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Old 07-04-2013, 07:35 AM   #1
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Need a little insight please

Hello,
I am new to this sight but not new to neck and arm pain.
I am a 58 year old male with severe pain down my neck and left arm down to my thumb. I have had this for about 7 years. I also have a problem with my left leg. I have an abnormal gait....I tend to drag my leg somewhat. It does not have any pain associated with this problem, but it IS a pain to ME!!

I have had an MRI a few weeks ago and have an appointment with a neurosurgeon on the 12th of July.

I will post the MRI radiologists impression. If anyone can shed some light on what this means, I would very much appreciate it. I know that there are people on this site with lots of knowledge and advise.

1. There is severe spinal canal stenosis and severe cord compression at C5-C6 from a large broad-based disk osteophyte complex. The thecal sac is narrowed to 4 mm in AP dimension with abnormal cord signal suggesting myelomalacia.

2. There is severe spinal canal stenosis at C4-C5 from a large broad-based disk osteophyte complex. It causes moderate cord compression. The thecal sac is narrowed to 6mm in AP dimension.

3. There is severe spinal canal stenosis at C3-C4 from a diffuse disk osteophyte complex with a central disk protrusion. The disk protrusion contacts and moderately indents the ventral aspect of the cord, narrowing the thecal ac to 7mm in AP dimension.

4. Moderate canal stenosis is present from a large broad-based posterior disk osteophyte complex at C6-C7. It causes mild flattening of the ventral aspect of the cord without cord contact. The thecal sac measures 8mm in AP dimension.

5. There is severe bilateral neuroforaminal narrowing with impingement of the nerve roots at C5-C6. Please correlate for bilateral C6 radiculopathy, There is severe bilateral neural femoral narrowing at C6-C7. There is severe right and moderate-severe left neuroforamina narrowing at C4-C5. There is moderate right and mild left neuroforamamina narrowing at C3-C4.

6.There is multilevel disk desiccation, disk height loss, osteophyte formation and Modic-type degenerative endplate change.

7. There is reversal of the normal cervical lordosis,


I guess that about wraps it up.
Does this look like a possible 4 level ACDF??

I appreciate any light that can be shed on this before I go to see the NS next Friday.

Thanks,
Don

 
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Old 07-04-2013, 12:44 PM   #2
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Re: Need a little insight please

<< Does this look like a possible 4 level ACDF?? >>

To my amateur's eyes, it does. You have a really nasty MRI, probably even worse than my last one.

Two things I'm not sure of:

1. "Disk osteophytes" tend to growth off the vertebrae where they interface with the disks. The question is, would removal of the disks also allow for removal of the osteophytes? If so, then ACDF's are most likely what you need.

2. There's an outside chance that the heart of your problem is not so much the intrusion of osteophytes into the canal as it is that the canal is too narrow to start out with. The fact that you have such bad stenosis at FOUR levels makes me think that you may have hereditary canal stenosis. If so, then it's POSSIBLE that a surgeon might want to do decompressive surgery from behind (laminoplasty) rather than ACDF's. Something to ask about.

Given the overall severity indicated by the radiologist, I think it extremely unlikely that any surgeon would recommend anything other than immediate and extensive surgery. It's my >>amateur's<< opinion that you should comply.

When you talk to the surgeon you want to make sure that both the canal stenosis and the foraminal stenosis will be cleared up. You have a bad case of both and both need immediate attention.

Another thing that the surgeon will tell you is that surgery will be to keep your condition from getting WORSE. The length of time that you've suffered, plus the permanent cord damage (myelomalacia) mean that many of your symptoms are irreversible, I'm sorry to say.

Try to get two opinions, and REALLY try to get the best surgeon you can, not necessarily the first guy who tells you that you need surgery.

Good luck with this, and let us know what the surgeon recommends.

Last edited by WebDozer; 07-04-2013 at 12:47 PM.

 
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Old 07-04-2013, 02:43 PM   #3
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Re: Need a little insight please

Thank you for your review WebDozer.
I am trying to learn a much as I can, as fast as I can on these issues.
I am planning on getting a second opinion for sure.
I will get back after the 12th and let you know what the NS in Dallas has to say about all of this. I'm afraid that I am pretty "Jacked UP"!!!!
The Myelomalacia has me worried and am pretty sure I need to get something done soon.
Thanks for your great advice!!
Don

 
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Old 07-13-2013, 06:51 AM   #4
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Re: Need a little insight please

I went to see the Neurosurgeon in Dallas yesterday.
He confirmed that I needed surgery. He did suggest an ACDF.

