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Old 12-19-2009, 07:46 PM   #1
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MRI -Surgery Your imput Help

I am a 65 year old lady. I have been reading and trying to get all the information I can get. I came across this site a few mts ago.. Would like to get some of your opinions of what I am about to go through.

I have had problems with neck pain and pain between my shoulder blades --pain radiating into my head from my neck for many years. In the last 6 or 7 years have had trouble with hands and fingers going numb. Had had 2 different test in 90`s for carpal tunnel came back neg. Long story short I went to nero with leg pain, legs are ok but I ask him to run test on upper back. When the CT scan came back he said why did you not tell me about your bad back. I then had a MRI below are the results. I am due to have surgery Jan 5. 2010.

To fuse 5-6. I was in to see the neurosurgeon Thursday and he said I would need at least 2 or 3 surgeries on my upper back. First the 5-6 then there was a arthritic knot at 3 and a problem at 7. Need your input if you can. I am scared, have the best surgeon in my area, I trust him but am still scared.
I have been on lyrica and other drugs but none seem to help. Drs say only thing that will help at this point is surgery.

C5-6 Severe disc height loss and diffuse dehydration accompany moderate sized posterior and foraminal disc bulge extending posteriorly and foraminally on both sides but more to the right. The central and right hemi canal are moderately stenotic and the cord lightly displaced. Uncovertebral osteophytes are also noted especially on the left. Foraminal stenosis is moderate to severe bilaterally, on the right more from the soft disc bulge and on the left from the entophytes.

Impression: Focal advanced spondylosis C5-6 with moderate central and right hemi canal stenosis and moderate to severe bilateral foramina stenosis secondary to disc osteophyte complex.



Thanks in advance.

 
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Old 12-19-2009, 09:21 PM   #2
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Re: MRI -Surgery Your imput Help

Has he told you the name of the surgery? And has he told you all the levels he will be fusing. There are many of us who have had cervical spine surgery. I had a C5-C7 ACDF due to pain that radiated down my left arm and into my index and middle finger with numbness and tinging and bit of left arm weakness. The surgery helped relieve the pressure on the nerve quite well. I'll never be 100% but that searing nerve pain is gone. There are people who have had C2-C7 fused, etc, so there may be a way to avoid multiple surgeries but to get a lot of work done in one long surgery. Perhaps that's what they'll be doing?

An ACDF is an Anterior Cervical Discectomy And Fusion. This is done through the front of the throat. There are other types of cervical surgery that can be done from the back (posterior).

You also mentioned your back - are you having cervical (neck) problems and back (lumbar or thoracic) problems?
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Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 12-20-2009, 12:26 AM   #3
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Re: MRI -Surgery Your imput Help

Hello bon1234 welcome to the boards! I have a horrible cervical spine, my thoracic is bad, and my lumbar has started going bad - had a couple surgeries and totally understand your situation. It is normal to be afraid but you are doing the best thing and that is researching and learning about your condition and your options.

I was looking over what your MRI report says and that made me wonder why the doctor said you might need 3 surgeries. Is there more to the MRI report than what you wrote here? Where are the sections on C3 and C7 that your doctor noted and told you that you need surgery on? All you put here was C5-6.

Have you had an EMG? sometimes with long term compression on nerve roots
(in the foramins) - you will have some permament pain even after you fix. An EMG can tell how bad the compression is. Also it is well known that the older the pain/problem is - the more likely you will have residual pain. There is possibility it might only drop down 1-2 levels. So if you are only at a 4 there wouldn't be much gain. But if you are at an 8 there could be great gain. For most people we talk together with on here those that has long term chronic pain don't see it all go away after the surgery. Just trying to help you set expectations.

