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Cervical surgery? Can I wait to see best doc?

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Old 10-31-2012, 04:32 PM   #1
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Cervical surgery? Can I wait to see best doc?

I am 59, experiencing neck & radiating pain, at times debilitating, at times not so bad (if I do not use my arm for more than typing), weakness in left arm, for 5+ mos. Pain is always aching, sometimes stabbing, depending on position, activity.

MRI shows disc osteophyte complex C3-C6. Mild canal and foraminal stenosis, except for C5-C6, where radiologist notes severe left foraminal narrowing. not sure what the effacing language means..pushing on?

I assume that it is most likely that the largest osteophyte, at C5-C6, is putting pressure on the nerve root, causing the pain and weakness through my shoulder, left arm, making left arm functionally disabled - significantly limited range of motion, no golf, swimming, yard work, sleeping on left side.. Prescribed Diclonfenac Sodium for pain (NSAID, though not sure it is much more helpful than acetaminophen, or naproxen sodium), sometimes hydrocodone to be able to sleep at night (worse at night). My sleep is disrupted by the pain and discomfort, have to use sleep meds to get more than 3 hours, and even then, they don't work unless I use more than I am comfortable with. So chronic fatigue is a big part of the picture..

I have figured out that surgery is likely my best option for regaining function and range of motion in my arm and shoulder. It seems foraminotomy, at least, is in my future, depending on the exact location of the spurs, but I do not want to jump to conclusions.

I will see a neurosurgeon in a few days, trying to schedule appt for a 2nd opinion as well, scheduled for epidural injection in a couple of weeks, which is not likely to do much for function, but may relieve some pain for a while, or not.. unfortunately the spine surgeon that is most highly recommended is scheduling into mid-February of next year. I am guessing, from my MRI, that my situation is not urgent, if I can live with the pain, and I am wondering if I should wait 3 1/2 mos for the best guy, or see someone that can schedule me sooner (early December)?

Below are the results of my MRI - a lot of regular getting-old-rusty-neck-osteoarthritis stuff, but the pinched nerve, left arm pain and disfunction situation is debilitating.

Are there proactive non-surgical things I can do moving forward, to protect my neck from further deterioration? (stretch my neck?) Everything I know to date has been learned from this board - you all are an amazing resource. A few of you, who are so generous in sharing your time, accumulated expertise, and personal experiences have literally become my heroes - you know who you are.

MRI FINDINGS: On the sagittal images, there is loss of the normal cervical lordosis. Vertebral bodies remain normal in height. Mild degenerative endplate marrow signal and contour changes are noted at C4-C5, C5-C6, and C6-C7, levels where there is also mild to moderate loss of normal intervertebral disc volume. The craniocervical junction is normal in appearance. The cervical spinal cord is normal in contour and signal intensity.

C2-C3: The disc contour remains normal and the central canal and neural foramina are widely patent.

C3-C4: There is disc osteophyte complex with a superimposed more focal left foraminal disc protrusion. This effaces the left ventral CSF space and in conjunction with facet arthrosis, leads to mild left foraminal narrowing.

C4-C5: Disc osteophyte complex effaces the anterior CSF space and leads to mild canal stenosis (mid AP canal diameter of 8 mm). Uncovertebral hypertrophy more than facet arthrosis causes moderate narrowing of both neural foramina, left greater than right.

C5-C6: Disc osteophyte complex effaces the anterior (SF space and leads to mild canal stenosis. Uncovertebral hypertrophy and facet arthrosis contribute to mild right and severe left foraminal narrowing.

C6-C7: Disc osteophyte complex is eccentric to the right and results in mild canal stenosis. Uncovertebral hypertrophy contributes to mild to moderate narrowing of the right neural foramen.

C7-T1: The disc contour is probably normal and the canal and foramina appear patent.

IMPRESSION: Multilevel multifactorial degenerative changes as described above, with moderate C4-C5 and severe C5-C6 left foraminal stenosis.

