Questions re: c3-4, c4-5, c5-6 herniations - Hernia Message Board

Jay Bee · 08-28-2008, 12:51 PM

Please see the bottom of the post for MRI information. An ortho says surgery. I am going to a neurosurgeon next week... I have several questions that some of you may be able to help me with. I am a 33 year old male and don't know how / when this exactly happened, but have been experiencing tingling and numbness now for a few months. I have tried PT, including traction, but the symptoms remain.

Some questions:
a) For these 'small tears and herniations'. will I need to get these fixed up at the same time? So I'd be looking at a 3-level surgery? Does the risk of future problems in other areas of the spine later in life increase with the more levels you have done? I'm 33 now - should I basically assume I'll have more surgeries if I am still around in 15-20 years?

b) I'll certainly ask the neurosurgeon for his reasoning, but wondering how common this is --> he only looks at film. He will not look at my MRI results on film. The place where I had the MRI done said this was, 'strange'... I am **guessing** that the neurosurgeon will say the film is more revealing when reviewed as compared to images on a CD... which would be fine. But, is there any other reasons and is this not truly 'strange' as the MRI place told me?

c) What type of recovery time can I reasonably expect? I see many people talk of 4-6 weeks... if I have c3-4, c4-5 and c5-6 all done, should I expect a longer recovery time? A Co-worker had a C5-6 done and was back at work in just under 2 weeks... but from what I read on here, that would be outside of the norm.

d) After surgery, do most people feel more comfortable sitting up in a chair/recliner, or laying down in a bed?? Can I play some xbox 360 or should I forget about it?

e) Disc replacement material - any thoughts on the 'Prestige' system? Cadaver bones vs. artificial materials vs. your own hip bone? I'd rather not have my hip messed with, but...

Thanks for your thoughts in advance!!!

INTERPRETATION: Images reveal normally positioned cerebellar tonsils. Foramen magnum is large and normal in calibur. There is a large, broad-based posterior annular tear disc herniation at C5-6, extending across the full width of the spinal canal, but especially prominent on the left side. The disc indents and deforms the cervical spinal cord and encroaches upon the left C5-6 foramen, with C6 neural compression.

The C6-7 and upper thoracic discs appear normal. Thoracic spine is seen as low as T3.

At C4-5, there is a small central annular tear and disc herniation which midly indents the cord ventrally (series 5, image 12). C4-5 formina remain normal. The C3-4 disc exhibits a small midline and right paramidline tear and 1 mm disc herniation. This disc contacts the ventral surface of the cord but does not indent or deform the spinal cord. Foramina are normal at C3-4. The C2-3 disc level appears normal.

CONCLUSION:
1. Large posterolaterla disc herniation, C5-6 with cord impingement and left C6 neural compression.
2. Central and right paramidline small tear and disc herniation, C4-5, indenting and deforming the ventral surface of the cord.
3. Small central and right paramidline tear and 1 mm herniation, C3-4, with the disc contacting the ventral surface of the cord.

pg1chef · 08-30-2008, 06:49 PM

hi jay bee
I have c1 c2 c3 c4 c5 c6 disc problems too..herniation with cord impingment. I have lots of questions just like yours..I have serch the internet as i suppose you are...the one thing i have found to be interesting is laser spine surgery. look into it..that is the route i am going...i have really done my homework on it.... GOOD LUCK...

Laenini · 08-31-2008, 09:25 PM

Quote:

I'll certainly ask the neurosurgeon for his reasoning, but wondering how common this is --> he only looks at film. He will not look at my MRI results on film. The place where I had the MRI done said this was, 'strange'... I am **guessing** that the neurosurgeon will say the film is more revealing when reviewed as compared to images on a CD... which would be fine. But, is there any other reasons and is this not truly 'strange' as the MRI place told me?