I took my MRI from a month ago with an MRI from 5 years ago. He said that 6-7 was bad, but unchanged from 5 years ago. He suggested a 3 level for sure, and told me that it is up to me about the 4th level at 6-7. He explained that the 3 level could put strain on the 6-7, but since it is unchanged from 5 years ago, it might not?
I told him that I want to go ahead and do it also.....don't want to be back in there doing it 2 years from now. From everything that I have read, there are more chances that it would.....best to just do it while he is in there now. He agreed.

I have done lots of reviews for him and he has great patient reviews. I felt very comfortable and confident about him.
I am scheduled to have this done on the 24th of July.
He uses the PEEK disc replacements instead of the donor bone.....anyone have any thoughts on that?

Just as WebDozer said......he told me that this will not be to get rid of all my current problems, but it will be to prevent any further cord damage.
He thinks it will help with the arm pain, but any good thing coming from this for my leg will just be an added bonus.....can't promise that it will.

Thanks, just wanted to give an update and ask advice on the PEEK.
So I guess a 4 level.....3-4 thru 6-7

Don

 
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Old 07-13-2013, 07:48 PM   #5
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Re: Need a little insight please

Would love to hear back from you WebDozer.

Thanks,
Don

Last edited by Blue Blurrr; 07-14-2013 at 06:59 AM.

 
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Old 07-14-2013, 10:55 AM   #6
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Re: Need a little insight please

Sorry... don't know anything about PEEK. My one ACDF (16 years ago) used donor bone.

You could do a search on PEEK on this board. Or maybe start a thread with PEEK in the title.

You might want to look into loss of range-of-motion, specifically if adding that fourth level will make a significant difference....

Last edited by WebDozer; 07-14-2013 at 10:57 AM.

 
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Old 07-15-2013, 08:13 PM   #7
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Re: Need a little insight please

From what I did find very quickly there are books about PEEK/PEAK.... Just do some quick ones & you can find lots of information on it.,

PEEK or PEAK from what I found as well is the same thing called " Polyaryletherketones". Which is a group of thermal plastics.

Myself I had a 5 level ACDF & PCF done in April.
I had a Cervical Mesh Cage & 2 kick plates with screws installed then. Then 3 days later the OS & NS installed a "DePuy Mountaineer System
as well. I also had a bone fusion stimulator ordered as well to promote the fusions.

Wish you the best on you upcoming surgeries & remember it is a hard road to recovery & it will take time. Also make sure you read the ACDF must haves! There is a lot of helpful advice there.
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C & L:Fusion of spine of C4-T-1 Brain:Large #of white matter. Most likely Lumbar & Thoracic surgeries soon

Last edited by roadiez; 07-15-2013 at 08:16 PM. Reason: edited some info

 
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Old 07-20-2013, 03:15 PM   #8
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Re: Need a little insight please

Thanks for the info, and the well wishes.
I did check out the PEEK disc replacements.
They seem to be having very good results in Multi-Level ACDF surgeries.

Mine is scheduled for the 24th. I did all my pre-op stuff Friday. They have me scheduled for a 3 level and possibly the 4th (6-7).

We are trying to get everything ready around the house. Wednesday will be here very quickly.

Hoping this will stop the pain down the arm and halt the myelomalacia.

Will give update when I get home and feel like getting on the computer.

Don

Last edited by Blue Blurrr; 07-20-2013 at 03:17 PM.

 
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Old 07-26-2013, 08:25 AM   #9
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Re: Need a little insight please

Well I had my 4 level ACDF on Wednesday the 24th. I was sent home Thursday evening the 25th.
All went well.
Thanks to all the great posts that I have read on this site, I pretty much knew just what to expect.
I am feeling really good! My throat is very sore and swollen. Will only be having VERY soft and creamy things to eat for a while. I actually had a bad episode with jello of all things in the hospital! I thought I was going to choke to death....learned a valuable lesson in that! I am in no hurry to eat.

I have the usual pain in the back of my neck and shoulders. I had a pain med last night and again this morning.....they are working well.
All in all everything is going just fine. I am just going to take it slow and easy.
I was able to sleep all night in my bed with the hard collar, so I was happy with that.

Thanks again for all the good advice from everyone here.

I might be asking for more as this goes along, but I am feeling pretty good about all of it. Haven't felt any pain down the left arm..YEA!!!!

Don

 
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Old 07-26-2013, 08:30 AM   #10
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Re: Need a little insight please

All sounds good, Blue Blurr... and all within three weeks of your first post here!

I'm interested to know how long you keep the collar and, eventually, what your range-of-motion is like.

