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  • decompression & fusing C3-C4 - step one?

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    Old 10-01-2003, 09:54 PM   #1
    Vince Cataldi
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    Location: Milw., WI. USA
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    Post decompression & fusing C3-C4 - step one?


    decompression & fusing C3-C4 - step one?

    Below I submit a summary of my situation, seeking good
    questions, ideas, suggested testing, or opinions
    regarding: surgical decompression of C3-C4 with
    anterior decompression using arthrodesis and cervical
    plating, then perhaps additional surgical ntervention
    for a posterior decompression.


    I am still concerned about the possibility of a
    posterior decompression after surgical intervention
    using anterior decompression and the fusing of these
    vertebrae. I find it difficult to understand how the
    second procedure,which made become required, could be
    accomplished in order to decompress. After the
    vertebrae have been anteriorly fused, would a
    posterior decompression cause seriously increased

    stress on some other point of the spinal column, or
    perhaps break the fusion of the vertebrae corrected
    during the first suggested surgery.

    I have been informed that working on the spinal column
    to perform a posterior decompression is much more
    risky especially with regard to working around the
    arteries. I wish to understand more clearly the
    risk/benefit trade-offs, the likelihood of success in
    the first process so that the second process is never
    required, and the possibility of doing both the
    anterior and a posterior decompression and fusion
    simultaneously.

    I am also somewhat troubled by the apparent
    symmetrical nature of my spine with respect to its
    abnormalities overall. There are slight
    abnormalities at the very top and the very
    bottom of the spine. There is also an apparent
    asymmetrical nature correlating the cervical and
    lumbar abnormalities, and stress fractures in the
    center, in the thoracic vertebra. It worries me that
    decompression of C3-4 especially during the
    second posterior process, might precipitously
    exacerbate problems in other areas in ways, which I
    do not yet understand well enough.

    "He does have evidence of myelopathy and the abnormal
    signal within the cord at C3-C4. I would recommend
    surgical decompression of the area and in his case
    would probably favor an anterior decompression with
    arthrodesis and cervical plating. The main goal of
    the surgery would be to prevent his symptoms from
    increasing.. I did discuss with him also that he
    may need a posterior decompression at some point in
    time if he continues to have stenosis from
    posteriorly." Jack H. Deckard, M.D.

    ===================================

    I built an Internet web site with 140 million bytes of
    information pertaining to my medical status: including
    all the medical opinions from my doctors, all the lab
    work I could get my hands on, MRI and x-ray images.
    There is also my medical status journal, and all of
    this information is highly index, and therefore easy
    to find and navigate through.

    Below I submit a summary of my situation, seeking
    questions, ideas, or opinions. Although complete
    details are all available on the web site, I have
    included bits and pieces of the medical opinions
    below, so that you could conveniently understand the
    situation in summary form.

    I initially went to my friend of 35 years, Dr.
    William Dicus, he sent me to Dr. Marvin Wooten, and
    he sent me to Dr. Jack Deckard: I have great trust,
    admiration, and respect for all these doctors, and
    then on my own, I found Dr. R. Oelke, also of the
    Columbia St. Mary's group. Each of these doctors
    agree that I need immediate surgery to decompress and
    fuse C3-4 anteriorly, and then perhaps further
    procedures to fuse them posteriorly.

    My scientific nature, it's curiosity, tugs at me,
    pulling me to find a second opinion from a totally
    different group of medical experts, with different
    ideas, different technology, and different
    experiences.


    Medical opinions and report [url="http://www.givehealthachance.org/Vince/Opinions/default.htm"]www.givehealthachance.org/Vince/Opinions/default.htm[/url]

    My medical journal has further details [url="http://www.givehealthachance.org/Vince/Status/"]www.givehealthachance.org/Vince/Status/[/url] [url="http://www.givehealthachance.org/Vince/Status/History.htm"]www.givehealthachance.org/Vince/Status/History.htm[/url]

    The MRI image most interesting to Dr Deckard is
    MRI Cervical Scan- 02c (center): .
    givehealthachance.org/scans/cervical/C02c_center.htm

    Thank you very much for your time and attention

    Most Gratefully and Most Respectfully,

    Vincent J. Cataldi

    ===================================

    August 27, 2003 -- Dr Kurt R. Oelke

    surgical-solution second opinion confirmed

    IMPRESSION: This is an unfortunate 49-year-old male
    who presents to my orifice as a self-pay patient and a
    serious C3-C4 stenosis with resultant myelopathy.The
    neuro examination seems to suggest an ongoing
    myelopathy. The hyperret1exic characteristics on his
    neurologic examination strongly suggest that there is
    ongoing damage at the spinal cord level. I strongly
    encouraged the patient to proceed quickly with obtaining
    insurance and proceeding with the surgical procedure
    outlined by you.
    ===================================

    August 6, 2003 -- Dr. Dicus

    I reviewed the MRIs and would agree that there is very
    significant stenosis at C3-4 and likely a myelopathic
    change in the cord at that level. The lumbar MRI shows
    relatively lesser changes with some stenosis at L4-5 and
    less at 3-4. There also is a suggestion of foraminaln
    encroachment at L4-5 and 5-1 on the left. On both of these
    studies, he has some areas of hyper-intense return in the
    vertebral bodies, which were interpreted as fatty infiltration.
    Please see also a letter from Dr. Deckard to Dr. Wooten,
    which is dated 06//16/03.

