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Old 02-01-2010, 05:07 AM   #1
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5 level cervical laminectomy & fusion, anybody?

Hi,
I am scheduled to have a 5 level cervical laminectomy and fusion c3-4 to T1 at the end of this month. I keep looking on line but cannot find others who have had more than 3 levels fused at once. The PA at the doctors office said it is rare.
I have myelopathy at 2 levels (3-4 and 4-5) and spondelytis throughout. I have a bulging disc at C2-3 and C6-7 and C7-T1. My neck is straight instead of the normal curve. I have no pain really, and pretty good range of motion in my neck. But numbness in my hands, weakness in wrists, tingling in arms.

I have been to two orthopedic spine surgeons and both say the same thing.
I'm scared, of course, and wondering if anyone has experience with something like this, with so many levels. I'm wondering if I should still try for a 3rd opinion, perhaps from a nuerosurgeon, although that might mean posponing this surgery. The symptoms are increasing, but very slowly. So, has anyone else been through this at so many levels? Thanks in advance for any advice you can offer.

 
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Old 02-03-2010, 07:13 PM   #2
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Re: 5 level cervical laminectomy & fusion, anybody?

Hi,

I just had the same procedure done on Jan 11, 2010. My fusions were from c-2 thru T-1, and yes I could not find anyone else who had so many levels. I had mine done by a nuerosurgeon and I had gotten 4 opinions that ranged from new york to south florida. I am a 45 year old male. Yes, it is a scarey procedure and be prepared for a rough first week. I am finding the most difficulty is the sleepless nites and I have been very bored as I am a very active person. Get yourself plenty of movies and books to keep yourself busy. It all started with a stiff neck and about a month later I was in surgery due to the servere spinal cord compression. Be patient and things will improve daily. It is to early for me to tell you anything else as I am still in the recovery process. Good Luck...

 
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Old 02-04-2010, 02:14 PM   #3
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Re: 5 level cervical laminectomy & fusion, anybody?

Hello - there are people around here who have had this many levels, mostly not done all at once, the people I know about had fusions over many different surgeries. There are lots here with multiple levels fused and are trying to avoid the full cervical spine being fused. I am C4-7 and they want to do the other levels but I will not at this point. I suggest you get a 3rd opinion from a neurosurgeon who is non-related to the practice of the people you have already seen! Do not tell that surgeon what you were already told. What I found is sometimes once you go to one surgeon - if the 2nd opinion knows what the first said they may generally not offer a different solution. I am not saying this is always the case but in some cities this is the practice - they may just say yes they would agree this is a surgery that could be done for you.

Do you live in a large, metro city? I think this is a pretty big deal and if you have the capability get a couple more opinions.

 
Old 02-04-2010, 02:51 PM   #4
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Re: 5 level cervical laminectomy & fusion, anybody?

Thanks for your quick reply. Yes, I agree, and now am scheduled to see a 3rd neurosurgeon at Mass General in Boston. They have a clinic that specializes in 2nd opinions for spines. I did not tell the 2nd ortho I saw about the 1st one, because I wanted his opinion to be as independent as possible. But he said the same thing as the first one, and in fact he added a disc! So, I would be fused from c3 to t1, which would essentially mean my neck and thoractic spine would be fused together. OMG. I am looking and looking on line and not finding anyone talking about such an extensive procedure. The doctor did say I had diffuse myelopathy which I took to mean it was spread over a wide area. This is so hard to figure out. I am trying. Thanks for your help and encouragement.

 
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Old 02-04-2010, 03:06 PM   #5
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Re: 5 level cervical laminectomy & fusion, anybody?

