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Old 07-05-2011, 09:09 AM   #1
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cervical stenosis: laminectomy vs laminoplasty

Hi, I had ACDF done at C3/4 and C5/6 in 1991 for spinal cord decompression caused by disc herniation. I used to be physically active in sports prior to that. I have congenital marginally narrow cervical spinal canal which contributed, to some extent, to my cervical spine compression. I had gait problems on my left leg but didn't have pain in my neck or anywhere in my body. The surgery didn't help but I was told that I would have risked paralysis otherwise. Since then, I have been taking MRI regularly to monitor the spine. To make the long story short, I have experienced new symptoms in the last 2 years and recent MRIs show progressive deterioration at the adjacent levels (C2/3, 4/5 and 6/7). I have seen numerous Neuro and Orthopedic surgeons nationwide and received various recommended treatments two of which are laminectomy and laminoplasty. It will be from C2 to T1. I am not afraid of the surgery but worry about the consequence. I am seriously considering surgery and hope to hear from someone who had either surgery done and would appreciate it very much if they can share with me their experience as well as offer me advice. (I am turning 56 next month.)

Thank you

Last edited by Administrator; 09-07-2011 at 09:34 AM.

 
Old 07-10-2011, 12:32 PM   #2
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Re: cervical stenosis: laminectomy vs laminoplasty

my situation is quite similar to yours, although the laminoplasty I ended up getting was only three levels. SEVEN levels really sounds like a project.

BTW, when you say that certain levels have "deteriorated", can you be more specific, perhaps even quoting the radiologist's report?

Last edited by Administrator; 07-10-2011 at 06:36 PM.

 
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Old 07-11-2011, 06:37 AM   #3
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Re: cervical stenosis: laminectomy vs laminoplasty

Working on SEVEN consecutive levels (C2-T1) is more extensive than anything I've seen before, I think. I'm afraid it really opens you up to issues of instability (particularly with laminectomy) and loss of range-of-motion (if fusions are done). I would urge you to learn all you can about the five basic approaches to such problems: ACDF, foraminotomy, laminotomy, laminoplasty and laminectomy (I've undergone the first four of those). Also, to consider the possibility of having multiple surgeries. It might make sense to have laminoplasty at a couple of levels, ACDF at a couple more, and just foraminotomies or laminotomies at others. The anterior approaches could be done in one surgery, and the posterior in another.

Last edited by Administrator; 09-07-2011 at 09:34 AM.

 
Old 07-11-2011, 03:11 PM   #4
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Re: cervical stenosis: laminectomy vs laminoplasty

I also have a 4 level laminoplasty(C3-C6) with a C7 decompression. My neurosurgeon also does not do the entire neck for laminoplasty as it's makes it was too unstable. I don't believe that they can do a laminoplasty or laminectomy at C2. Fusion yes but not those 2 options.

And if they fuse you from C2 to T1, you will lose about 75% of the movement of your head. I am C3 to T1 and I lost about 50% of turning and tilting. I think what Webdozer suggested is excellent. Find a spine doc who is willing to do multiple methods to control the symptoms.

And whatever you do, don't go rushing into this. Seems like some one did rush you into the ACDFs. I had to have a 6 level fusion(C3 to T1) 3 months after my laminoplasty but at least the cord compression was fixed prior to that. It is life changing surgery. You are putting a lot of muscles out to pasture as nothing moves anymore and that makes them ache and spasm. Driving is a big problem. I can't look up without tipping backwards.

But the biggest problem is that once you start to link that many vertebrae together, it acts like a giant hammer on the vertebrae above and below. You damage C1 and you will be fused to your skull and can't move your head at all. And once its starts to go down the spine, it can continue to until you are fused halfway down your back.

If it were me, knowing now what I do about bad necks, I'd say go with work on the fewest number of vertebrae and go with the one that has the least amount of impact. Laminectomies remove bone forever, leaving your cord open to injury and they must fuse the bones. Laminoplasties have their limits and they can also destabilize the neck and leave you open to further damage but at least they protect the cord and you have no fusion. ACDF's can leave the vertebrae open on the back where the cord is and doesn't address the problem of cord compression. Perhaps doing a 360* fusion of the vertebrae already fused will help with other interventions elsewhere.

What did your latest MRI say...do you have the report? That would give us a better idea what is going on where.