For anyone that can share their impressions or thoughts, I am extremely grateful. I am used to being very active, and have needed both knees replaced for more than a year (also osteoarthritis), moving towards that.. The development of cervical problems as well has left me feeling pretty "old", but I am determined to regain my functionality and do what it takes to prevent further damage.

Bless you all! (WebDozer, I already owe you a huge debt of thanks, from reading your replies to others. Knowledge is power.)

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Old 11-19-2012, 06:20 PM   #2
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Re: Cervical surgery? Can I wait to see best doc?

Hartford - I think you are right about the need for a foraminotomy. I've had ACDF, foraminotomy and laminoplasty, myself. I do NOT think you should wait for the best guy (who may not be the best, anyway). Given where you live (you have access to NY and Boston markets), there will be no shortage of excellent surgeons. I think you should see a minimum of TWO surgeons, ASAP. Keep in mind that affected nerves can become DAMAGED nerves if left too long.

Remind me if you want a more detailed response to the MRI, but I'm just too tired right now.

Old 11-19-2012, 07:26 PM   #3
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Re: Cervical surgery? Can I wait to see best doc?

Hi, I can relate to weakness in arm-dropping things, numbness. Also, CFS, but another story-
What has made my wrist and neck considerably better has been spinal epidural(s). Don't underestimate them. If you choose to do it, I'll let you know what to expect.
You may have to get a series done, but they have been extremely helpful.
Are you involved in PT or with a rehabilitative facility? If not, I think it could only be helpful. I think it could be life-changing.
There are myriad options available to you. Not just surgery. For example, when I first began at the center I am at now, I saw a physiatrist who recommended trigger point injections in my neck. You want these! They are tiny needles filled with pain medication. It was the first time in 6 months I had any pain relief. I had a series of three. I am hoping insurance pays for more. Your nerves are all connected, so your arm weakness should be positively affected.
As far as what else you should be doing, aside from joining a rehab center for gentle PT, sleep with pillows at the end of your bed, prop up your feet. Ice the area that hurts for 20 minutes. I do this on my own-no one has told me to do so-but, at bed-time, I use moist heat at my neck. Your shoulders want to move upward to avoid trauma. You don't want this to happen, so get those elastics designed for Pilates, hold it from the back and gently flex in a downward position. When in supine position, always use a pillow to prop legs-better yet-a foam roller. I know I'm missing a lot here. I will give you more info. if I can think of it, OK? You're not old-(!) you're gonna be OK.
Look into rehab. facilities tomorrow. PT can't hurt, and it's important to be around like-minded people who can help you out now.
Take care of yourself.

Old 03-20-2013, 07:17 PM   #4
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Re: Cervical surgery? Can I wait to see best doc?

Thank you, WebDozer and Hemlock07. Update: I did get a second neuro opinion, which was that I was a "perfect" candidate for minimally invasive surgery, and concurred that the only neurosurgeon in my neck of the woods that does minimally invasive was my best option. I had a left c5-6 foraminotamy on 1/2, surgeon said he had to "clean out a lot of stuff," hard and soft, and do some dissection of the C6 nerve. My recovery was a good deal longer than I had anticipated, surprisingly long, but I did start PT 3 weeks post-op, with a very good physiotherapist, and am assured that things are healing well. I am now focussed on rebuilding the arm and shoulder muscles that had weakened over a year of reduced use. My pain is largely gone (some late day aching in neck/shoulder/arm), my range of motion still not 100% but greatly improved. The PT says that my neck "is a mess," and I should anticipate more surgery in my future.. I do use a foam knee pillow to elevate my legs, use moist heat on my neck and shoulder, and do a lot of PT with the stretch-band thing, using a 65 mm ball (strengthening my core, I am told..).

I am back at work doing a lot of computer/desk work in a less than ergonomically ideal situation. Honestly, my biggest concern now is that I have started to experience numbness and tingling in the ring finger of my RIGHT hand, that lasts for hours, no matter how much I shake or massage it, but no pain. My MRI did not really focus on the C7-T1 region, so now I am wondering if the disc osteophyte complex is affecting my lower cervical spine.. taking a "wait and see" approach for now. Thanks, WD, for the reassurance and offer of a more thorough analysis of my MRI, think through enough visits here I am good on that, and Hem for all the notes, and info about trigger point injections, I was not familiar with those, good to know. And you are so right about the PT. Self-education, patience, PT, and a good neurosurgeon.. thanks all, so much.