Quote:
Originally Posted by tl1446 View Post
Hi,

I just had the same procedure done on Jan 11, 2010. My fusions were from c-2 thru T-1, and yes I could not find anyone else who had so many levels. I had mine done by a nuerosurgeon and I had gotten 4 opinions that ranged from new york to south florida. I am a 45 year old male. Yes, it is a scarey procedure and be prepared for a rough first week. I am finding the most difficulty is the sleepless nites and I have been very bored as I am a very active person. Get yourself plenty of movies and books to keep yourself busy. It all started with a stiff neck and about a month later I was in surgery due to the servere spinal cord compression. Be patient and things will improve daily. It is to early for me to tell you anything else as I am still in the recovery process. Good Luck...
Wow. Thanks for writing, especially after having surgery so recently. At this point, I hope that you are getting a little better and a little less bored. I'm a bit older, 59, female, and probably less active, but I do work full time, walk, drive, travel, etc.. I'm already storing up books and movies.
Can I ask you, did you have a quick onset of symptoms? Where did you finally have your surgery? When you went to different places to get opinions, did everyone recommend the same thing?
I also have not had much neck pain, and so when I went to see the doctor about the numbness in my hands I was dumbfounded by the results of the MRI and the idea of surgery. When they started to examine me I had all these little random things that I had never attributed to spinal cord damage. I've kinda felt like a deer in the headlights these last few weeks. It feels like I went in to pay a parking ticket and got a 30 year sentence.

I really hope that you are feeling better and would love to hear about your progress, if you feel up to it.

 
Old 02-04-2010, 10:05 PM   #6
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Re: 5 level cervical laminectomy & fusion, anybody?

That is a great place for a 3rd opinion! I am wondering if you might consider discussing this next item with the surgeon on adding that T1.

I feel my thoracic problems came on after my cervical fusions. I knew I was destined for the lumbar to go bad soon, but previously my thoracic wasn't showing the signs of DDD. I had immediately felt the static position of my spine after the cervical surgeries, even though it didn't impair my ability to turn head etc, I did feel the new alignment. I feel the static position in the cervical put more pressure on my thoracic and helped speed up the problems I am having there. I would recommend you really push on why this level (T1) needs to be included and discuss the pros/cons of excluding it from the surgery! You will have a lot of levels, maybe by keeping T1 free it will help the pressure off the thoracic???

I saw your post to tl1446 and I wanted to add that I never had neck pain other than from too much computer here and there. I woke up one day in extreme arm/shoulder blade chest pain and that is when I found out about my problems. Originally they screened me for heart a week before they figured it out. I too ignored some warning signs I had for the year prior - because I never thought I had anything wrong with me! From symptom onset for first surgery and second surgery I waited about 6 months. I actually wish I had done it immediately because I have perm nerve damage from letting the impingements continue to rub while I waited - now they send pain signals 24/7 because the cells are all mixed up - I have some arm muscle function loss but nothing that impairs my ability. There are so many muscles/nerves the others pick up the slack.

You will blow this up way more than it will be, I don't want to minimize it, but we all make these things way bigger than they end up being. With yours though I think you should be prepared for a longer recovery time, maybe a little more pain early on. If lucky it will go fast, but at least you will be prepared if you take more weeks than normal! Plus all the friends you make will be here cheering you on and ready to share hints.

Generally I have not met too many people who are made worse by their surgeries. Usually it is at least the same or better than it was. Sometimes symptoms don't all go away, the key is to stop the immediate damage that is being done!

Good luck and I will be praying and wishing for a speedy recovery for you.

 
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Old 02-05-2010, 12:01 PM   #7
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Re: 5 level cervical laminectomy & fusion, anybody?

Hello Neckpatient, Once again, thanks for your quick and thoughtful reply. I am concerned about all the issues you bring up. I have seen 2 ortho spine surgeons. Both said laminectomy. #1 said fuse c-3 to c-7. #2 said fuse C-3 to T-1. #2's Reason: because the thoractic level is already rigid, leaving the one level unfused between (C7-T1)will create a lot of pressure on it and hasten it's deterioration. Made sense at the time. However, it seems to me that Im going to be essentially fused from C-3 right through the thoractic area, given the rigidity of that area. I wonder if there are any unknown problems in my thoractic area. They never took a picture of that. And, also, I wonder about the pressure on the C2-3 levels above that big ol' fusion.
I would like to hear the details of your story/case, but I will look back through your old posts so you don't have to repeat yourself.
Have you ever considered artificial disc replacement, single or multi-level (yes, I know multi-level is not approved...but I see on line that some people do it ine Germany, etc)?

Regarding the recovery, don't worry, you won't scare me. I'm already scared :-).
Again, thanks for your time and your kind thoughtful words.

 
Old 02-05-2010, 06:07 PM   #8
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Re: 5 level cervical laminectomy & fusion, anybody?

