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.