Pre-Op and Post-Op MRI - Spinal Cord Disorders Message Board

settingsons · 06-21-2007, 08:39 AM

I have posted on this before, but because my NS gave me so little info on my post-op MRI I took it to a neurologist who reviewed it with a neuroradiologist.

*********** gave me some very good info during a previous post on osteophyte growths. I am not sure if you are viewing these forums currently but if you are maybe you might be kind enough to help again.

Pre-Op (day before op)
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There is a C5/C6 disc prolapse. There is narrowing of the exit foramina of the left C6 root with a disc osteophyte and an uncovertebral joint hypertrophy as well as apophyseal hypertrophy. The cord appears distorted at that level but not compressed.

Post-Op (exactly 3 months post-op)
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The post operative picture still shows a far lateral narrowing of the left C6 exit foramina by a combination of a discal bar and neurocentral joint hypertrophy. The disc height at C5/C6 is very much reduced.

Questions:
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Does this mean the NS messed up? His operation notes say he removed an osteophyte, but surely the osteophyte did not grow back in 3 months?

The disc height is very much reduced. I thought the operation is supposed to maintain disc height. I had a 5mm PEEK cage fitted so maybe the cage was too small?

Am I likely to need a surgery from the back of the neck to widen the foramina?

Many thanks in advance.

End Jan 2007 - ACDF C5/C6 with PEEK Cage

PNo · 06-22-2007, 12:31 AM

Hi settingsons, I end up reading the board when I try to take my mind off my own problems. How is your pain? Are you feeling any better since we last chatted?

Osteophytes don't grow back in 3 months. Not being a dr. I would kind of form the same opinion as you and would be asking questions of the NS. Before jumping to very many conclusions, was your MRI read by the same person? Did they have access to the original MRI ? Remember unless they use specific measurements in the reading notes, this can be subjective as to what the height etc. really is.

- They can measure on the x-rays and/or MRI to see the height on pre and post pictures. Maybe you should ask the radiologist to actually take a measurement comparison.
-PEEK cages are very successful at gaining height, so i would have come to the conclusion that it should have given you height increase.
-Perhaps there is reason the dr. chose that size. It could be as you suggest that he chose a conservative size and it ends up not being enough. It may be that's the size that fit your anatomy?
- I had posterior osteophytes and they went in through the front and were able to access where they needed, therefore, I would think for lateral these could be done from the front?

Seems like you should have a better outcome. Are you comfortable with the dr. that did this? The dr.s are unlikely to rat on each other, what did the Neurologist you consulted with say?

settingsons · 06-22-2007, 02:44 AM

Hello ***********. Thanks again for taking time to respond especially as you have problems yourself. Your responses over the last month or so have been a godsend.

Unfortunately my legs and arms are still pretty bad, although there are times where the arms do ease up. I control every movement I do, which is pretty much what I have done for the last 7/8 years.

Unfortunately the radiologist report for the post-op MRI was a one-liner, and he actually mentioned the wrong level (C6/C7 rather than C5/C6)! It did not even discuss disc height. That is why I asked my neurologist to review it with the old pre-op MRI and he did so with a neuroradiologist . Therefore the comments that I quoted were based on the same drs looking at both MRIs which is not good news.

I will write to the hospital today that did the MRI and my surgery and ask them to write a more detailed report as you suggested. After all, I paid for the MRI which includes a fee for the radiologist.

One thing the neuroradiologist told my neurologist is the osteophytes were 'far lateral' and he said 'maybe it was too difficult to reach' but he said he cannot be sure as he is not a surgeon.

I actually saw four NS, I looked at the history, reputation, and finally chose the one I thought was best. I said to my wife before the op, whoever I choose I guess it will be the wrong choice, and guess what!

My neurologist does not want to comment on the surgery in writing, although he has put in writing what I quoted in my earlier post to this thread (ie: there is still narrowing........). I am going to see another NS that he has recommended for an opinion, but I have to be careful because as you rightly say, they will not 'turn' on each other. I will just go along and say I am still in pain, these are the MRIs, and what can be done.

I just turned 40 a couple of weeks ago, and someone said to me it is downhill from now on. I replied I started on the downhill slope 8 years ago when this damm neck started giving me problems.

Once I have some news I will post details. Thanks again.

PNo · 06-22-2007, 11:59 PM

Don't throw in the towel yet! You are still young enough to make a difference and maybe get back to functioning close to your normal. Until they say it is over and nothing more can be done, you should keep hope.

Do post as soon as you get more info, I am interested to see what happens to you.

Take care, till next time.

settingsons · 07-18-2007, 05:50 AM

Here is an update.

I went to see another NS for an opinion on my surgery. He actually did say that he knows my NS that operated on me so maybe he wasn't the best choice.

Anyhow he said he thought my residual stenosis does not look too bad. One comment he made was that by spinal cord around the C5/C6 area was oddly shaped..... and mentioned something about maybe a loose disc fragment being there. He went on to say that its nothing to warrant further surgery.

Although my arm pain has eased up a in the last 3 weeks I still get severe pins and needles in either hand when laying on my side for a few minutes. Could this be related to the stenosis?

I also still experience my leg burning and pain which was one of the reasons I had the ACDF surgery for (I have had it for 6 or so years). Does anyone think that a stray disc fragment might be the cause of this leg pain? Could it be on the cord? I would expect this cannot be removed now that I had been fused at that level.

Any advice greatly appreciated.