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Old 08-22-2013, 08:47 AM   #1
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Question Neurosurgeon says I need an ACDF to C5/C6... shocked!!

I was a passenger in a severe car accident about 5 months ago, which I thought I was going to fully recover from without any issue. Last month, I bent down and felt something pop in my neck and immediately felt like there was a knife in the back of my neck. The pain was excruciating and sharp in the base of my neck and through my right shoulder blade area. I could barely walk at that time due to the pain. I got a cervical spine MRI shortly after this incident and this is what they found:

FINDINGS:
Straightening and slight reversal cervical lordosis is noted. Prevertebral soft tissues appear normal. Bulging discs at multiple levels are noted. C5-6 disc protrusion causing central spinal stenosis is noted. T1-T2 disc bulge is also noted.

The spinal cord is normal in morphology and signal intensity, although compressed and narrowed at C5-C6 level. The cerebellar tonsils are anatomically aligned. Right maxillary sinus retention cyst or polyp 1 x 1.3 cm in size is noted.

C2/3: Small 2 mm broad-based disc protrusion slightly contours the ventral thecal sac with AP diameter of the thecal sac narrowed down to 9 mm is noted. No foraminal stenosis is seen on the right and mild left foraminal narrowing is seen.

C3/4: 2 mm posterior central focal disc protrusion is noted slightly to the right of midline. Midline AP diameter thecal sac is approximately narrowed down to 8-9 mm. Mild left foraminal narrowing is noted.

C4/5: C4-5-2 millimeter broad-based disc bulge is noted with AP diameter of the thecal sac narrowed down to approximately 8 mm. Mild central canal narrowing is noted. No evidence of significant foraminal narrowing is noted.

C5/6: There is a large 5-6 mm central, slightly right paracentral disc protrusion effacing the cord. Midline AP diameter of the thecal sac is narrowed down to approximately 4 mm causing severe central spinal stenosis at the level of the disc protrusion. The cord signal is still preserved. Minimal right foraminal narrowing is noted.

C6/7: 1 mm broad-based disc bulge is noted. Midline AP diameter of the thecal sac measures 8 mm. Mild central canal narrowing is noted. No evidence of significant foramina! stenosis is noted.

C7/T1: Unremarkable.

IMPRESSIONS:
There is a large 5-6 mm central, slightly right paracentral disc protrusion contouring the ventral thecal sac and effacing cord. Midline AP diameter of the thecal sac is narrowed down to approximately 4 mm causing severe central spinal stenosis at the level of the disc protrusion. The cord signal is still preserved. Minimal right foraminal narrowing is noted.

There is a lot of stuff in the MRI that I do not understand, but according to the neurosurgeon, he is recommending an ACDF to C5/6. I am 37 years old and a relatively healthy guy. I am pretty shocked to hear this news especially after the sharp pains have subsided after a couple weeks now. I now only have some minor radiating pain in the same areas as mentioned above. Also, I have no tingling or numbness. In the meantime, the surgeon is ordering another MRI to confirm his recommendation since it as been a month since the 1st MRI and I told him I feel much better than before.

Please help explain the MRI in simple terms. According to the report, it looks like I have serious disc issues at all levels. Is it possible for a disc herniation or disc protrusion to heal on it's own? Any advice, support, or help would be greatly appreciated. I can post the 2nd MRI when I receive it to hopefully show an improvement.

Thanks much.

 
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Old 08-22-2013, 10:22 AM   #2
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

4mm is certainly very narrow. I suspect you started out with a narrower-than-normal canal, so you'll have less leeway when things go wrong. A c5-6 ACDF makes sense, but of course you'll want a second opinion....

 
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Old 08-22-2013, 12:14 PM   #3
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

Let me add that I do not think that you " have serious disc issues at all levels". With the exception of C5-6, those bulges are small. Even the radiologist uses the word "small". Your foramina seem to be fine (foramina are the holes through which pass the spinal nerve roots).

I suspect that you have congenital spinal stenosis, which just means that heredity has endowed you with a narrower-than-normal spinal canal. Something to ask the surgeon about.

As for self-healing, it would seem the surgeon thinks it's a possibility, else why order a second MRI?

 
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Old 08-22-2013, 01:16 PM   #4
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

I'm a little frantic right now, but I am working on getting that 2nd opinion right now. Unfortunately, I have to work with my HMO that typically takes some time to get the approvals.

Thank you for pointing out the narrower than typical spinal canal; I will definitely bring that up in the next consultation. The self healing aspect is pretty rare from what I have heard; especially for a disc that has a 5-6mm herniation. I am hopeful, but we will see if the disc has backed off in the 2nd MRI.

