problem was initially a grade 1 spondylolisthesis at L4-L5 and severe central canal and foraminal stenosis that created L5 radiculopathy and the sciatic pain that prevented me from standing or walking any distance. I had a one level fusion which was considered medically successful, but it never resolved my pain. After I healed, I had the identical symptoms I'd had for years prior to surgery. After this point, I spent a good two years going from one specialist to another trying to find the source of my pain. My MRI looked clear from nerve compression so no one could figure out what was going on.
Eventually I ended up having a revision surgery where I ended up being fused from L3 to S1. The interesting thing is that when they opened me up, my surgeon was surprised to see that I basically had no facet joints at L3. Due to the instability they had worn away and were just little nubs...and of course, my spine was able to move in ways that nature had not intended! This was not evident on any imagine I'd had done through the years....

My guess is that the subluxations you mention may be creating some instability that is at least irritating a nerve, if not compressing it. This causes the facets to enlarge, creating even less space for the nerves. The more the body senses instability, the more it lays down more adhesions in an attenpt to stop the undesired movement...osteophytes form, joints enlarge, and the nerves suffer.

This can also result in bio-mechanical issues further down in the spine, as muscles and soft tissue compensate.

I think you would benefit from the information an EMG/ncv could provide, some sort of scan to look at the facets and a thorough evaluation by a new set of eyes.

 
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Old 01-08-2013, 11:56 AM   #8
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Re: Spondylolisthesis, facet disease, cervical spine

Wow. Your words reinforce what I think I need to do. I'm resolved to try to talk to an orthopedic surgeon locally. That in itself is a challenge. Did your second fusion make a difference with your pain?
Thanks,
drmva

 
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Old 01-08-2013, 12:08 PM   #9
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Re: Spondylolisthesis, facet disease, cervical spine

HUGE. It was a really long recovery as my surgeon and I both regarded the surgery as my "last chance" to fix my issues. If it failed, I would have to move on to pain management, perhaps a neurostimulator.

At the 4th day post surgery, my leg pain went away and I was off all medications by the 10th day post surgery, and I have been without nerve pain ever since. Of course there are certain activities that I know will bring on the beginnings of sciatic pain, so I avoid them as much as possible. But I can now walk as far as I want with no pain at all, was able to garden last summer for the first time in years and even planted 9 evergreens. Cooking Thanksgiving and Christmas dinners was once again manageable!

I have some residual numbness in my feet as my toe numbness began around 2000 and a doctor told me it was peripheral neuropathy, which I never questioned. Once I had an EMG after my spine problems began and after my first fusion, it was determined I had no PN...so it must have been from the spinal nerve compression all along. I just didn't realize it.

I was very lucky. Many revision surgeries don't turn out so well.

 
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Old 01-08-2013, 12:24 PM   #10
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Re: Spondylolisthesis, facet disease, cervical spine

You give me hope. Thanks very much. I need it as I have hit so many roadblocks. I have a wonderful physiatrist; but, she generally is anti-surgery. My neurosurgeon lacks interest. Laser Spine probably wants my money. I know they can help me on the thoracic spine whereas no one else will touch it. They would likely attempt to desiccate the disc by heat or laser to pull them in to reduce the herniations. I doubt they will be able to stabilize the movement. Is your doctor still in practice? Is he/she an ortho or neurosurgeon? I was declined by the Barrows institute after I changed my insurance so they could see me. I can't even get in to see anyone at the Mayo clinic.
I'm very happy for your good outcome! Thanks for your kindness.
drmva

 
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Old 01-08-2013, 07:42 PM   #11
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Re: Spondylolisthesis, facet disease, cervical spine

I know as well as anyone that making broad generalities is silly. That being said, I truly believe that ortho spine surgeons are less fussy than neurosurgeons. At least the ones I know are more willing to take on a patient who has had previous surgeries, surgeries with another spine surgeon and, at least some are willing to take on cases that are challenging and for which the outcome is not obvious.

Are you in Arizona? If so, I have a board friend who has a wonderful surgeon -- I think he is in the Phoenix area, but I'd have to check.

 
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Old 01-09-2013, 04:40 AM   #12
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Re: Spondylolisthesis, facet disease, cervical spine

We live in Tucson and in Lakeside. I am definitely willing to travel. I got the names of several Spine Orthopedic Surgeons in Tucson so will check them out also. Thanks for the name(s) of anyone you have regard for.
drmva

 
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Old 01-09-2013, 05:31 AM   #13
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Re: Spondylolisthesis, facet disease, cervical spine

I'll email my friend and get a name. She's had a number of surgeries with several different doctors, and finally has one she thinks is terrific.

 
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Old 01-09-2013, 10:13 AM   #14
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Re: Spondylolisthesis, facet disease, cervical spine

These two spine surgeons are affiliated with Phoenix Orthopedic Consultants. My friend has used both of them and has had both lumbar and cervical surgeries. She also has several friends who have used them as well and are pleased.

John R. Ehteshami, M.D. Jonathan Landsman, M.D

Hope this helps and that one of them works out for you.

 
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Old 01-09-2013, 10:31 AM   #15
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Re: Spondylolisthesis, facet disease, cervical spine

Thanks again. I will hold onto the names. If I don't make headway with the local orthopods (in Tucson), I will try your recommendations.

I really appreciate your help. I hope that someday I will be in a position where I too can offer hope to someone who feels as desperate as I have over the last several years.

Thanks again. If ever I have further questions, I may try to reach out to you. Take care.
drmva

 
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