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Old 10-05-2012, 01:44 PM   #1
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Laminectomy vs Laminoplasty

I just joined today and have spent most of the day reviewing posts and responses. I feel like this Board is a lifesaver. My MRI results are not pretty. Key excerpts:
C2-C3: Disc space height is preserved. There a small central
posterior disc osteophyte complex without significant neural
foraminal narrowing or central stenosis.

C3-C4: There is loss of disc space height and disc desiccation
with Modic Type I endplate changes. There is unchanged diffuse
disc bulge and asymmetric right paracentral posterior disc
osteophyte complex formation causing moderate central stenosis
and moderate to severe right neuroforaminal narrowing.

C4-C5: There is mild loss of disc space height and disc
desiccation with Modic Type I endplate changes. Asymmetric right
paracentral posterior disc osteophyte complex formation and
diffuse disc bulge causes unchanged moderate to severe central
stenosis and mild right neural foraminal narrowing.

C5-C6: There is loss of disc space height and disc desiccation
with posterior disc osteophyte complex formation causing
unchanged severe central stenosis and moderate bilateral
neuroforaminal narrowing. There are Modic type I endplate
changes.

C6-C7: There is disc desiccation and loss of disc space height
with posterior disc osteophyte complex formation causing
unchanged severe central stenosis and moderate right greater than
left neuroforaminal narrowing. There are Modic type I endplate
changes.

C7-T1: There is disc desiccation and loss of disc space height
with posterior disc osteophyte complex formation causing
unchanged mild central stenosis, moderate right, and mild left
neuroforaminal narrowing.

The spinal cord is of normal volume, contour and signal

I have seen 3 surgeons. Surgeon #1 -- orthopedic -- recommends laminectomy with fusion -C2-C7- if symtoms get worse which they are. Surgeon #2 -- neurosurgeon -- no surgery unless symptoms get significantly worse. Surgeon #3 --neurosurgeon -- recommends laminoplasty C4-C6 (maybe C3-C6). I've scheduled an appointment with Surgeon # 4.

I would greatly appreciate hearing from those of you who have gone through either procedure and what your experiences have been. And if given a choice, why you picked one versus the other. WebDozer, it would be great if you would respond since I was left hanging when the adminstrator cut you off and referred to the Blogs. I could not find where you finished your recovery.

 
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Old 10-06-2012, 06:00 AM   #2
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Re: Laminectomy vs Laminoplasty

Let me answer a little later. In the meantime, look up "MY pre-laminoplasty MRI" for an example of a situation that WAS addressed with a laminoplasty, and also an example of how a radiologist's report SHOULD look, in contrast to yours, where the radiologist didn't give measurements.

 
Old 10-06-2012, 07:30 AM   #3
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Re: Laminectomy vs Laminoplasty

Will do thanks!

 
Old 10-06-2012, 12:14 PM   #4
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Re: Laminectomy vs Laminoplasty

OK, I'm back.... For starters, with regard to my unfinished "blog"... right after my last post, things got better fast. The pain went away. I did, for a while, have NEW symptoms ("chills" in feet), but those dissipated over time. Other pre-op symptoms that "came back" have also mostly dissipated. I should add that I've had three ops, each following various symptoms. It's not unusual for me to have symptoms now which I can clearly identify as originating with spinal problems, but I can't necessarily say whether they are left over from my pre-ACDF problems (1996), from my pre-foraminotomy problems (2004) or from my pre-laminoplasty problems (2011). As long as they are occasional, I won't complain, and as long as they don't get worse, I won't worry.

As to my objection to your MRI report's lack of measurements:

""posterior disc osteophyte complex formation causing unchanged severe central stenosis and moderate bilateral neuroforaminal narrowing""

OK, the d-o-c causes severe central stenosis, but does that happen because the d-o-c is REALLY BIG, or because the spinal canal starts out REALLY SMALL and it doesn't take much of an intrusion to cause problems? This is a critical distinction to consider when deciding whether to remove the d-o-c via an ACDF, or to open up the canal by some kind of posterior decompression.

Fortunately, one can INFER from the fact that two surgeons recommended posterior decompression that they have looked at the images themselves and pretty much ignored the radiologist's report (as two ns's have told me they usually do). The recommendation of posterior decompression implies that the BASIC problem is not the intrusions into the canal, but the fact that the canal is too small to start out with.

As for my amateur's opinion about your surgery options:

The C2-7 laminectomy/fusion seems extreme. For one thing, the C2 doesn't really seem to need that. As for the C3, while work there may be beneficial, complete "ectomy" doesn't seem necessary, yet. You've read what I had to say in my blog about messing with the C7. That was in connection to laminoplasty, but I don't really see why it wouldn't also apply to laminectomy.

Anyway, while you MAY, over the course of your life, need most or all of the work involved in a C2-7 laminectomy/fusion, I don't see the need to go that far yet.

Obviously, I'm much more in agreement with Surgeon #3. You could ask him if he plans to do what my surgeon did at C3, which was to shave some off the inside of the lamina w/o actually moving it (a laminotomy). Also, I'd ask about C7 which, given the severe central stenosis at C6-7, would seem to need work. Is he proposing to skip it because he doesn't think it's necessary, or because he's concerned about post-op neck muscle problems?

Finally, will #3 do the multi-level, bilateral foraminotomies that you seem to need at the same time he does the laminoplasty?

Two more things... just because you might agree with #3, doesn't mean you shouldn't go out of your way to find the BEST surgeon to perform the laminoplasty. Finally, keep in mind that I'm just a slightly-educated amateur with too much personal experience, and am only trying to provide some background for further discussion with physicians.

Last edited by WebDozer; 10-06-2012 at 12:16 PM.

 
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Old 10-06-2012, 11:09 PM   #5
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Re: Laminectomy vs Laminoplasty

Your reply and your posts (all of which I've read!) have been incredibly helpful. I appreciate your caveat reminding us that your not a professional. But the amount of expertise you've accumulated during your complex journey is amazing. And your willingness to take the time to repeatedly share it is incredibly generous.

The MRI excerpts I provided were from my 3rd MRI and were much less detailed than the first. There were still no measurements but the surgeons all looked at the scans themselves. After reading all about the C7 potential issues, I have the same question in terms of addressing it. The pro laminoplasty MD was clear that he wanted to avoid the C7. I thought with the laminectomy and fusion the C7 issues were not relevant.

I clearly have to circle back with each of them now that I have more educated questions to pose. I am pretty well connected in the Boston medical community and the surgeons I'm seeing are all highly experienced cervical spine experts. But evaluating who is "best" is a challenge. Especially when dealing with the laminoplasty/laminectomy biases. And finding the combination of "best" skilled who is also willing to explain things in detail to a control freak like me is even harder. I'm going to try to connect with Jenny. I've read her posts as well.

Meanwhile, thanks again and I'll keep you posted.

 
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cervical stenosis, laminectomy & fusion, laminoplasty



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