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Old 12-03-2011, 12:04 PM   #1
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confused about diagnosis and options

Hi Folks,

First time poster, but long time lurker

I' a 44 year old male with a long history of RA and joint pain. Went to see the doctor as my mid and lower back were very sore, right leg completely numb. She ordered a MRI and what appears to be the main results are:

T1-T2: Normal disc height and T2 signal. Bilateral paracentral through far lateral shallow protrusions partially efface ventral CSF. Left ligamentum flavum calcificaion with a minimal extradural mass effect upon the thecal sac. Bilateral moderate foraminal narrowing. Mild facet degenerative degenerative change.

T3-T4: Normal disc height and T2 signal. Bilateral paracentral through far lateral shallow protrusions partially efface ventral CSF. Right moderate and left mild foraminal narrowing. Right moerate and left mild to moderate facet degenerative change. Prominent ligamentum flavum calcification bilaterally indents teh dorsal aspect of teh cord and deviates the cord anteriorly. There is near complete effacement of CSF surrounding the cord. Subtle increased T2 signal within the cord at the interspace level is poorly circumscribed.

T6-T7: Normal disc height and T2 signal. Right paracentral tiny protrusion just abuts the ventral cord. Bilateral moderate facet degenerative change. Mild foraminal narrowing. Bilateral ligamentum flavum calcification indents the posterior aspect of the cord and deviates teh cord anteriorly at the mid T6 level.

She referred me to a neurosurgeon, who took a look at my MRI and report and is recommending T3 and T6 laminectomy. Based on some research, it seems like laminectomy in the thoracic region is much less common than elsewhere.

I plan on getting a second opinion (heck, maybe even a third!). I guess what I am asking is whether the laminectomy is the best course of action, and what is the urgency of getting this taken care of - I can deal with the pain, etc. but I do not want to risk causing more damage!

Also - if anyone can recommend a good neuro in the Seattle area it would be appreciated.

Thanks!

Ray

 
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Old 12-03-2011, 05:11 PM   #2
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Re: confused about diagnosis and options

Forgive the odd question, please, but are you of Japanese descent? Apparently ligamentum flavum calcification is much more common in Japan, hence the popularity of laminoplasties there.

I had ligamentum flavum "hypertrophy" before my recent cervical laminoplasty. That hypertrophy could have been due to calcification, but that was not specified. (and no, I'm not Japanese)

From what little I know of thoracic surgery, I THINK laminectomies are not so bad, because the thoracic spine is locked in place, unlike the cervical spine, where laminectomies can lead to instability (and so are often accompanied by posterior fusions). But that's just my dangerously uninformed opinion.

You may get better info here, or you might want to try the Back Board (as this board concerns itself more with cervical issues).

Last edited by WebDozer; 12-03-2011 at 05:13 PM.

 
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Old 12-03-2011, 08:51 PM   #3
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Re: confused about diagnosis and options

Quote:
Originally Posted by WebDozer View Post
Forgive the odd question, please, but are you of Japanese descent? Apparently ligamentum flavum calcification is much more common in Japan, hence the popularity of laminoplasties there.

I had ligamentum flavum "hypertrophy" before my recent cervical laminoplasty. That hypertrophy could have been due to calcification, but that was not specified. (and no, I'm not Japanese)

From what little I know of thoracic surgery, I THINK laminectomies are not so bad, because the thoracic spine is locked in place, unlike the cervical spine, where laminectomies can lead to instability (and so are often accompanied by posterior fusions). But that's just my dangerously uninformed opinion.

You may get better info here, or you might want to try the Back Board (as this board concerns itself more with cervical issues).
Thanks! I'll post on the back forum as well. And no - no japanese ancestry as far as I know...though I am eating sushi tonight.

Thanks,

Ray

 
Old 12-04-2011, 05:06 AM   #4
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Re: confused about diagnosis and options

I 'think' they plan to relieve pressure on the spinal cord and nerve roots. As with any surgery and especially with the spine, there are never guarantees. The goal is to prevent further damage and improve symptoms. Not doing surgery can further impair/destroy the nerve that's causing your leg to be numb and my experience is that tingling and numbness is first, then that nasty BURN feeling sets in (nerve pain). You don't want that. Also, it sounded to me like your cord is being compromised which would be a good reason to act on this quickly. One of the most important things is the surgeon. Do ask how many like-surgeries he's done, the outcomes, complications, etc.. and def get a 2nd opinion (or third) before following thru. Don't give in to pressure, make sure you are totally informed and comfortable (well, you know) before allowing them to operate. Good luck, I hope you feel better soon.

 
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