    The MRI performed at Columbia Hospital on 01/29/03,
    was interpreted as showing possible multiple myeloma,
    whereas the later studies were said to show fatty infiltration.
    It is easy to see why the patient is concerned.

    ===================================

    July 29, 2003 -- Dr. Jack H. Deckard

    surgical-solution opinion

    I did have a lengthy discussion with Mr. Cataldi
    including reviewing the films. He does have evidence
    of myelopathy and the abnormal signal within the cord
    at C3-C4. I would recommend surgical decompression
    of the area and in his case would probably favor an
    anterior decompression with arthrodesis and cervical
    plating. The main goal of the surgery would be to prevent
    his symptoms from increasing. Hopefully, however, he
    would gain some improvement in his complaints.

    ===================================

    January 29, 2003 MRI Scan report

    MRI OF THE CERVICAL SPINE

    INDICATION: MYELOPATHY.

    SAGITTAL T1 - WEIGHTED, T2 - WEIGHTED, AND STIR
    IMAGES AND GADOLINIUM ENHANCED SAGITTAL
    IMAGES AND AXIAL IMAGES FROM C2-C3 THROUGH
    C7-T1 ARE SUBMITTED.

    CERVICAL VERTEBRAL BODY HEIGHTS ARE NORMAL.

    THERE IS DIFFUSE HYPOINTENSE SIGNAL ON Tl-
    WEIGHTED IMAGES, HYPERINTENSE SIGNAL ON T2-
    WEIGHTED AND STIR IMAGES, ABNORMAL CONTRAST
    ENHANCEMENT OF THE C3 AND C4 VERTEBRAL BODIES.

    THERE IS DESICCATION OF THE C2-C3, C3-C4, AND
    C4-C5 DISKS.

    AT C5-C6, DIFFUSE HYPERINTENSE SIGNAL ON T1-
    WEIGHTED AND T2-WEIGHTED IMAGES, DESICCATION
    AND LOSS OF HEIGHT OF THE DISK, AND ANTERIOR
    OSTEOPHYTE FORMATION ARE PRESENT.

    AT C6-C7, DESICCATION INVOLVES THE HEIGHT OF
    THE DISK, ANTERIOR OSTEOPHYTE FORMATION,
    AND HYPERINTENSE SIGNAL IN THE SUPERIOR END
    PLATE OF C7 ON T1 -WEIGHTED AND T2-WEIGHTED
    IMAGES ARE PRESENT.

    THERE IS NO HERNIATED DISK.

    AT C3-C4, THERE IS MARKED AP NARROWING OF THE
    THECAL SAC COMPATIBLE WITH CENTRAL CANAL
    STENOSIS. NO OTHER ABNORMAL CENTRAL
    STENOSIS IS PRESENT.

    THE CERVICAL SPINAL CORD IS NORMAL IN SIZE AND
    SIGNAL INTENSITY.

    THERE IS NO ABNORMAL CONTRAST ENHANCEMENT
    OF THE CERVICAL SPINAL CORD.

    IMPRESSION

    1. CENTRAL CANAL STENOSIS IS PRESENT AT C3-C4.

    2. DIFFERENTIAL DIAGNOSIS OF ABNORMAL SIGNAL
    INTENSITY AND CONTRAST ENHANCE OF C3 AND C4
    VERTEBRAL BODIES INCLUDES METASTASES AND
    MULTIPLE MYELOMA.

    3. CERVICAL DEGENERATIVE DISK DISEASE AND
    SPONDYLOSIS ARE DESCRIBED ABOVE.

    ===================================

    RAD ORDER #: 90001 INV ORD #: 2

    EXAMINATION: MRI THORACIC SPINE

    COMBINATION 01/29/2003 PROCEDURE

    REASON: MYELOPATHY RESULT -
    MRI OF THE THORACIC SPINE

    SAGITTAL T1-WEIGHTED, T2-WEIGHTED, AND STIR
    IMAGES, AXIAL T2-WEIGHTED IMAGES FROM T6-T7
    THROUGH T9-T10, AND GADOLINIUM ENHANCED
    SAGITTAL T1 -WEIGHTED IMAGES ARE SUBMITTED.