(FYI, I lost my 21-year-old youngest son unexpectedly a week after I posted here, hence my failure to see your responses and thank you earlier.. it is now 4 1/2 mos since his death, 2 1/2 mos since my surgery. I suspect that grief played a big role in my slow recovery from surgery.. ah, the mind-body connection. I do hope that you both see my belated thank you. It helps immensely to have such support, it so does. Namaste.)

Old 03-28-2013, 12:35 AM   #5
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Re: Cervical surgery? Can I wait to see best doc?

Hello, i had C-3,4,5,6,7, and T-1 surgery with a fusion at my C-7 and T-1. I have extreme nerve damage now and i also limp on my left leg now because of my surgery. I was on a walker for 18 month's and had to learn how to walk all over again. I had a very slow recovery and i am on several medications for pain, spasticity, and other problems that have occured since then. This happened to me back in 2008 and now my neck is popping very hard when i put my head chin to my chest looking downwards. Have you ever heard of this happening to anyone before? Thanks!

Old 04-18-2013, 09:28 PM   #6
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Re: Cervical surgery? Can I wait to see best doc?

Dear Sci2008 - Wow, you have been through a lot. I do not have enough experience with cervical surgeries and spinal issues to give you a good response to your question. You would likely get a better response from people who have some experience with the symptom you are describing if you post your concern on a new thread, its own thread, rather than a post a comment on this thread, which originated last fall and not many people will see. You need to describe your situation in a few words as a new thread, a new topic, and hopefully some of the more experienced and knowledgeable members will respond. Something like, "2008 C3-T1 surgery/C7-T1 fusion, now neck popping hard, worried!" I am sure by now that you have consulted with your doctor about this symptom. If not, you should, even get a second or third opinion.. you have already suffered too much damage. Sorry for the late response, back at work and don't get on here much. But there are great people here who know a lot, keep posting. Good Luck!

Old 04-20-2013, 02:40 PM   #7
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Re: Cervical surgery? Can I wait to see best doc?

Hartford, and are you able to sleep more than 3 hours?
I remember you said you cannot sleep more than 3 hours. So did the neck surgery you had helped you sleep 8-9 hours without sleeping medications?

Were you injured?

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Old 04-20-2013, 04:47 PM   #8
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Re: Cervical surgery? Can I wait to see best doc?

Hi nochange, No not injured, just old(er) and unlucky - disc-osteophyte complex. The discs between my cervical vertebrae are getting thin, old, hard, disappearing, lots of bone spurs on vertebrae and discs, as the vertebrae rub together.. one was large, pressing on the C6 nerve, and causing severe stenosis in the C5-6 foramina. The result was pain, loss of function and range of motion of my left arm; I could also not sleep on my left side, which was a problem, as I also have arthritis in both my knees, and have to be able to change my position during the night. I am happy to report that the surgery, which was a minimally invasive C5-6 foraminotamy, was successful, though my recovery took far longer than I expected, than many people (the neurosurgeon said he had to remove a great deal of material, hard and soft, and do some dissection of the nerve. But now I have regained my range of motion and am pain-free in the arm, working on rebuilding the muscles. I am told that my neck is in bad shape, and that I should expect more surgery in the future, but I will cross that bridge when I come to it..

As for sleeping, I can sleep on my left side again without pain, so I can shift around as I need to. I have not been able to sleep without meds for many years (stress, insomnia, depression), but now - with meds (mild ones, I think, not Ambien, got off that, but Lunesta, Sonata) - I am able to sleep 5-7 hours, which is a great improvement, I can live with that (I also use a CPAP machine, sleep apnea...again, getting older..). Doing OK.. grief complicates everything, including post-op recovery. Thanks for asking.

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cervical canal stenosis, disc-osteophyte complex, foraminal stenosis, foraminotomy, pinched nerve

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