 
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Old 07-26-2013, 06:39 PM   #11
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Smile Re: Need a little insight please

The NS says I have to stay in the Miami J Collar for a month. He said I can take it off to eat, shower, and sleep, if I want to.
I slept in it last night in my bed and it wasn't too bad. I sleep with a Bi-Pap machine for sleep apnea, so once I put my mask on, I go out pretty quickly, and don't really move around a lot. I might try sleeping without it, but a little afraid to do that just yet. It really feels good to have it on right now.

Not sure what ROM I will end up with after the fusion, but right now with a plate and 10 screws, I still have a pretty good range....a lot more than I expected!!

Had 3 hydracodone and walked close to 1 mile this afternoon.....feeling pretty good so far!!
Ready for this throat thing to get better soon!!

Don

 
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Old 08-14-2013, 04:21 PM   #12
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Re: Need a little insight please

Hi Don,
I am new on here today. I am facing similar surgery soon but was glad to read you are doing well. I look forward to hearing how you progress. Sure hope you continue to do just great. Please keep us all posted and we will keep you in our thoughts for fast healing!

 
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Old 09-03-2013, 10:03 PM   #13
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Re: Need a little insight please

Quote:
Originally Posted by Blue Blurrr View Post
The NS says I have to stay in the Miami J Collar for a month. He said I can take it off to eat, shower, and sleep, if I want to.
I slept in it last night in my bed and it wasn't too bad. I sleep with a Bi-Pap machine for sleep apnea, so once I put my mask on, I go out pretty quickly, and don't really move around a lot. I might try sleeping without it, but a little afraid to do that just yet. It really feels good to have it on right now.

Not sure what ROM I will end up with after the fusion, but right now with a plate and 10 screws, I still have a pretty good range....a lot more than I expected!!

Had 3 hydracodone and walked close to 1 mile this afternoon.....feeling pretty good so far!!
Ready for this throat thing to get better soon!!

Don
Don,
I am wondering how you are doing and progressing? I am facing very similar surgery soon and very anxious about it. Hope to hear from you soon.

 
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Old 09-07-2013, 06:52 AM   #14
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Re: Need a little insight please

Hi Julie,
I am 6 1/2 weeks post surgery now. I have been back to work in an office desk job for 4 weeks. I did wear my collar for the first 4 weeks.
I have been one week back on my motorcycle. I am not riding far yet...trying to get used to the weight of the helmet. It has made my neck muscles a little sore, but I am just taking it easy and taking my time getting back to longer rides.

Julie, I have really felt great! I had no pain to speak of after 1 1/2 weeks....and that was just soreness around the back of my neck and shoulders.

The main problem was swallowing. It was hard to swallow hardly anything. I had to eat soft things that would go down easily. I have to say that it did improve a little every day. At about 3 weeks I could eat about anything I wanted....just had to take small bites and keep water close to help wash it down.

At 6 1/2 weeks, It is still not back to normal as before surgery, but I rarely even think about it being a problem now. I do make sure that I have a glass or bottle of water with me when I eat. If it stays at this level, I would be just fine with it.

The main thing is, I have no pain down my left arm anymore. I do get a little twinge from time to time, but nothing like before and I believe it is just the nerves healing. I went 7 years hurting before I did this surgery.

Julie, I am 100% happy that I had this surgery. It has gone better than I ever imagined that it would.
I have read MANY horror stories about this type of surgery, but I was determined to go ahead and I expected a very good result and I had extreme confidence in my NS.

I wish you a very successful surgery and a very smooth quick recovery!
I know that it can be done....I am proof of that!

Please feel free to ask me anything.

Don

Last edited by moderator2; 09-07-2013 at 07:25 AM.

 
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Old 09-07-2013, 04:04 PM   #15
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Re: Need a little insight please

Hi Don! I was so happy to hear you are doing so well, your recovery sounds amazing! And such an encouragement for the rest of us so I for one, truly appreciate you taking time to post on here. It is like our MRIs are almost exactly matched; I have very similar problems with the stenosis, etc. and I am just a couple years older than you. I too, have myelomalacia at C5-6 too which is super scary to read about. I'm just grateful my surgeon knew what it was and is willing to help try to fix it. I am feeling a little more than 'jacked up' as you put it when I think about the surgery and recovery but thankful my surgeon is willing to help me with the chance of a better life after suffering for more than 15 years. Thanks again for your updates and please continue to let us know how you progress. I hope your swallowing will continue to improve.

Last edited by julie30; 09-08-2013 at 05:49 PM. Reason: posted before done

 
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