Cervical Stenosis, received opposite medical recommendations
I am a 46 years old male, six months ago I have been diagnosed (MRI report) with cervical spondylosis and stenosis at C5-C6 and C6-C7 level. The discs and osteophites are causing compression to spinal cord, AP diameter reduced to 8mm at one level. My normal lordosys is reversed. My symptoms are-
Neck and shoulder pain, occasional numbness in hands, right hand finger tips
sensitive to pressure (typing).
I can function without medication but ability to work has reduced. To be able to sleep is a challenge because of neck pain and occasional numbness.
Following are opinions from three different Surgeons I visited-
Neurosurgeon 1: He thinks it is pretty bad. It will only get worse. It’s not urgent but it’s safe to do surgery. He will replace three discs (C4-C5 is also slightly degenerated) and two vertebrae because the vertebrae are also too close to the spinal cord. He thinks I can defer surgery as long as the pain is tolerable, I can do it now as well as precaution against accident and fall.
Orthopedic Surgeon 1: He thinks it is not bad. I need surgery after 10 years, in my mid 50s. He gave me PT, recommended injection but strongly warned against surgery. It will be two discs replacement. His recommendation is to do nothing and watch, visit doctor once a year, perform MRI once in every 2 years.
Orthopedic Surgeon 2: He thinks my MRI report is bad but I do not have corresponding or matching symptoms. Reports tells him I need surgery right now, my symptoms (no weakness in hands or legs) tells him opposite. But like the first surgeon, he thinks nothing wrong to perform a surgery right now. He is not in favor of injection because he thinks the space is too tight. He would perform ADCF with alloe graft on three levels which will restore my normal lordosys.
So, I am confused and worried as to where I stand and what is safe and wise to do next.
Any suggestions or sharing of similar experience will be much appreciated.
Re: Cervical Stenosis, received opposite medical recommendations
Dear reston guy, If Im understanding you right all 3 drs are not recommending surgery at this time, nor injections, nor PT. Which dr is treating your symptoms & what medical treatment are you receiving?
The Following User Says Thank You to gmak For This Useful Post: restonguy (01-04-2013)
Re: Cervical Stenosis, received opposite medical recommendations
gmak, thank you for your time in reading and replying my post. Main dr is Orthopedic 1, because I visited him twice and went for PT according to his advice. He gave me Tramadol HCL for pain which I have not started to take. He also asked me if I want injection. He thinks I need surgery after 10 years. Other-2 is against injection, he is in favor of quick surgery, but not urging for it.
At present, I am only doing neck stretches at home, no other medical treatment. My neck pain reduced after PT, but recently I am getting more and more occasional numbness in my hands.
Here is my MRI report taken 5 months ago.
Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.
C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect
C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal
C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.
C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.
C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.
C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.
T1-T2 and T2-T3: Small central disc protrusion without mass effect.
The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.
2. Cord signal is normal
Just to recap my dilemma, the Ortho 1 said- do not let any one scare you to surgery. While the Ortho-2 said you need surgery, you can do it now as a precaution, otherwise after sometime when your symptoms will advance and you will give in. It sounded like 10 months max, not 10 years. I cannot go back to Ortho-1 before one year because that's when he will see me next. I have symptoms that are scary but not disabling yet.
Should I wait, should I do a surgery or see more doctors?
Re: Cervical Stenosis, received opposite medical recommendations
gmak, thank you for your time in reading and replying my post. Main dr is Orthopedic 1, because I visited him twice and went for PT according to his advice. He gave me Tramadol HCL for pain which I have not started to take. He also asked me if I want injection. He thinks I need surgery after 10 years. Other-2 is against injection, he is in favor of quick surgery, but not urging for it.
At present, I am only doing neck stretches at home, no other medical treatment. My neck pain reduced after PT, but recently I am getting more and more occasional numbness in my hands.
Here is my MRI report taken 5 months ago.
Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.
C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect
C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal
C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.
C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.
C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.
C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.
T1-T2 and T2-T3: Small central disc protrusion without mass effect.
The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.
2. Cord signal is normal
Just to recap my dilemma, the Ortho 1 said- do not let any one scare you to surgery. While the Ortho-2 said you need surgery, you can do it now as a precaution, otherwise after sometime when your symptoms will advance and you will give in. It sounded like 10 months max, not 10 years. I cannot go back to Ortho-1 before one year because that's when he will see me next. His office will not take appointment until it is one year from my last visit. I have symptoms that are scary but not disabling yet.
