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Old 12-29-2011, 11:05 AM   #2
WebDozer
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Re: One Year post ACDF and problems

To start with, you have developmental canal stenosis, which means that your spinal canal is too narrow TO START WITH. That's hereditary. It means that anything that intrudes into the canal over time can have an exaggerated effect because the spinal cord and the nerve roots have no leeway (and you have plenty of things intruding, I'm sorry to say).

C2-3 - This is a level that's usually non-problematic, even in people with severe problems farther down. That the radiologist only mentions uncovertebral joint hypertrophy - a bone alongside the vertebra expanding backward into the canal and into the openings (foramina) for the peripheral nerve roots - and that would not compress the thecal sac (the membrane filling the spinal canal) down to 8mm unless you started out with a very narrow canal. The thecal sac probably ought to be around 15mm at that level.

C3-4 - No problem with the disk but bone spurs on the uncovertebral joint and facets are impinging on the canal. Central canal stenosis is "moderate" (one step below "severe"). I don't think I've ever seen uncovertebral joints cause such a level of canal stenosis all by themselves, so that's further evidence that your canal is just way too small to start with. The impingement on the nerve root (foraminal stenosis) on the left side could certainly be causing neck/shoulder/arm pain and dysfunction.

C4-5 - This is the first level that should have been fixed. The "disk/osteophyte" complex occurs when the disk protrudes backward into the canal, and the vertebrae lay on osteophytes above and below it. I would want to know how you can have a disk/osteophyte complex WHEN THE DISK ISN'T THERE ANY MORE. Once again, the canal stenosis is only partly explained by the intrusions into the canal, and more explained (implicitly) by the developmental stenosis. The radiologist says the canal stenosis is "severe" (very bad) and that the cord is indented ventrally (from in front). Although this is the only level at which the cord is shown as indented, I doubt - just given the 6-7mm dimensions of the thecal sac - that this is only level at which the cord is affected. My guess is that it is flattened at other levels, which could be as bad as being indented.

C5-6 - this level appears to be fixed

C6-7 - "endplate osteophytes" refer to bone spurs growing off the back of the top and bottom of the vertebrae, where they used to come in contact with the since-removed disk. We don't know how bad "prominent" is, but it can't be good. Once again, all this does not explain the 7mm dimension of the canal, which must primarily be due to developmental stenosis. I would have thought that the endplate osteophytes would have been fixed in the ACDF. Since they weren't, I kind of wonder what the point of that surgery was. Of course, we don't have the pre-surgery MRI, so we can't judge.

C7-T1 - Back to the "unfixed" levels. The disk here is protruding quite a bit and indenting the cord. Not good. Oddly, there is no facet/uncovertebral hypertrophy, and hence no foraminal problems.

Last edited by WebDozer; 12-29-2011 at 11:08 AM.