 
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Old 08-22-2013, 01:21 PM   #5
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

I wouldn't be frantic, if I were you. A C5-6 ACDF is not THAT big a deal. Car accidents often cause significant neck muscle damage (whiplash), and that's a much more intractable problem than just a slipped disk.

 
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Old 08-22-2013, 02:46 PM   #6
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

I would agree with Webdozer. Don't let anyone rush you into surgery, especially when you have no signs of numbness or tingling, and pain isn't even a big problem.

Herniated discs can and do heal. It is almost unheard of to operate on a disc in the rest of the world unless there is instability. We are alone in the world in rushing people into surgery so quickly.

 
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Old 08-24-2013, 07:21 PM   #7
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

I had the same thing after a car accident but mine happened 5 weeks after the accident. I had a 2 level ACDF at C4-5 and C5-6 in early 2012 and I'm doing great. I had it done because after 7 months of pain it never got better in spite of the pain meds, PT and epidural injections.

Please, be careful about taking the advise of people who post here regarding their opinions on what you should and shouldn't do. They are NOT medical professionals. The people you should be directing your concerns to are your doctors, not anonymous people on a message board.

 
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Old 08-28-2013, 06:15 PM   #8
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

Teteri, I don't have numbness or tingling, but I have recently started developing some weakness in my hands and feet, coincidentally right after I had my 2nd MRI. I just got the results and will post them shortly. Hoping that the 2nd MRI shows some improvement to reflect my decrease in overall pain.

Realhousewife, do you recall how much disc herniation was measured in your C4-5 and C5-6 prior doing the ACDF? Was the disc herniation protruding into the spinal canal or foraminal area?

 
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Old 08-29-2013, 08:40 AM   #9
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Question Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

Here are the results of the 2nd MRI, as follows.

FINDINGS:
There is 1-2 mm of dorsal subluxation at C4-5 and CS-6. The cervical vertebral bodies are unremarkable in height. There is no vertebral body fracture. The paraspincus musculature is unremarkable. There are no significant areas of marrow replacement. The atlantoaxial and the atlanta-occipital relations are unremarkable. There is no intradural mass. The craniocervical junction is unremarkable. The cervical cord is unremarkable in size and signal intensity.

The AP diameter of the cervical spinal canal is developmentally narrow measuring no greater than 11 mm from C3 to C7. This is likely to predispose the patient to central spinal stenosis.

There is no significant disc bulge or herniation of the C2-3 intervertebral disc. There is minimal right uncovertebral spurring. There is no central spinal stenosis or significant neural foraminal narrowing.

There is no significant disc bulge or herniation of the C3-4 intervertebral disc. There is minimal left uncovertebral spurring. There is no significant central spinal stenosis or neural foraminal narrowing.

There is no significant disc bulge or herniation of the C4-5 intervertebral disc. There is no significant neural foraminal narrowing. There is mild central spinal stenosis.

There is a central disc protrusion at C5-6 extending inferiorly along the superior end plate of C6 measuring up to 3 mm in AP dimension compressing and distorting the thecal sac and the ventral cervical cord. There is no appreciable alteration in the cord signal intensity. There is severe central spinal stenosis. There is bilateral uncovertebral spurring without significant neural foraminal narrowing.

There is a posterior disc bulge at C6-7 measuring 1 mm in AP dimension with mild mass-effect on the thecal sac. There is mild central spinal stenosis without significant neural foraminal narrowing.

There is no significant disc bulge or herniation of the C7-Tl intervertebral disc. There is no central spinal stenosis or significant neural foraminal narrowing.

Spondylosis is present at T2-3 and T3-4. There appears to be associated central spinal stenosis most pronounced at T2-3.

IMPRESSION:
1. Developmentally narrow AP diameter of the central spinal canal which would likely predispose the patient to central spinal stenosis.
2. Central disc protrusion at C5-6 compresses and distorts the thecal sac and the cervical cord with severe central spinal stenosis.
3. Multilevel spondylosis results in mild central spinal stenosis at C4-5 and C6-7. There appears to be additional central spinal stenosis at T2-3 and T3-4.

This 2nd MRI was taken approximately 2 months from the 1st MRI (see initial post above for the 1st MRI results). I would appreciate some help on comparing this 2nd MRI from the 1st MRI and to see if there is any difference. I am hoping to see that this 2nd MRI shows that my disc has healed a bit. Any comment or advice would be much appreciated.