It wouldn't be very typical to plan out 3 surgeries for something that if really needs fixing could be addressed all at once - especially in your age group. The usual path is to follow a very conservative route and continue trying therapies to get you more stable and comfortable and also to see how fast your symptoms are progressing or if they have stayed kind of the same. That might include PT, rest, oral medication, but also move on to epidural injections. Have you had any epidural injections? When you say medications have several combinations been tried because sometimes it takes several tries to get the right types. Many people find neurontin to be more effective for this type nerve pain - have you ever been given that med (gabapentin)?

Also if you do not mind me asking what is your pain level and frequency - is it all the time or random? I am not a medication advocate, but I am also not a surgery advocate all the time, so I take medications to keep me functioning as do many other people. Many people live with these conditions and do not do surgery.

I think you are talking about an ACDF surgery. To give you any other ideas - we would need to understand what is wrong with C3 and C7. I took your MRI and have tried to explain it in plain english below.


EXPLANATION: as we age it is very normal for us to have disc height loss. WHen that happens the discs become prone to bulge and tear. Also when the discs are not flexible they cannot do the shock absorber job they used to and arthritis starts forming in our spines. It looks like at C5-6 that is what has happened and the disc has bulged and is in spaces where it doesn't belong and pushing on your spinal cord and nerves.

The foramins are these little canals where the nerve roots that divide off your spinal cord run through and go on to your body parts. There is a right and left pair at each level. For you - there is narrowing in these canals because disc material is in there. Stenotic means narrowed - the central canal is where your spinal cord runs. Uncovertebral is a part of the vertebrae joints and osteophytes are bone spurs. It is very common to get arthritis in this area when the discs start drying out. that part is not usually where the most pain comes from. For you it is most likely the spinal cord/nerves being pressed.

I think before I would proceed with surgery I would seek at least one more opinion. There are a couple different surgical approaches and one doctor may prefer one and another doctor may think a different was is better for your condition. Since you have multiple levels bad as you say, it might be worth hearing another opinion. Since you saw a neurosurgeron the other opinion could be an orthopedic spine specialist. There is no way I would agree to a plan that says multiple surgeries - get a good plan to fix what needs fixing. Make sure you surgeons are Board Certified in that specialiaty! And most of the best spine doctors are fellowship trained on top of all their training.

Also - understand that sometimes when we do things to our spines it can trigger other problems, some doctors think this is because of the new aligment, the forces that the fusion cause on the other levels.

I know this is long - almost done. Are you in generally good health? Although there are far worse surgeries - the recovery can be difficult - especially the older we are. Do you good have assistance at home for the first week?

I hope I have started to give you some of what you are looking for. We will watch for your next posts.

 
Old 12-20-2009, 10:12 AM   #4
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Re: MRI -Surgery Your imput Help

I donít know the name of the surgery --he showed me a white disk looking cage and a piece of titanium, and said he would take bone marrow from my hip which would help with the fusion.
Right now he will be fusing 5/6 going in through the front of the neck.
I do have some pain in lower back, nothing like the upper. I have allot of leg pain, he said we will address that later.
My pain level over the years has been say 8, when I worked I had to use lots of pain meds. Since I have retired I have learned to control the pain some. Heat, laying flat helps. About 2
times a week the pain will keep me awake, I would say a level 8.
There is no more to this MRI report but he has more on the computer in his office. c-3 and c7 have some issues but he said he had to fix this bad part c 5/6 first. He does not like to do from 3-7 all at once. maybe my age uh.
I had the Nero and neurosurgeon tell me that treatment would not help.
The Nero guy did say he would treat me with injections etc., but he highly recommended surgery.
My over all health is great. I work in my back yard nursery most of the year. This has kelp me in shape.
Thanks for all the input. I see I will need to get second opinion.

 
Old 12-20-2009, 11:38 AM   #5
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Re: MRI -Surgery Your imput Help

Bon:

Yes, I think a second opinion is your best bet. While the surgeon may want to do more surgery later - if there is indeed a problem at accompanying areas of the spine some surgeons may choose to do a "once and done". Since the recovery is tough from spine surgery I'm asking my surgeon who will be going into my low back to "fix whatever you see when you get in there" so I have one recovery even if it's longer. I've basically given him permission to do more worth than planned if it gets a lot done and then avoids, or minimizes, further surgeries.