You don't need to go reading my old posts I can pretty much summarize it pretty simply here - I type faster than it will take you to go read. Artifical replacement isn't for me, I have too many levels in all parts of the spine bad - I am waiting on some much bigger science advancement - I hope it comes soon! I was generally a very active, healthy person who worked a high stress, wonderful career and raised a family.

I had a surgery in 2004 from C4-6 and that was a very bad impingements at the nerve roots and very small cord indent. I didn't have a choice as it was bad. I had a choice between lamni surgery and the acdf. I chose acdf because it sounded like a speedy recovery. The boards were not too developed back then and patients were only begining to share their experiences. I rushed back to work. I was 100% great for about 9 months and then boom it hit again. They took out the old fusion, cleaned it all and extended it to include C7 but we left the T1 junction free, and we also left C2-3 free. THose levels need it also but not as bad and they are probably not the ones making my symptoms so we decided to leave them alone unless my cord gets indented there. I have a congenitally narrow spinal canal so it compounds my problems. Well over the next few years my discs have degenerated in lots of parts of my spine and bulge out and herniate - causing lots of bone spur ridges that are pressing on the thecal sac and nerve roots in all the areas. The thoracic was first after my cervical problems, then finally a really bad central herniation in my lumbar which I have been avoiding surgery, but am now seriously considering going back and doing it because it is finally putting me back down in bed lots of days with bad back pain and bi-lateral sciatica. Along the way I had Thoracic Outlet Syndrome from guarding my arms from pain, problems with bladder retention from the lumbar problem, and also curiously developed unknown effusions around heart and lungs for no reason that they can find. I have lots of nerve pain - I do cycles of gabapentin - can't stay on it long stretches I get goofy. Something really stupid along the way - I also stopped processing vitamin D correctly and that shot my pain levels through the roof. Finally they have been treating me with high doses and now I have only normal pain which for me hangs around 5's even treated, but on daily basis if I am too active can easily get to 7s and even and 8 here and there.

I have a large 2 level hemangioma but it doesn't worry them - and honestly not one of the doctors can really explain how they know if it is really causing symptoms or not because I have such widespread problems it gets complicated. I go to pain management, use fentanyl patch and other meds, I get regular cycles of epidurals and stopped my career and watch my activities. I have been to lots of surgeons, even Mayo and haven't found my golden ticket yet.

I am not really a rush to surgery advocate, but if there is a reasonable plan to at least stop the immediate damage being done I try to encourage people to do the surgery, but keep in mind pain symptoms might not completely go away. The good news is the pain usually does go down a few levels, and when you are talking difference between 8s and 9s to 5s that is a big difference. Also talking about neurological problems not getting worse - then it is a good thing to do surgery.

I have spent the last 6 years researching and studying trying to become a layman expert on the spine and the surgeries. Going as far as reading the surgical books because I keep hoping I might ask the right question for myself that will open the lock. I share what I have learned and if it helps good, and if it doesn't help someone then that's ok too - at least I put it out there.

Please do keep posting here, my next cervical surgery will be the lami because I have grown bone ridges in the acdf that is going to been to be fixed in the next 5-7 years and I would really like to have someone hang on here and post their laminectomy experience for me and others in the future.

Regards, NP

Last edited by PNo; 02-05-2010 at 06:12 PM.

 
Old 02-09-2010, 07:47 AM   #9
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Re: 5 level cervical laminectomy & fusion, anybody?

Thanks so much for your reply and all that good info. Sorry I didn't reply promptly, I've been busy doing my own investigations. It is difficult and time consuming. And I'm still not a doctor! As you probably are aware, there are not too many alternatives available for me. So, I have kept my surgery date, but in the mean time I will keep on digging. I'm trying to find more info on who does multi-level cervical artificial disc replacement, especially in this country. Yes, I know it isn't common, but I think it is done, I just don't know where exactly. I'd also like to know if it's possible to just fuse a couple of levels then replace one disc, or some other mixed technique that doesn't leave me fused from top to bottom. I am thinking of asking the surgeon for an MRI on my thoractic to see if there are problems lurking there that might be aggrevated by a big fusion, just as you say. Anyway, thanks. I'll try to keep in touch and let you know. Next week I'm going somewhere warm for a few days, so probably won't be reading anything but novels (.