I went back to the neurosurgeon who had performed my C4-5 fusion almost 2 years ago to get his opinion on some ongoing swallowing problems I am having. I ended up having a very disturbing encounter! I brought with some imaging studies that had been ordered by a spine rehab clinic that I followed with after my surgery. These films were actually on a CD that had been provided to me by the radiology facility who performed the studies. The neurosurgeon had me get some X-Rays of my cervical region before the appointment so that he could evaluate my previous fusion. When I checked in I gave the new films from that morning to the receptionist along with the CD which had cervical and lumbar MRI's on it, a cervical CT, and a series of cervical X-Rays. When I was called back to see the doctor he had the new films up on a traditional viewer. He pretty much point blank announced "there is nothing wrong with your fusion. Go back to your ENT and have a swallowing study done." I was taken aback as I wasn't there only to have him check my fusion. The MRI on the disc showed new herniations at the levels above and below my fusion site and my ENT was just as concerned that those new herniations were causing my swallowing issues as any problem with my old fusion might be. So I asked him what his opinion was of those new herniations on the MRI and he said he hadn't looked at them! I told him I really valued his opinion and asked if he would look at it with me right then. He said he didn't use normally use CD's, so I showed him there were directions for loading the images right on the CD case. He then lead me over to a computer in their hallway. He really didn't seem very familiar with the computer at all. He opened the CD drive and put the CD in, but didn't seem to know how to close it again. I reached over and closed it for him. The viewer program started to load, but then an error message popped up and prevented it from completing. Since some settings would have needed to be changed to proceed I asked if there was another PC we could try. He said sure and brought me back into the office. He put the CD in to load on the PC there and when the permission box popped up asking if it was OK to install he clicked "cancel", took the CD out, turned to me and proceeded to go off on me! He told me that he didn't need to look at the CD to know there was nothing wrong with me! He said that the outfit who performed the studies did poor quality work and that it wasn't worth his time to try to look at the CD anymore. I was dumbfounded and actually started to choke back tears as I felt like I had just been slapped across the face! Needless to say, I gathered up my things and left.

Anyway, this doctor obviously had no computer skills. When I had unknowingly backed him into a corner by asking him to load up the CD to view with me, he ended up going off on me rather than just admit that he didn't know how to do it. Now, I really have to wonder about a neurosurgeon who can't manage to load up images on a windows based viewer. The imaging company who performed those MRI's is a huge company with 16 locations in Minnesota and operations in 8 other states. I hardly think they would have grown so large by performing poor quality work. I really think the problem was with this one surgeon, not with the CD images or the imaging company. I would think that neurosurgery would be one of the more high tech surgical specialties and I guess I would have to think twice about a surgeon who can't manage simple, day to day technology that any 5th grader could manage.

Now, I live in Albertville, MN and I see that you live in Minneapolis, MN. The neurosurgeon I saw last week has offices in Minneapolis (next to Abbott NW Hospital) and in Edina (next to Fairview Hospital). I can't help but wonder if you and I could be talking about the same doctor? I'd sure be interested in what your doctor has to say when you ask him why he insists on films, not cd's. Post back after your appointment and let us know how things went?

Jay Bee · 09-01-2008, 12:11 PM

Hi laenini, thanks for the message-- sounds like were talking about the same doc (hames). I'll let you know how the visit goes.... PS how was your experience with the surgery a couple of years ago?

Laenini · 09-01-2008, 06:02 PM

Yes, it is the same doc. He did my C 4-5 ACDF in November 2006. If I had it to do over again, I would have used a multi-disciplinary spine clinic for my care. A multi-disciplinary clinic can offer both surgical and longer term rehab services from a team approach that utilizes surgeons, physiatrists, physical therapists, and other health care providers to provide overall comprehensive care. I never would have returned to get a second opinion from Dr. Hames last week except that my ENT doctor specifically wanted me to go back to the surgeon who had performed my surgery.
I had doubts about Dr. Hames before my surgery too. He really wasn't very nice to me right from the start. He had been highly recommended to me by a relative who is a nurse, and when I went to see him with my original MRI in hand back in '06 he told me that I was "one slip in the shower or one bumper tap in the car away from a wheelchair." So he scared me sufficiently into having the surgery without seeking out a second opinion or even learning a whole lot about what my options might have been. After the surgery I saw him briefly in the recovery room and barely remember the encounter. And I never, ever saw him again until I went back into his office last week. I was followed in the hospital and for 12 weeks after the surgery by his nurse practitioner. When I continued to have ongoing pain issues and some swallowing difficulties during that 12 weeks I felt like they were very dismissive of my concerns. And while I can understand delegating some of the post-op follow-up to a nurse practitioner, I really feel like he could have taken the time to see me at least once during that time, particularly when I was continuing to complain of problems.
You strike me Jay as someone who like me wants to actively participate in their health care. You want to know your options, understand the risks and benefits, and would appreciate a relationship with a health care provider who is going to be comfortable with you asking many questions. I would sum my experience with Dr. Hames up as authoritarian and dismissive. He probably isn't the only neurosurgeon like that, in fact I think its kind of a stereotype of neurosurgeons as a group. But that is where a multidisciplinary clinic can provide a more complete experience. When the surgery is over and the surgeon wants to move on to his next case, there are still the rehab providers on the team who can continue to provide you with appropriate care.

Whatever choices you make regarding your care, I wish you the best Jay! Please keep posting? I'd like to continue to hear how you are doing.