Should I do surgery so there is no permanent nerve damage, should I wait, or see more doctors?
Re: Cervical Stenosis, received opposite medical recommendations
#1 and #3 seem to be proposing very different surgeries. Replace two VERTEBRAE? Are you sure he's proposing that?
You do not mention what each guy said about the other two's recommendations, so should I assume you didn't ask them? I think it is critical that you do so. Don't beat around the bush. Lay it out for each one. If they won't explain their positions, kiss them goodbye.
Re: Cervical Stenosis, received opposite medical recommendations
Hello webdozer, thank you for your response. the first doctor indeed mentioned about replacing two vertebrae, I kind of ruled out his recommendations.
I told second one about the first doctor, he was upset and said don't let anyone scare you to surgery.
I told third doctor about second one and his strong words against surgery. Third surgeon kind of toned down after hearing it and started saying my report doesn't match with my symptoms.
Here is my MRI report-
Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.
C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect
C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal
C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.
C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.
C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.
C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.
T1-T2 and T2-T3: Small central disc protrusion without mass effect.
The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.
Re: Cervical Stenosis, received opposite medical recommendations
Thank you webdozer and gmak for your time to read and respond to my posting. I have been replying to your responses but don't see them posted. So I thought I will try again.
Currently I am only doing some neck stretch that Therapist gave me. Ortho-1 prescribed me Tramadol HCLfor pain which I haven't taken yet.
for webdozer- yes, the first surgeon, who is a nureo surgeon of age 46, told me he will replace three discs and two vertebrae, which is strange. The second surgeon is an orthopedic spine surgeon age 54 said don't let anyone scare you to surgery, you need surgery after 10 years. I told his remark to the third surgeon, orthopedic- 41, he toned down his surgery recommendation after hearing that. He said he don't see weakness in my hands or legs, so I can wait but MRI report is pretty bad. To dig what is in his mind, I said do you think it is a good idea to go for a surgery now, he said yes. He also mentioned my symptoms will definitely progress and I will give in. It sounded like I have one year time.
With stenosis ( 8mm AP diameter) can I take injection and will it reduce my numbing and tingling symptoms?
I would rather believe the Ortho-1 who said 10 years, but I am getting more and more numbness in hands and legs in last 2/3 weeks. So, I am confused.
Re: Cervical Stenosis, received opposite medical recommendations
Injection will not reduce numbing and tingling. Might reduce pain, inflammation ans stiffness, esp. that coming from C6-C7.
Have you tried cervical traction? If your surgeon says it is safe, that could help with numbing and tingling. It helps my shoulder and arm pain and numbness. It can. Be done at home after a qualified PT. shows you how and sets limits.
__________________
C3-C7
Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
Re: Cervical Stenosis, received opposite medical recommendations
Daffydolphin, thank you for your response. About four months ago I got PT, and part of it was cervical traction. It help reduced my shoulder pain. I think it is a good option to try. Can I buy some avail device from Orthopedic store and start doing it at home following user manual? Thanks!
Re: Cervical Stenosis, received opposite medical recommendations
Many medical device stores will require a prescription to sell it. They can be bought online without. If you get the Rx, your insurance might pay 70 to 80% of it.
You want the lay on the floor, pneumatic (bike pump) trac type (the sit chair, mount over door type can screw your jaw joint up). Mine was retail priced at $1,000 in the medical equip store, sold on Amazon for around $600, my insurance approved price was $525 of which I only paid the equipment store about $160. And it looks like something that should not retail more than $125 with the case. The manual mine had only told me how to care for it, clean it, store it etc. For use, it told me to see my doctor or physical therapist.
My PT told me to set it at between 15 to 30 pounds of pressure, and to clear it with Dr. before going over 30. I set it at 25. Use for at least 15 to max 30 minutes per session, at least 3 times a week, but can use daily or even twice a day. Release pressure slowly and remain stretched out on floor for at least a minute before standing up, and then get up slowly.
__________________
C3-C7
Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
Re: Cervical Stenosis, received opposite medical recommendations
Thank you Daffydolphin for giving detail about traction device. During my PT I took 25 pounds for 10 minutes session, and felt good immediately after. I think I will go for it. Will talk to doctor about it. Thanks again!
Re: Cervical Stenosis, received opposite medical recommendations
We can't really tell if laminoplasty might be called for w/o seeing the MRI radiologist's report. Laminoplasties are for people with congenitally narrow spinal canals, where the intrusions into the canals (disks, bone spurs, swollen ligaments) may not be particularly big. The idea is that, instead of treating the intrusions directly, you treat the narrowness of the canal.