 
Old 02-09-2010, 08:49 AM   #10
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Re: 5 level cervical laminectomy & fusion, anybody?

tl1446 Just wondering how you are feeling, now you are a few more weeks out from surgery? Hope you are doing well.

 
Old 02-09-2010, 12:06 PM   #11
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Re: 5 level cervical laminectomy & fusion, anybody?

Quote:
Originally Posted by cotton1 View Post
Wow. Thanks for writing, especially after having surgery so recently. At this point, I hope that you are getting a little better and a little less bored. I'm a bit older, 59, female, and probably less active, but I do work full time, walk, drive, travel, etc.. I'm already storing up books and movies.
Can I ask you, did you have a quick onset of symptoms? Where did you finally have your surgery? When you went to different places to get opinions, did everyone recommend the same thing?
I also have not had much neck pain, and so when I went to see the doctor about the numbness in my hands I was dumbfounded by the results of the MRI and the idea of surgery. When they started to examine me I had all these little random things that I had never attributed to spinal cord damage. I've kinda felt like a deer in the headlights these last few weeks. It feels like I went in to pay a parking ticket and got a 30 year sentence.

I really hope that you are feeling better and would love to hear about your progress, if you feel up to it.
My goodness - your story is so like mine and we are the same age, same interests in travel and walking etc. I am just waiting for a date for my surgery. Difference is I do have pain - in my arms and some days are worse than others. I am expecting to have the surgery at the end of this month or early next. I was told it was urgent but it seems not enough to take place immediately. In the meantime my NS said it was OK for me to go on the holiday I booked some time ago which involves a 3 hour flight (to Portugal). I am really looking forward to it. I am only away for a week. I just wonder how long I have had this problem and if some of the odd symptoms I have had in recent years are down to the spinal compression. Likening the situation to a 30 year sentence is exactly what I feel - for example not going out in bad weather, limiting use of the car, changing my pillow and sleeping position, using a walking pole in icy weather if I do go out. I have become a real couch potato. And the shock of it all and the pain has resulted in me taking time off work - for more than the odd day - first time I have ever had so much time off.

Hope you get better.

 
Old 02-19-2010, 05:31 PM   #12
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Re: 5 level cervical laminectomy & fusion, anybody?

Quote:
Originally Posted by cotton1 View Post
Hi,
I am scheduled to have a 5 level cervical laminectomy and fusion c3-4 to T1 at the end of this month. I keep looking on line but cannot find others who have had more than 3 levels fused at once. The PA at the doctors office said it is rare.
I have myelopathy at 2 levels (3-4 and 4-5) and spondelytis throughout. I have a bulging disc at C2-3 and C6-7 and C7-T1. My neck is straight instead of the normal curve. I have no pain really, and pretty good range of motion in my neck. But numbness in my hands, weakness in wrists, tingling in arms.

I have been to two orthopedic spine surgeons and both say the same thing.
I'm scared, of course, and wondering if anyone has experience with something like this, with so many levels. I'm wondering if I should still try for a 3rd opinion, perhaps from a nuerosurgeon, although that might mean posponing this surgery. The symptoms are increasing, but very slowly. So, has anyone else been through this at so many levels? Thanks in advance for any advice you can offer.
I just had a multi-level 4 ACDF done on Feb.15 and from what I gather, it is not common to do so many levels at once. Today is Friday and I am just now able to sit up without assistance. A lot of post-op info for multi-level is according to your own pain levels. I am having to sleep in a recliner due to the swelling on my neck and shoulders being so swollen I am unable to lie comfortably. I also had a hip graft done because I am at high risk for non-fusion. Did anyone mention the CervicalStim to you? I have consulted with 5 doctors and suffered through this for 2 years. Thing is, when one level is done, it puts pressure on the joints above and below and the chances are you having to go back for more surgery is almost a given. In my case, I had a c6 compression with c3,4, 5, and 7 starting to protrude. I was also sick of being in pain, so I thought carefully about having them all done at once. It hurts a lot post-op but I can also keep in mind no more numbness, etc. and having to wait till it ruptured for something to be "done". Hope this was somewhat helpful to you and good luck. A second or even a third opinion never hurts and check carefully any surgeons.

Last edited by Eleanor7734; 02-21-2010 at 01:44 PM. Reason: More info added.

