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Old 11-22-2012, 02:10 AM   #1
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Long story but could use any opinion necessary - Cervical Stenosis at 31

Hello everyone. I have been trolling this website for a long time and finally decided to see if what I have is actually something I need to get surgery on or if I can wait and try other methods. Please excuse the long explanations and bad grammar.

I will try to explain my situation as best I can and I will post a copy of my recent CT and MRI reports in hopes that someone can advise me in the right direction as Ive been told that I should get a laminoplasty for my stenosis though I have heard that I should get a ACDF as well .... I also had a neuro surgeon tell me 5 years ago that I need nothing.

I am 31 years old, slightly overweight but certainly not obese - something like 5'10'' and 210-220 .. I get some exercise but not that much due to my extreme pain, feelings of weakness, etc in my legs as well as in my shoulders, upper arms. It takes so much just to get up and move around. I constantly feel like absolute crap and am getting to my whits end. I have a one year old baby with another on the way and this is absolutely ruining my marriage as I am too damn tired, weak, and horrible feeling to do much of anything with the baby. My legs and feet shuffle, it just feels like so much effort to work my arms and legs at times ...

Ive had neck and back pain now for as long as I can remember including a few bouts of extreme pain that I can remember as a child where my neck would literally stay in one place and I couldnt move it without pain. This would last a few days and would go away ... Ive had the usual scans, tests, etc and naturally everythings basically come back as normal and they would tell me to go do physical therapy or work out or whatever else doctors tell kids.

Ive tried physical therapy which did nothing. Ive tried prednisone which made my face fat and didnt have much of an impact either. Chiropractor seemed to make my weakness worse after one session so I never went back as that freaked me out.

Day to day is a different type of pain. Usually its on my left side of my neck as well as my shoulder blade and upper back area. However there are times when my left side wont hurt and my right will be the one in tremendous pain. If I sit or stand in certain positions I have a feeling of weakness in my arms and upper legs. Also of late I have been experiencing lower back pain that seems to radiate into my butt and the outside of my hip and knee.

my body constantly "cracks" and that seems to be the only thing that will aleviate some pain for a precious millisecond. Im constantly trying to "get comfortable" but I never can so im constantly moving trying to "crack" something out of my back and neck and my lower back, hips, knees, when there is pain there which basically is always.

If I sit or lay in certain positions a part of my body will go numb whether its my pinky, my hand, my back, or my foot.

Ive seen a neck specialist and he suggests a laminoplasty. I am hesitant as I dont really know if this is the issue I have and it isnt some other problem and I go into surgery for nothing and theres still this problem. I dont know any of the medical terms on the reports but there are words like "severe", "herniation", "congenital" ... So I assume SOMETHINGS going and for all I know this is absolutely whats going on and I should get into surgery right away.

EXAM: MRI OF THE CERVICAL SPINE WITHOUT CONTRAST

CLINICAL INFORMATION: Left neck pain radiating to the left shoulder, arm and hand with
associated numbness.

TECHNICAL INFORMATION: Sagittal fast spin echo T2-weighted, GRE, T1-weighted FLAIR, STIR
and axial fast spin echo T2-weighted and GRE images of the cervical spine were obtained.

Examination was performed on a 3.0 Tesla MRI scanner.

INTERPRETATION: No comparison.

Straightening of the cervical lordosis with generalized dextrocurvature. No acute fracture. C1-2
articulations and bony craniocervical junction are unremarkable. Imaged posterior fossa
structures, lung apices and paraspinal soft tissue structures are unremarkable. Carotid and
vertebral arterial flow voids are present. Annular bulging is demonstrated at C7-T1 through C2-3.

Disc space narrowing is mild at C3-4 and mild to moderate at C4-5. Cervical spinal canal is mildly
developmentally narrowed throughout.

T2-3 and T1-2: No central stenosis or cord compression. Mild facet hypertrophy is evident
bilaterally at T1-2 and there is mild to moderate left chronic foraminal narrowing at this level.

C7-T1: Mild degenerative/developmental central stenosis without cord compression. Mild to
moderate left facet arthrosis with mild right uncinate spurring. Foramina are patent.

C6-7: 2 to 3 mm AP diameter, chronic-appearing right paracentral to posterolateral disc herniation
with overhanging osteophytes contributes to severe central stenosis with cord compression. Mild
left facet hypertrophy with mild bilateral uncinate spurring and chronic mild left foraminal
narrowing.

C5-6: 4 mm AP diameter left posterolateral disc herniation with severe central stenosis and cord
compression. Mild left facet hypertrophy with mild to moderate left and mild right uncinate
spurring and chronic mild to moderate left foraminal narrowing.

C4-5: 2 to 3 mm AP diameter, chronic-appearing left posterolateral disc herniation with
overhanging osteophytes and resultant mild to moderate central stenosis with left ventrolateral
cord flattening, but no cord compression. This also contributes to moderate medial left foraminal
narrowing. Mild left facet hypertrophy with mild to moderate left and mild right uncinate spurring.
The right foramen is patent.