I know I am headed for the lengthening of my fusion to include T2 and who knows how much more. I will steadfastly not let anyone touch C2 unless I am in danger of an internal decapitation. I'm not ready to give up driving. So I take it day by day and vertebra by vertebra. I'm not going to have any more done until and unless I am in imminent danger of paralysis, not just someone's threat that it might happen. I want numbness and muscle dysfunction and even then, I'll wait and watch until they show me on MRI just how close I am to being in big trouble. A fused neck is a pain in the neck.

Jenny

 
Old 09-05-2011, 08:25 PM   #5
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Re: cervical stenosis: laminectomy vs laminoplasty

Webdozer and Jenny:

Please accept my sincere apologies for the long delay in response. It has been a hectic summer. Below are the assessments and recommendations from 3 surgeons:

Dr. D.C (Neurosurgeon) 8/25/2011
Review of patient’s cervical MRI from March 2011 revealed severe compression at C4-5 secondary to a disc. There was also evidence of a disc herniation at C2-3 disc without associated cord compression. There was also evidence of bilateral foraminal compression at C6-7. His MRI of the thoracic spine from May 2010 revealed no spinal cord compression and his MRI from Feb 2011 revealed no significant stenosis. A lengthy discussion was had concerning his options and a C3-5 laminoplasty with C2-3 inter-laminar decompression and bilateral C6-7 laminoforaminotomies were discussed …

Dr. B.T. (Orthopaedic Surgeon) (2/10/2010 first visit)
This is a 54-year-old patient with gait instability and cervical spine changes consistent with stenosis. We discussed at quite some length the risks, benefits and alternatives to operative intervention with this patient and recommended Laminoplasty C3-6 with dome decompressions at C2 and C7 and partial C7 laminoplasty. We do recommend that the patient undergo this procedure within 1 year given his progressive symptom and significant disability. We did discuss at length the perioperative course that he would require approximately 3 days of hospitalization and 6 weeks of immobilization in a hard collar …
Dr. B.T. (Orthopaedic Surgeon) (8/24/2011 second visit)
Same assessment and recommendation as last visit.

Dr. S.B. (Neurosurgeon) (4/4/2011)
I had a very long conversation with the patient about his complex cervical myelopathy. The patient on the MRI also is said to worsening of his a distal level stenosis particularly at C4-5 however there is change in the spinal cord signal also at C2-3. I discussed with the patient that because of the worsening of his symptoms along with worsening of his MRI I do recommend for him to consider a surgical decompression and fusion of the cervical spine. My recommendation for him would be to do an anterior cervical disectomy and fusion at C4-5 followed in the same setting by a posterior laminectomy from C2 to C7 with fusion from C2 to T1. I discussed with the patient the reasoning behind the decompression and fusion anteriorly and posteriorly because of the long-term problems associated with the decompression without fusion in a multiple level segment with patients under 65 ….

I feel that it would be helpful if I also include History of Present Illness and Physical Exam in Dr. B.T.'s report :

History of Present Illness
The patient is a 54-year-old man with a long history of back problems with unstable gait, weakness, and left lower extremity clonus who initially underwent spinal surgery on May 6, 1991, at which point he underwent C3-4 and C5-6 cervical fusion. This surgery failed to improve his unstable gait and weakness in his bilateral lower extremities and thus in 1998 he underwent T7-8 diskectomy. That surgery also did not help alleviate his symptoms and he has had which has somewhat worsened over the past year and a half. The patient does not have any history of trauma. He denies any fine motor difficulty with the bilateral hands. He denies any hand or upper extremity numbness or tingling. He does note some (minor) right foot numbness in the toes that increases with exercises. He denies any bowel or bladder difficulties. He has difficulty walking and has been noted to be worsening by his family and friends. He is not experiencing any back, leg, neck or arm pain, but he is very concerned about his unsteadiness and losing his balance while walking.

