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    Old 04-28-2015, 09:09 PM   #1
    Cervicalgirl
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    Please Help - Need Advice

    I am a 46 year old healthy female (aside from my neck).

    In 2011, I underwent an MRI, proceded with an ACFD at C5-6 and 6-7.

    In 2015, I underwent another MRI.

    I presently have left arm pain, mild in the bicep, pretty severe in the ulnar, esp when I bend my elbow or carry my dog, or handbag or type for long periods of time. This seems to be worsening slowly. My left hand shakes too.

    My neck has hurt since 2011. It feels as though someone beat me with a mallet. NONSTOP hurting. I would give it a level 7-9 depending on the day. As the day progresses, I get terrible burning across my shoulders.

    I have SEVERELY TIGHT TRAPS. Massage therapist says the tightest that she has ever seen. They wont let go and if feels like my neck is choking me.

    I am finding the pain hard to manage with tylenol and ibuprofen. I am at so discouraged. Thoughts, advice, experiences, please share!!! Any suggested medications would be great too... just don't want to become dependent Sad

    I will list my mri by levels and date...
    ___________________________________
    C2-3
    2011 There is no evidence of disc herniation, significant spinal canal stenosis or neural foraminal narrowing.

    2015 Disc space shows mild diffuse disc bulge with no significant canal or foraminal stenosis.
    __________________________________
    C3-4
    2011 There is no evidence of disc herniation, significant spinal canal stenosis, there is minimal narrowing of the left C3-C4 neural foramen, best appreciated on image 6-6, secondary to hypertrophic change in the uncovertebral joint.

    2015 Disc space shows moderate diffuse disc bulge with contact of the midline cervical cord. Uncovertebral Osteophyte causes moderate right and severe left oraminal stenosis at C3-C4

    ________________________________________ ______________
    C4-5
    2011 There is no evidence of disc herniation, significant spinal canal stenosis or neural foraminal narrowing.

    2015 Disc space shows disc space narrowing and disc bulge with contact of the midline cervical cord. Uncovertebral osteophyte causes moderate right and severe left foraminal stenosis at C3-4

    ________________________________________ _________________
    C5-6
    2011 There is a broad-based left paracentral degenerative disc osteophyte complex resulting in central canal stenosis with mild deformity of the cervical spinal cord and narrowing of the left C5-C6 neural foramen, best appreciated on image 4-13 and 5-13.

    2015 Disc space shows prior anerior spinal fusion surgery without canal stenosis

    ________________________________________ ________
    C6-7
    2011 There is a cenral degenerative disc osteophyte complex resulting in central spinal canal stenosis and deformity of the cervical spinal cord, best appreciated on image 6-16. There is no neural foramen stenosis at this level.

    2015 Disc space shows prior anterior spinal fusion surgery with prominent central osteophyte encroaching into the canal and indenting the ventral cervical cord

    ________________________________________ ________________
    C7-T1
    2011 There is no evidence of disc herniation, significant spinal canal stenosis or neural foraminal narrowing.

    2015 Disc space shows diffuse disc bulge and small central herniation slightly contacting the ventral cervical cord. There is mild bilateral foraminal stenosis.

    ________________________________________ _______________
    IMPRESSION:
    2011 - 1. Degenerative disc osteophyte complexes at the C5-C6 and C6-C7 levels resulting in mild deformity of the cervical spinal cord.
    2. Mild left C3-C4 neural foramen stenosis due to unconvertebral joint hypertrophic change.

    2015 Status post fusion surgery with central osteophyte encroachment into the canal at C6-7.
    Degenerative disc disease at several levels as detailed above with foraminal stenosis probably greatest at C3-4.
    Disc herniation centrally C7-T1.


    This has changed so drastically in just a few years. I am afraid of what the next MRI will look like. Surgery doesn't seem to help and I am wondering why the osteophyte was there at 6/7 before the operation (2011) and after the operation (2015 MRI)

    Is surgery avoidable and if not, can I have just the most important things fixed and what are they?

    This is debilitating!! I have been attempting to cope with tylenol and ibuprofen but I take a lot of it. I work long hours. I can't manage it anymore with these meds and I broke down and went to er. They prescribe oxycodone (5mg) and valium (5mg). For the first time in almost 4 years, I feel normal. Is it okay to take 5mg 4x per day and valium 3x per day. I feel like a drug addict taking these things but if I take them as prescribed and I feel so normal, is that bad? If I have a doctor willing to prescribe them as indicated above, I feel I could avoid surgery but I don't want to mask pain that's going to cause permanent nerve damage or risk paralysis. This is so confusing because surgery doesn't seem like an exact science and doesn't seem to improve the quality of life of a lot of people suffering from this. Any advice would be so deeply appreciated!! The pain without the medication is making me vomit, nauseated, I have lost 13 pounds due to not wanting to eat and I am beginning to miss work. The meds don't make me groggy or loopy, they actually make me painfree and functional but will that always be the case or will I develop tolerance and need higher and higher dosages because I won't go that route if that's the case, I will just attempt to deal with the suffering. There are so many hard decisions to make.

     
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    ANGELINMICHIGAN (05-30-2015)
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    Old 04-30-2015, 01:09 AM   #2
    ChuckStr
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    Re: Please Help - Need Advice

    Welcome to the board CG!

    There are a lot of things going on in your post. Lets start with the medication. It looks like you are taking 20mg/day of oxycodone and 15mg/day of valium. I would think that you couldn't sustain that level of either drug for very long without developing tolerance and dependence. Benzo withdrawal, I've read, can be particularly difficult
    have you tried any of the "nerve pain" medications such as Lyrica or gabapentin? These have been known to help generally better than narcotics.

    I sympathize with you and your symptoms as ive had/have many of them myself.

    Because many of the issues in your spine are due to osteoarthritis (rather than overt herniation) there is very little chance that they will get better. Now *you* can get better possibly as you can possibly stabilize and strengthen the muscles around the spine as well as address any inflammation. There is often some inflammation component when there is nerve compression pain and if thats the case with you, addressing it will help. That is what happened to the pain in my case. Steroids and various other ant-inflammatory therapy addressed the acute pain I was feeling.
    I mention all that because I think it is likely the surgery decision will be up to you and how much you can deal with your symptoms vs the risk and recovery of surgery. There appears to be several levels of problems so surgery would not be an easy fix for sure. The most concerning areas are probably c3/c4, c4/c5 where you have severe narrowing of the left exit area for the nerve roots. These are probably the source of your symptoms in your left arm and shoulders.

    I'm not a surgeon but from talking with many and reading a lot I'd say if surgery were required you probably would not be able to.just "add on" to your existing surgery. You'd probably have to have c3-c7(at least) fused. Of course you should get opinions from a couple spine specialist surgeons if this ever becomes likely because there may be alternate opinions.

    I would definitely ask your surgeon what happened with the osteophyte at the area that was previously fused. If there is instability that isn't completely addressed there can be new osteophyte formation but I'm not sure that's what happened there. I wonder I'd it was just too difficult to remove the osteophyte so the surgeon just trimmed it resulting in the growth seen now.

    In general fusion surgery is quite successful. In a couple of large scale, long term studies as many as 90% of patients reported good or excellent short/medium results. Long term that dropped to about 66%. Unfortunately it's difficult to apply that to individual situations but if you have a good surgeon you should have a pretty good chance for a good outcome.

    You should have these discussions with at least one neuro or ortho spine specialist as well. They are the ones that know the options and can reccommend the best course of action.

    Whew, I think that's it.but if you have more questions please let us know.

    Take care and let us know how you get on...

     
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    ANGELINMICHIGAN (05-18-2015)
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