Just something to know, also, is that kyphosis is a counterindicator for laminoplasty. You have "reversed lordosis", which may or may not rise to the level of actual kyphosis (the two are opposites).
Re: Cervical Stenosis, received opposite medical recommendations
Jen, I like northern Virginia too. Thank you for your response and valuable advice. I didn't count the first doctor's opinion, and I probably heard it wrong. No one of these three advised laminoplasty. One reason could be that it is not their expertise. The second surgeon said no surgery because he told me my 8mm AP diameter and symptoms are acceptable. BTW, So far I did not feel weakness in hands or legs, I feel numbness several times a day and during sleep. He said I have 10 years and surgery is needed when it will show red on the MRI (being naive I didn't ask many follow up questions). The third surgeon is listed as one of the nation's top 50 spine surgeon according to a website and he is with NIH (Dr. Jay Khanna). He leaned towards immediate surgery. I made appointment with another surgeon who supposed to be very good too (Dr. Abraham Kader) but I agree with you, I probably haven't found the right surgeon yet. I am not settling until I am fully satisfied and until I can bear my symptoms. I have done XRAY besides MRI. What other kind of tests are there?
webdozer, thank you for your comments. Here is the full MRI report taken 6 months ago. I will appreciate your comment, and anyone else's who may have similar situation or know about this condition.
Open MRI Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.
C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect
C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal
C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.
C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flattening of the cord. Foramina mildly narrowed.
C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.
C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.
T1-T2 and T2-T3: Small central disc protrusion without mass effect.
The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.
Re: Cervical Stenosis, received opposite medical recommendations
Your MRI report does not looks particularly alarming to me. I'm a little surprised that two out of three surgeons recommend immediate surgery. I would say, though, that surgeons should always read the images themselves, and many just ignore the radiologist's report. It's entirely possible that the radiologist is missing something, or he's understating what he does see.
Radiologists use a progression of adjectives to describe anomalies...
minimal - I can just barely see it
mild - I can clearly see it, but don't think it's problematic
moderate - bordering on problematic, bears watching
severe - probably needs to be fixed
Your radiologist is, unfortunately, a little light on the adjectives, but you will note that he never says "severe". You do have disk protrusions touching the cord at three levels, though, and mild encroachment on both foramina at C6-7.
I'm curious about the right-hand finger tingling.... Is it the tips of all the fingers that are sensitive, or just one or two (and which ones)? Any other symptoms in the hands (weakness, tightness, shocks, slowness)? The reason I ask is because sensitivity at the tips of all fingers does not sound like a cervical problem to me.
Anyway, from your report, one can't really say if laminoplasty is called for. Laminoplasties are meant to treat congenitally narrow spinal canals (by swinging open the lamina bones at the back of the spine). The radiologist does not give any indication that your canal started out too narrow, and he doesn't mention "short pedicles", which may be the main reason for narrow canals. Still, if you do have congenital narrowing - and at three levels - then a laminoplasty is a reasonable approach. To repeat, though, kyphosis is a counterindication, and your "reversed lordosis" leaves it open to question that you may be considered kyphotic.
Normally, I would say that seeing three surgeons is a sufficient effort at getting a full range of opinions. I'm afraid, though, that you need to get one or two more. You might also get a second radiologist's report. I know there are radiologists who advertise online for second-opinion reports. I can also give you the name of a pretty good radiologist who did a couple of reports for me.
Re: Cervical Stenosis, received opposite medical recommendations
Back in 1996-1997 I had really severe lumbar issues. I had a condition known as "Flatback syndome" that cause me to bend forward and unable to maintain a normal posture.
Prior to that I had lumbar surgery for herniated discs and cervical surgery for stenosis. Both surgeries were done by the same doctor a neurosurgeon. So I went back again to be evaluated.
His recommendation was to lose weight and take some aspirin. BAD ADVICE. So here I see someone else and went thru the medication route and physical therapy. NOTHING worked.
I ended up seeing an orthopedist in NY at one of the top orthopedic hospitals in the country. The recommendation was surgery with Harrington Rods. So taht is why I said bad advice by the original surgeon that I saw.
But with anything I always get a second or third opinion if necessary. after my initial consult with the orthopedist I in my heart felt that was great advise but did get another opinion.
I usually like to get another opinion from a different doctor at a different hospital So I proceeded uptown to another hospital and saw a neurosurgeon this time. I liked the doctor, he was thorough. But his recommendation was not to do surgery and go back to work. I totally disagreed with his opinion.