On physical examination today, he is in no apparent distress. He is alert, awake, oriented, cooperative, and pleasant. He walks with a very spastic gait on the left lower extremity. He has no pain with flexion of the cervical spine. He has 5/5 strength in the bilateral upper and lower extremities throughout the deltoids, biceps, triceps, wrist extension, wrist flexion, grip, and interossei, and bilateral iliopsoas, hamstrings, quadriceps, tibialis anterior, gastrocsoleus, and extensor hallucis longus muscles groups. He is sensory intact to light touch throughout the bilateral upper extremities and lower extremities throughout the C2 to T1 nerve distributions and L2 to S1 nerve distributions, equal bilaterally. He is nontender to palpation throughout his entire spine. He does have a positive Hoffman on the left. He has significant clonus of the left lower extremity. He has difficulty with heel, toe, and tandem gait, and he has increased patellar and Archilles reflexes on the left lower extremity. His previous incision sites are clean, dry, and intact without surrounding skin erythema, swelling, drainage, or tenderness. He does have a positive reverse radial reflex on the right and decreased brachioradialis reflexes bilaterally. He has a negative scapulophumeral reflex on the right and positive scapulohumeral reflex on the left.

I look forward to hearing from you.

Thank you and have a wonderful day!

Last edited by Administrator; 09-07-2011 at 09:35 AM.

 
Old 09-06-2011, 04:15 PM   #6
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Re: cervical stenosis: laminectomy vs laminoplasty

Wow... that SB guy is pretty, um, "ambitious", isn't he? You really should find out if he has ever done a laminoplasty and, if not, WHY not? If he's recommending you get half you spine fused just because he DOESN'T KNOW HOW TO DO A LAMINOPLASTY, then he needs to be introduced to a new profession, like maybe picking up roadside trash. I wonder what jennybyc will have to say about this...

When you went back to BT a couple of weeks ago, did you tell him what SB said? How did BT react?

Quesera, I can respond in a little more detail, but I'd do better if I knew what your most recent radiologist's report says (and even, if possible, how it differs from the previous one). If you can't do that, lemme know.

I suppose you have considered that your gait problems might be lumbar-related, or might not be a spinal problem at all?

 
Old 09-07-2011, 09:57 AM   #7
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Re: cervical stenosis: laminectomy vs laminoplasty

Hi Webdozer,
Thank you for your prompt response. The MRI reports are all quite long and I am looking for a way to convert the MRI reports into a text file like MS WORD. I type SLOW. I will get the MRI reports to you by this weekend even if I have to type. Dr. BT felt that the procedure suggested by DR. SB is excessive. Both Drs. BT and DC feel that ACDF at C4-5 would be uncessary as the cord will drift backward away from the disc after the laminoplasty. Dr. SB is highly recommended by a friend who specializes in neuro-radiology and is the head of the radiology department at a major hospital where Dr. SB operates. In his words, "I do not know how many cervical laminectomies/posterior fusions Dr. SB has done, but he does many more than any other neurosurgeon that I have seen. Those patients seem to do well. I do not see many complications." Dr. SB does not do laminoplasty and he is not fond of the procedure either because of complications on the hinges and other issues.
More later,
Que Sera Sera

 
Old 09-07-2011, 12:03 PM   #8
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Re: cervical stenosis: laminectomy vs laminoplasty

Webdozer,
It was me who sent the last reply. I was careless in using th exact user name. By the way, can you tell me why you doubt the connection of my gait to the cervical myelopathy?
Have a nice day!
queserasera2005

 
Old 09-07-2011, 02:08 PM   #9
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Re: cervical stenosis: laminectomy vs laminoplasty

""Dr. BT felt that the procedure suggested by DR. SB is excessive""

Yeah, that makes three of us.

"Both Drs. BT and DC feel that ACDF at C4-5 would be uncessary as the cord will drift backward away from the disc after the laminoplasty"

That's a question that has interested me for a while. Yes, the cord should "drift" backward, but won't that just allow the disk to follow it? I think maybe this one is a question of just how badly herniated the disk is, and maybe also how bad your canal stenosis is.

"Dr. SB does not do laminoplasty and he is not fond of the procedure either because of complications on the hinges and other issues."

I don't know if he really believes that or if it's just an excuse. I have never heard of complications with the hinges. Maybe you can find something about that on the Net. My impression has always been that the main complication is neck muscle pain (but that by Not doing the C7, the incidence of this can be cut drastically). As for how MANY laminectomy/fusions SB has done, I am not questioning his skill, only the necessity of doing that at all. Anyway, Jennybyc has written about how one does after such an operation, if you want to look for that.