C3-4: Chronic-appearing, 3 mm AP diameter left posterolateral disc herniation with overhanging
osteophytes contributes to mild to moderate central stenosis without cord compression. There is a
small focus of relative T2 prolongation demonstrated in the left lateral cervical cord at the upper C4

vertebral body level seen on series 2, image 7 and series 6, image 20 without associated cord
expansion in this distribution. Mild left facet hypertrophy with moderate left and mild to moderate
right uncinate spurring and chronic severe left and mild to moderate right foraminal narrowing.

C2-3: 1 mm right paracentral disc protrusion with mild to moderate degenerative/developmental
central stenosis, but no cord compression. Mild left facet hypertrophy with mild bilateral uncinate
spurring. Foramina are patent.

CONCLUSION: Developmentally narrowed cervical spinal canal with multilevel degenerative disc
disease and the following notable findings:

1. 4 mm AP diameter left posterolateral disc herniation at C5-6 with severe central stenosis and
cord compression.

2. 2 to 3 mm AP diameter chronic-appearing right paracentral to posterolateral disc herniation at
C6-7 with overhanging osteophytes and resultant severe central stenosis and cord compression.

3. 2 to 3 mm AP diameter, chronic-appearing left posterolateral disc herniation at C4-5 with
overhanging osteophytes and resultant mild to moderate central stenosis, left ventrolateral cord
flattening, and moderate left medial foraminal narrowing but no cord compression.

4. Chronic-appearing, 3 moderate AP diameter left posterolateral disc herniation at C3-4 with
overhanging osteophytes contributes to mild to moderate central stenosis without cord
compression.

5. Small focal area of abnormal cord T2 hyperintensity left laterally at the upper C4 vertebral body
level likely reflects underlying cord edema or myelomalacia.

6. Chronic foraminal narrowing is mild to moderate on the left at T1-2, mild on the left at C6-7,
moderate on the left at C5-6 and severe on the left and mild to moderate on the right at C3-4.

7. No acute fracture.


.... I also have my CT if that would help anymore but this post is already way too long. Hopefully I get some good advice as I meet with the Dr. Tuesday to discuss laminoplasty again and if its the way to go. Id love to go in knowing a little bit more.

Thank you much for sitting through this insanely long post and I greatly appreciate any advice I get.

HAPPY THANKSGIVING !

 
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Old 11-22-2012, 09:31 AM   #2
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Re: Long story but could use any opinion necessary - Cervical Stenosis at 31

I don't think your cervical problems can be addressed with just one surgery. However, a laminoplasty looks like a reasonable start. Just so you know, I have had a single-level ACDF, a single-level foraminotomy, and a multi-level laminoplasty-with-foraminotomies.

I think you really, really need to educate yourself as much as possible before your appointment on Tuesday. The more you know, the better the doc will treat you, the more he'll tell you and the more you'll learn.

May I suggest that you start by reading two threads on HB - started by yours truly - called "My pre-laminoplasty MRI" and "Cervical Laminoplasty Chronicle". Read these in the context of knowing that you have congenital (developmental) cervical spinal stenosis (albeit "mild").

You can also look around online and find a schematic of how a laminoplasty works.

After you've done that, you can bring your questions back here and we will continue...

Last edited by WebDozer; 11-22-2012 at 09:33 AM.

 
Old 11-23-2012, 09:41 PM   #3
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Re: Long story but could use any opinion necessary - Cervical Stenosis at 31

Quote:
Originally Posted by WebDozer View Post
I don't think your cervical problems can be addressed with just one surgery. However, a laminoplasty looks like a reasonable start. Just so you know, I have had a single-level ACDF, a single-level foraminotomy, and a multi-level laminoplasty-with-foraminotomies.

I think you really, really need to educate yourself as much as possible before your appointment on Tuesday. The more you know, the better the doc will treat you, the more he'll tell you and the more you'll learn.

May I suggest that you start by reading two threads on HB - started by yours truly - called "My pre-laminoplasty MRI" and "Cervical Laminoplasty Chronicle". Read these in the context of knowing that you have congenital (developmental) cervical spinal stenosis (albeit "mild").

You can also look around online and find a schematic of how a laminoplasty works.

After you've done that, you can bring your questions back here and we will continue...
I have cervical spinal stenosis since 2002 and have a fusion at c4-c6 with hardware , the problems has since reared its ugly head again , I am back with the specialist , physical therapy etc.......... this time I got second opinions and I got the same answer , unless you are screaming in pain, you don't need surgery , I'm almost at that point, I would get a second opinion to see if both doctors see the same need for any surgery, I'd like to know how you come out, thanks for posting

 
Old 11-24-2012, 09:19 AM   #4
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Re: Long story but could use any opinion necessary - Cervical Stenosis at 31

Capatga - The people who gave you that "screaming in pain" answer are idiots. Cervical spinal problems - even the most severe ones - do not necessarily manifest themselves as pain. In fact, problems with gait and coordination, or loss of muscle function, may be considered much more serious, even if no pain at all is involved.

It has been posted here many times, in fact - not by me - that pain, in and of itself, is not sufficient reason for surgery, no matter how bad it is. I don't consider that statement any more valid than the one foisted off on you, but it goes to show the very wide range of opinion and, I'm sorry to say, the wide range of ignorance in the medical profession.

 
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Tags
cervical, laminoplasty, mri report interpretation, stenosis



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