I wish I had done the same for my neck. I'm not sure but I could be facing an additional ACDF within a few years. Knowing there were some problems at C4 when I had my C5-C7 ACDF I now wish I had talked with my surgeon about doing a C4-C7 ACDF instead.

As you go through the process please let us know if you have any further questions.
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Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 12-24-2009, 07:07 AM   #6
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Re: MRI -Surgery Your imput Help

hi bon, sorry you are also in this type of situation. you have gotten some great advice and info from two really great and knowledgable people here. i just wanted to also 'third' in getting that second opinion too. it really is kind of important in just getting at least two seperate opinions from two completely unaffilitated specialists(not in the very same practice?)espescially when we are talking the c spine area. i too really cannot see having you go thru more than one actual surgery for this when it can usually all be done with one single surgery ,which just would bring down alot of the risks of just having any surgeries that come along for the ride?

honestly? most neurosurgeons actually DO prefer to do all levels needed at one time with one surgery vs having to go back into an area that has already started to grow some pretty thinck fiberous scar tissue? i had to have two seperate surgeries done on my c spine a few years back becasue i did not actually fuse at both endplates. from what my NS told me, and these surgeries were only 9 months apart? i had actually grown ALOT of very thick and fiberous scar tissue just within that short of time that made the surgery more difficult ONLY becasue it took so much time to just cut thru it all just to actually even GET to my spinal column again. scar tissue is just a natural consequence with just about any surgery thats done in our bodies, so lessening the overall surgeries to that only one if possible really would be a much better idea for the surgeon and for you too. this is just another real reason that you just really do need that second opinion. trust me when i say that not all surgeons even within the very same specialty are created equal and how they 'prefer' to actually even do any given surgery either.

just wanted to add my two little cents here too. but DO seek out another opinion bon. i sought out three for my actual spinal cord surgery and it was not til i even got to the last one that i truely found the absolute best one for MY particular type of problem. he just had ALOT(over 35 years)of actual hands on knowledge and experience with MY rather rare type of spinal cord lesion that the others had lacked. good luck hon. but i would put that surgery on hold til you have actually consulted and been evaled by at least one other surgeon. believe me, anything you may have to wait for here really is pretty minimal when we are talking your spinal area. please keep us posted hon, Marcia
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3-22-01,herniated C-6-7
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Old 12-24-2009, 06:35 PM   #7
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Re: MRI -Surgery Your imput Help

I am assuming that you have already had multiple spine surgeries by the items listed at the bottom of your post. Did this surgeon you are referring to perform those previous surgeries? If that is the case, I definitely would seek out a second opinion. Scar tissue can form at each surgical site one may have from past surgeries. Given that this can cause problems in any subsequent surgeries, I would seek out a second opinion and I would not use someone that is affiliated with the previous surgeon or the one who is now recommending this surgery. There is a sound basis for this opinion as I have known of others who have had multiple surgeries on cervical discs and they have actually been worse off than before having those subsequent surgeries. One actually had a neurosurgeon close them back up after beginning without doing a repair as there was uncontrollable bleeding due to the nature of scar tissue and vascular supply to that scar tissue which resulted in yet another surgery. I just think that if you have already had so many surgeries that you would be less likely to have a good outcome. Having had a fusion and plating of C5-7, I was told that the areas above and below that level are subject to further problems as it does stress those other levels due to the stationary stabilization of the repair.

I know that having multiple surgeries is taxing on one's body. I definitely agree that it is risky to have multiple surgeries. That being said, I would opt to fix all that could be done safely in one surgery, but I do recognize that it is risky also. Having multiple incisions, having multiple areas that need guarding when gettting up, walking, etc. would make one's recovery difficult especially if you had a cervical and lumbar surgery at the same time.

I just think that I would seek out the advice of another due to what you have said here.

 
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