    THERE IS A COMPRESSION FRACTURE OF T9

    VERTEBRAL BODY WITH MINIMAL LOSS OF HEIGHT
    OF THE ANTERIOR VERTEBRAL BODY AND CENTRAL.
    THERE IS MINIMAL HYPERINTENSE SIGNAL OF THE
    SUPERIOR END PLATE OF T9 ON T2-WEIGHTED AND
    STIR IMAGES. THERE IS MINIMAL ENHANCEMENT OF
    THE SUPERIOR END PLATE OF T9 ON THE T1-WEIGHTED
    IMAGES.

    NO OTHER COMPRESSION FRACTURE IS PRESENT.

    THE THORACIC SPINAL CORD IS NORMAL IN SIZE AND
    SIGNAL INTENSITY. THERE IS NO ABNORMAL
    CONTRAST ENHANCEMENT OF THE CORD.

    THERE IS NO HERNIATED DISK.

    NO ABNORMALITY OF THE SPINAL CANAL.

    IMPRESSION:: THERE IS A T9 COMPRESSION
    FRACTURE WITH THE DIFFERENTIAL DIAGNOSIS
    INCLUDING TRAUMA AND PATHOLOGICAL
    FRACTURE CORRELATION WITH HISTORY OF
    TRAUMA IS COMMENDED.

    ===================================

    July 14 MRI Scans

    CERVICAL SPINE MRI WITHOUT CONTRAST THE
    EXAMINATION IS DONE FOR EVALUATION OF
    MYELOPATHY,

    THERE IS SOME SWALLOWING ARTIFACT AND SOME
    MOTION ARTIFACT WHICH CAUSE SOME
    DEGRADATION OF THE AXIAL IMAGES.

    THE MIDLINE STRUCTURES AND THE PARASAGITTAL
    STRUCTURES IN THE POSTERIOR FOSSA APPEAR
    UNREMARKABLE. THERE ARE SIGNIFICANT-AREAS
    OF HIGH SIGNAL INTENSITY THROUGHOUT THE
    CERVICAL SPINE INVOLVING C3, C4, C5, C6, AND C7.

    THESE ARE ALL CONSISTENT WITH AREAS OF FATTY
    INFILTRATION BECAUSE OF DECREASED SIGNAL
    WHEN FAT SUPPRESSION IS APPLIED. THESE ARE ALL
    CONSISTENT WITH DEGENERATIVE CHANGES WITHIN
    THE VERTEBRAL BODIES.

    C2-3: AT THIS LEVEL, THERE IS A NORMAL APPEARING
    DISC. THE DISC SPACE IS WELL MAINTAINED.

    C3-4: AT THIS LEVEL, THE DISC SPACE IS SLIGHTLY
    NARROWED. THERE IS A DIFFUSELY BULGING DISC
    AT THIS LEVEL, THERE IS SIGNIFICANT FACET
    HYPERTROPHY , AND THE COMBINATION WITH THE
    MILD DISC BULGE CAUSES ENTRAPMENT OF THE
    CORD AT THIS LEVEL. THERE IS FLATTENING AND
    IMPINGEMENT OF THE CORD JUST BELOW THIS LEVEL,
    THERE IS AN AREA OF FOCAL HIGH SIGNAL INTENSITY
    WITHIN THE CORD CONSISTENT WITH AN AREA OF
    MYELOPATHIC CHANGES.

    C4-5: AT THIS LEVEL, THERE IS A DIFFUSELY BULGING
    DISC WITH AN ASSOCIATED POSTERIOR OSTEOPHYTE .
    THE DISC IS MINIMALLY BULGING. THE VENTRAL CSF
    SPACE IS MAINTAINED, ALTHOUGH NARROWED.

    C5-6: AT THIS LEVEL, THE DISC SPACE IS MARKEDLY
    NARROWED. THERE IS A POSTERIOR BONY RIDGE THAT
    CAUSES SOME FLATTENING OF THE VENTRAL THECAL
    SAC BUT NO IMPINGEMENT OF THE CORD.

    C6-7: AT THIS LEVEL, THERE IS DISC SPACE NARROWING
    THERE IS A POSTERIOR OSTEOPHYTE AS WELL AS A
    DIFFUSELY BULGING DISC POSTERIORLY . ON THE RIGHT
    SIDE, PARTICULARLY ON THE SAGITTAL SLICE 10 OF THE
    T2 WEIGHTED IMAGES.

    THERE IS A FOCAL DISC HERNIATION . THIS IS NOT WELL
    VISUALIZED ON THE AXIAL IMAGES. THERE IS NO EVIDENCE
    OF MYELOPATHY.