 
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Old 08-29-2013, 04:21 PM   #10
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

There doesn't seem to be a difference between the two MRI's, other than it was a different radiologist. The new guy points out your hereditary spinal stenosis (which I'd suspected, as the reading in the first MRI implied it).

4mm is very narrow. That, by itself, might very well not cause pain. Both radiologists say there's no signal change. Still, I can't recall reading of someone with a cord narrowed to 4mm where the surgeons just say wait-and-see.

My nonprofessional inclination is that the surgeon's suggestion of a C5-6 ACDF is not at all unreasonable. I would strongly suggest that you have three opinions in hand and then compare them before making up your mind. And I'd also suggest that you not waste any time in getting those opinions.

btw... when a surgeon tells you that you're one slip away from severing your cord, ask him how many such cases he KNOWS of. Inquiring minds want to know....

 
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Old 08-29-2013, 04:23 PM   #11
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

There doesn't seem to be a difference between the two MRI's, other than it was a different radiologist. The new guy points out your hereditary spinal stenosis (which I'd suspected, as the reading in the first MRI implied it).

4mm is very narrow. That, by itself, might very well not cause pain. Both radiologists say there's no signal change. Still, I can't recall reading of someone with a cord narrowed to 4mm where the surgeons just say wait-and-see.

My nonprofessional inclination is that the surgeon's suggestion of a C5-6 ACDF is not at all unreasonable. I would strongly suggest that you have three opinions in hand and then compare them before making up your mind. And I'd also suggest that you not waste any time in getting those opinions. Don't just schedule because you're in a hurry, though. You not only want to get the best opinions, you want to get the BEST surgeon.

btw... when a surgeon tells you that you're one slip away from severing your cord, ask him how many such cases he KNOWS of. Inquiring minds want to know....

Last edited by WebDozer; 08-29-2013 at 04:24 PM.

 
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Old 08-30-2013, 03:09 AM   #12
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

Quote:
Originally Posted by WebDozer View Post
btw... when a surgeon tells you that you're one slip away from severing your cord, ask him how many such cases he KNOWS of. Inquiring minds want to know....
I would like to know too.

 
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Old 08-30-2013, 05:43 PM   #13
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

I just had my 2nd neurosurgeon consultation, this time it was someone I specifically asked for after much research. He basically told me there are 3 options, as follows:

Option 1: Do nothing. The doctor indicated that my disc at C5-6 will give me greater problems sooner/later in time; the disc will slowly degenerate further and dry out to the point when surgery will be the only option. He added that the disc will never go back to normal with the amount of herniation present and I will end up needing to address it by surgery anyway.

Option 2: Non-surgical spinal decompression therapy. Expensive (not covered by insurance) and therapy takes at least 2 months minimum to be effective. The doctor noted that this is a chiropractic type of treatment using a combination of physical therapy and a special motorized stretching table and has a 60-80% chance that the disc could retract 1-2 mm. He added that I may end up needing surgery anyway because of the conservative nature of this treatment may not give me the desired result.

Option 3: Surgery; 1-level ACDF at C5-6. Doctor indicated that this is the ultimate solution and will address the problem directly and improvements will be noticed immediately. He added that risk of disc disease at adjacent discs after surgery are minimal due to the fact that most of the neck motion is at the upper disc levels of the cervical spine.

He basically recommended getting the ACDF, but added that if time and money was not an issue, that I could try decompression therapy first. Has anyone tried this non-surgical spinal decompression therapy? With what I have been told so far, is there any other reason to put off surgery? Terrified of surgery...

 
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Old 08-30-2013, 08:23 PM   #14
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

Interesting.... never heard of (2). Not aware of (3), either. I know there is debate about so-called Adjacent Disk Syndrome, but never seen any mention that it's worse when above C5-6.

No opinion about (2), though...

 
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Old 09-01-2013, 10:13 AM   #15
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Re: Neurosurgeon says I need an ACDF to C5/C6... shocked!!

How are you feeling, hands. Feet numb and tingly, are you dropping things. , headaches ,by the sound of things, I am 10 days outta. Surgery c4567 they remove 2disks and put in man made , I was so scared when I first found out ,mine was cause from an abusive ex, 7years ago. my symptoms became so bad,I could not wait to have surgery, make sure you like and feel good about you Dr ,I had a couple different opinions. I do feel better but wearing the hard collar for 6weeks then the soft one. 6 more weeks. Is tuff ,but its better than the alternative. do as much research as you can, that helped me. How old are you , I have family and friends who have been a great help, but none of them. Actually know how it is to feel this way keep your chin up and listen to your instinct.

 
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