Here it was almost a year since I could walk upright. Medication did NOT help; physical therapy did NOT help. I could not function in my normal daily routines.
So here I was with 2 separate opinions.
I decided on a 3rd opinion. This time I headed to lower NYC to yet another hospital and another doctor. Back to an orthopedist.
When I told him the 1st doctors opinion, then the 2nd doctors opinion (neurosurgeon) his comment was that the Neurosurgeon was *&% of )^$^
(BLEEP BLEEP). Bottom line I needed surgery.
In my heart and soul and from what I researched on my own I knew that the original doctors opinion was right.
Sometimes we need to be proactive, look at all the evidence; all the opinions and come to an answer that makes the most sense to us. None of us want surgeries, but you were the one at the doctors office not us. Look at the doctors that gave you the opinions. I tend to look at who did I trust the most? I never regretted going thru any of the surgeries I went thru because I took the time to evaluate the situation and think what made the most sense. I knew in my heart what the answer was. Good luck in whatever you decide.
Re: Cervical Stenosis, received opposite medical recommendations
Reston, I agree, of course, that the fingertip problems don't SOUND like something that has a cervical spinal origin. Definitely a good idea to approach those from a different angle. I'm sure you're smart enough to at least make allowance for surgeons who make self-serving diagnoses, too.
I want to stress, though, that I am giving you our (amateur) impression of someone else's impression. As to the "reversed lordosis", I really don't know just HOW reversed it may be. Does a radiologist apply the adjective "reversed" when ten percent of the healthy curve has been lost, or does it have to go all the way over into bending in the wrong direction (kyphosis)? Kyphosis is definitely a counterindication for laminoplasty, but relatively mild reversal-of-lordosis may not be.
Last edited by Administrator; 02-08-2013 at 01:11 AM.
Re: Cervical Stenosis, received opposite medical recommendations
Thank you again. It is helpful, yes I do not take any of these as physician's recommendation but it is helping me to know what else is there. I had done hours of reading almost everyday on this issue last few months, but through this forum I got much more information in few days than what I could extract from my reading
Web, to answer your question, I have sensitivity to all finger tips, mainly right hand, slightly on left hands. They are sensitive to pressure, I get it when I type, not too much, at times it subsides of its own for days.
Eggyby, one of my colleague has almost exact neck symptoms as I do. He went to a different surgeon who gave him EMG/NCS. I am going to see the same surgeon following week. I can ask for EMG/NCS. Thank you for the information. I will also ask about Laminoplasty.
Many people mentioned that a 8 mm diameter is not that bad, it can go down to 6, 5 even 4 mm before surgery. I am wondering if performing day to day activity and a desk job is possible with let's say AP diameter 6mm?
Re: Cervical Stenosis, received opposite medical recommendations
Web, I'm trying to remember how I progressed from loss of lordosis to reversed lordosis and eventually kyphosis.
If I recall, the loss of lordosis came when they looked at the MRI and took a straight line from T1-2 to C1 and if there wasn't a definite curve to the inside, it was a loss of lordosis, lordosis being that inward curve toward the throat. But I also had a reversal of lordosis at particular vertebrae when one would get out of line and appear to go to the opposite side of that straight line...basically a retrolisthesis. So if I'm remembering correctly, a "loss of lordosis" is the entire neck(C3 to C7) whereas a "reversal of lordosis" can refer to any vertebra that crosses that straight line due to any one of several reasons.
Kyphosis is when that line that they draw shows a neck that is totally bowing to the opposite direction and the effect is that you can't hold your head up or are losing that ability. I know the only way I could hold my head up was with my hands.
Re: Cervical Stenosis, received opposite medical recommendations
Web, if you can give me name of radiologists that would be good. BTW, I do not have other symptoms in hand. Only occasional numbness on left hand, which is not complete numbness, slight sluggishness in sensitivity, like going into sleep. Same happens in left leg. Sometimes right hand and leg but after activity I am able to get them back to normal. Thanks!
Last edited by Administrator; 01-06-2013 at 03:39 PM.
Re: Cervical Stenosis, received opposite medical recommendations
The radiologist is Barry Jay Berkowitz at various Southern California locations. Here's a link to a Healthboards post of my latest MRI. I thought it was a good example of a radiologist doing his job well (which often does not happen).
You will note that I was down to "less than 5mm", and I was certainly capable of doing any kind of work. My symptoms did not include with weakness, paralysis or pain.