 
Old 02-21-2010, 06:45 AM   #13
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Re: 5 level cervical laminectomy & fusion, anybody?

Hello All, Thanks for posting. I have been away a few days, plus very busy researching, talking to doctors offices etc. As it stands I have postponed the surgery I was due to have this week. It would have been C3 to T1 fusion. I may still wind up having that done, but I felt like I knew nothing about what was happening to me o r why. Till this Jan. I didn't know I had spine problems. As it stands now, I am going to see my original surgeon with a list of questions on Monday, then a 2nd surgeon on Weds. I have to know more, make sure this is my best/only option. But I feel like I am playing with fire because of the spinal cord compression too. So, whatever happens must happen pretty soon.
Eleanor, thanks for writing and sharing your story. I hope that you are doing better by now. I was told to expect about a month to get feeling semi ok, even with the collar and restrictions.
NP thanks for sharing your story. I too am very concerned about starting a cascade of back problems lower down if they fuse my c spine to my t spine. I/they don't have any idea what is going on down there, as no one has ever looked. I'm going to ask for an MRI of that regiion, at the very least.
In your reasearch have you ever lookd at artificial disc replacement? I'm looking now at ADR at multiple levels, and wondering if it is a possibility for me. I have been looking on those forums and reading in pubmed (like you, NP, trying to educate myself) This stuff is all consider experimental, so would not be covered by insurance, I don't think. So, if I were to do it, it had better work, because then I'd need to go back to work to pay it off!!
I guess it's possible to do it one or 2 places here, plus overseas. A lot of people seem to go to Germany.
Again, it's hard to track down people who have done it and lived with it for several years to see how they feel, if they are happy they did it, etc. Just like a 5 level fusion, they are rare ducks I think.
Thanks everyone for you responses. I'll try to keep you posting. Please do the same.

 
Old 02-21-2010, 10:20 PM   #14
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Smile Re: 5 level cervical laminectomy & fusion, anybody?

Hi cotton,

I had a fusion in june 2008 from c2 -t2, although my problems of spinal chord damage and thinning were only in the cervical spine. two of the three doctors i saw including the one who did the surgery beleived the fusion needed to be extended into the thoracic area to protect the neck and spine from further injury.

the operation was ten hours and i exercised like a mad woman for months to make sure i was in tip top shape to cope with that amount of aneasthetic. because of the amount of levels fused my doctor took two bone grafts from one of my hips, which caused more discomfort after than the neck brace, which was on for seven weeks.

recovery was difficult i have mild spasticity which makes everything more complicated but the work paid off. my surgeon a spinal reconstructive surgeon, said to me the day he took off my brace, "you need to work hard for this, about 5 -6 hours of exercise a day to get yourself back on track" I have to say he was right and today I walk better than before and my neck feels much better than it did preop. I thought I had no pain but now I realise I did because I have absolutely no tension in my neck now.

I hope you find the answer you are looking for, for me it arrived when i found a surgeon that I had confidence in who demonstrated to me that s/he could provide some solutions. I am glad I had the operation and I hope this post has been of some help to you.

In relation to your concerns about further surgery I know how you feel, I had a laminectomy in 2000 which in some ways contributed to the 2008 surgery needing to happen, but as corny as it sounds you can't control life and the future - you can only make your decisions on the information you have now.

I am 37 I have a friend my age who is fused everywhere I'm not and she has had no revisions since the original operation at 16. I have an aunt who 30 years ago had three to four levels fused in her back and to date no one has had to touch her. So one spine operation doesnt mean there will necessarily be more.....

All my best to you,

GB
GB

 
Old 02-21-2010, 10:29 PM   #15
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Re: 5 level cervical laminectomy & fusion, anybody?

hi cotton,

i also just wanted to add a couple of things that concerned me before the operation that might help you:

1. I have 50% rotation either side of my neck, thats because C1 - C2 give you 25% for each vertabrae - so if its from C3, you will have 60% because every level under C2 gives you an extra 10%. I think you will find the limitation in movement an adjustment but something that you get used to comfortably. In terms of looking down I cant see my toes if I dont bend from the hips, but I've decided toes are overrated!!

2. I am now back at work fulltime and coping well.

All the best again,

GB

 
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