As for the gait problems, I don't really doubt the connection to the c-spine problems, which certainly could be the cause. Just wondering if you'd asked the docs about other possibilities.

 
Old 09-07-2011, 02:10 PM   #10
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Re: cervical stenosis: laminectomy vs laminoplasty

""Dr. BT felt that the procedure suggested by DR. SB is excessive""

Yeah, that makes three of us.

"Both Drs. BT and DC feel that ACDF at C4-5 would be uncessary as the cord will drift backward away from the disc after the laminoplasty"

That's a question that has interested me for a while. Yes, the cord should "drift" backward, but won't that just allow the disk to follow it? I think maybe this one is a question of just how badly herniated the disk is, and maybe also how bad your canal stenosis is.

"Dr. SB does not do laminoplasty and he is not fond of the procedure either because of complications on the hinges and other issues."

I don't know if he really believes that or if it's just an excuse. I have never heard of complications with the hinges. Maybe you can find something about that on the Net. My impression has always been that the main complication is neck muscle pain (but that by NOT doing the C7, the incidence of this can be cut drastically). As for how MANY laminectomy/fusions SB has done, I am not questioning his skill, only the necessity of doing that at all. Anyway, Jennybyc has written about how one does after such an operation, if you want to look for that.

As for the gait problems, I don't really doubt the connection to the c-spine problems, which certainly could be the cause. Just wondering if you'd asked the docs about other possibilities.

As for keying in the radiologist's report, keep in mind that you're only going to get an amateur's opinion, which might be worth exactly what you're paying for it.

Last edited by WebDozer; 09-07-2011 at 02:20 PM.

 
Old 09-08-2011, 09:57 AM   #11
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Re: cervical stenosis: laminectomy vs laminoplasty

WebDozer,
Several specialists were puzzled by my Cervical MRIs and CT scan regarding my gait(left leg). I had taken additional MRI's on brain, thoracic and lumbar as well as a thorough test by a neurologist who even ordered a blood test with 5 tubes of blood drawn. The results were all negative. At the end the neurologist recommended lumbar puncture to check the spinal fluid which I declined. The brain MRI is normal and the thoracic MRI is fine. There are arthritis in the lumbar but should not be the cause for the gait problem.
By the way, it has been about 3 months since you had your laminoplasty surgery, how are you doing? How is the range of motion of your neck? Would you still recommend laminoplasty over laminectomy? You are right, Dr. SB did mention about the pain. If I only need C3-5 as suggested by Dr. DC, without doing C6, then the pain will be less, right?
Thanks for your time.

 
Old 09-08-2011, 10:47 AM   #12
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Re: cervical stenosis: laminectomy vs laminoplasty

TX - I don't see why you would decline ANYTHING the docs suggest, even if it's a complete shot in the dark.

My doc suggested C3-C6 laminoplasty, but when we looked closer he decided to do a form of laminotomy at C3 instead, carving away a little of the inside of the lamina and thus opening up the canal a little w/o cutting the C3 lamina. I wanted to be sure we didn't do C7, which is thought to be a major cause of neck pain, but it wasn't necessary, so I didn't have to fight with the surgeon about it. As far as how much difference C6 makes, I don't know, but I don't think it's much. If you need a little room there, maybe the surgeon can do what mine did at C3.

As for me, I guess I'm doing OK. It has been three months plus a day now. I think I have lost some range of motion, but I can't really be sure. I've been losing flexibility for a while now, just as part of getting old.

I don't have much neck pain, mostly muscle soreness. It's odd to have something like that persist for so long. I'm used to muscle soreness being a 1-2 day kind of thing. My pre-op symptoms have lessened somewhat, and I'm keeping my fingers crossed on that. I have had NEW symptoms crop up, always "chills" in either arm or leg. Sometimes, it feels like I have both feet in a bucket of cold water. Not debilitating at all... just a sensory thing, so far. Since it is both feet and arms, I know it's a cord problem, as opposed to foraminal. Who knows what happens to a cord that's been 50% compressed - possibly for years - when it's suddenly given breathing space?

And I went for a 10-mile bike ride the other day, which I couldn't have done even three weeks ago, the problem being the head-up-and-arms-forward position that one has to adopt when riding a road bike.

Last edited by WebDozer; 09-08-2011 at 10:50 AM.

 
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