    IMPRESSION

    MULTILEVEL DEGENERATIVE DISC DISEASE WITH AREAS
    OF BULGING AS WELL AS BONY OSTEOPHYTES, AS
    DESCRIBED ABOVE. THE BONY CHANGES ARE MOST
    PRONOUNCED AT THE C5-6 AND C6- 7 LEVELS. FOCAL
    DISC HERNIATION IS IDENTIFIED ON THE RIGHT SIDE AT
    C6-7 ON THE SAGITTAL VIEW ONLY.

    THE MOST PRONOUNCED LEVEL IS AT THE C3-4 LEVEL
    WHERE THERE IS A SLIGHT ANTERIOR PONDYLOLIS-
    THESIS OF C3 ON C4 WITH A DIFFUSELY BULGING DISC
    AND SIGNIFICANT FACET HYPERTROPHY . THE CHANGES
    CAUSE IMPINGEMENT OF THE CORD AS WELL AS
    INCREASED SIGNAL WITHIN THE CORD CONSISTENT
    WITH MYELOPATHY

    THERE IS MULTILEVEL NEURAL FORAMINAL
    NARROWING, PARTICULARLY BILATERALLY AT THE
    LOWER THREE CERVICAL LEVELS.

    RAD ORDER # : 90001

    INV ORD 3 EXAMINATION:

    MRI LUMBAR SPINE W/O CONTRAST 07/14/2003

    PROCEDURE REASON:

    MYELOPATHY RESULT

    LUMBAR SPINE MRI WITHOUT CONTRAST THE
    EXAMINATION IS DONE FOR EVALUATION OF
    MYELOPATHY.SAGITTAL AND AXIAL T1 AND T2
    WEIGHTED IMAGES WERE OBTAINED.

    THERE IS SLIGHT RETROLISTHESIS OF L5 ON S1 .
    THERE IS INCREASED SIGNAL ON T1 AND T2
    WEIGHTED IMAGING ALONG THE END PLATES OF
    THE L4-5 DISC SPACE AS WELL AS THE L5-S1 DISC
    SPACE CONSISTENT WITH FATTY DEGENERATIVE
    MARROW CHANGES . THE SPINAL CORD ENDS AT
    APROXIMATELY THE L1 LEVEL.

    L1-2: THE DISC IS NORMAL

    L2-3: THE DISC IS NORMAL

    L3-4: AT THIS LEVEL, THERE IS DISC DEHYDRATION .
    THERE IS A DIFFUSELY BULGING DISC AND
    MODERATE BILATERAL NEURAL FORAMINAL
    NARROWING . THE BULGING DISC DOES EXTEND
    INTO THE FORAMINAL REGIONS . THE BULGING
    DISC IS SLIGHTLY ASYMMETRIC IN A RIGHT
    PARACENTRAL LOCATION AND RIGHT
    FORAMINAL REGION. .THIS IS THOUGHT TO
    REPRESENT A SMALL DISC HERNIATION.

    L4-5: AT THIS LEVEL, THERE IS DISC DEHYDRATION
    AND DISC SPACE NARROWING.THERE IS A DIFFUSELY
    BULGING DISC WHICH IS FAIRLY SYMMETRIC AND
    EXTENDS INTO THE FORAMINAL REGIONS
    BILATERALLY.THIS IS MUCH MORE PRONOUNCED IN
    THE LEFT FORAMINAL REGION AND IS CONSISTENT
    WITH A LEFT FORAMINAL DISC HERNIATION , AND
    THIS WOULD AFFECT THE EXITING NERVE ROOT .
    THERE IS SOME MODERATE SPINAL
    STENOSIS AT THIS LEVEL.

    L5-S1: AT THIS LEVEL, THE DISC IS DEHYDRATED AND
    THE DISC SPACE IS NARROWED.THERE IS A DIFFUSELY
    BULGING DISC SIMILAR TO THE LEVEL ABOVE. IT IS
    MORE PRONOUNCED IN THE LEFT FORAMINAL REGION
    THIS WOULD BE CONSISTENT WITH A FORAMINAL
    HERNIATION. THIS WOULD AFFECT THE NERVE ROOT
    THAT IS EXITED THROUGH THE FORAMINA. THERE IS
    BILATERAL FORAMINAL NARROWING WHICH IS FAIRLY
    SEVERE BILATERALLY AND PRIMARILY DUE TO THE
    INTERFACET DISEASE
    .

    IMPRESSION

    MODERATE STENOSIS AT L4-5 WITH MILD STENOSIS AT
    L3-4. THERE ARE DIFFUSE BULGES AT L3-4, L4 -5, AND
    L5- S1 FOCAL DISC HERNIATION IS IDENTIFIED PRIMARILY
    IN THE FORAMINAL REGIONS AT L4-5 AND L5-S1: ON THE
    LEFT SIDE AFFECTING THE EXITING NERVE ROOTS.

     
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