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    Old 02-12-2009, 03:55 PM   #1
    snowysand
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    After fusion and decompression

    My husband had decompression and fusion of C5/6 at the start of December 08. At the time his symptoms were leg weakness and on examination he was said to be myelopathy with hyperreflexia in both upper and lower limbs and increased clonus and weakness of his right lower limbs.
    He had the surgery and was in hospital for 3.5 weeks. When he woke up from surgery he was unable to move legs and had grips problems. He was put on heavy doseage of steroids to reduce swelling from the operation. On his return home he developed dvts in both legs and now on warfarin(sp). Slowy he was able to walk but only with aid of crutches. The surgeon now wants to go back into his neck but from behind this time to clean stuff out. He has been unable to walk properly since the fusion. His MRI scan day after the operation says "Severe centralcanal stenosis persists at the C5/6 level (5.5mm AP Diameter) apparently due to persisiting posterior vertebral osteophytosis. The cervical cord subsequently remains compressed and is below the level there is persisting increased T2 cord signal intensity reflecting oedema or arguably oedema superimposed on a small area of gliosis. Moderately severe bilateral neuroforaminal stenosis is also evident.
    AT c3/4 mild central canal and bilateral neuroforaminal stenosis persists
    At c4/5 made with bulge results in moderate severity central canal narrowing and severe neuroforaminal stenosis is again seen, whilst at C6/7 mild bilateral neuroforaminal narrowing is present.
    The craniocervical junction, cervical and upper and mid thoracic cord otherwise exhibit normal morphology and signal intensity"

    Sorry this post is so long.....My question or worry is this. My husband is now scared to have further surgery incase it goes wrong again and he is left in a worse condition than he is now. With the above MRI will he get worse if he does not have suurgery?
    Thank you for anybody able to help

     
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    Old 02-12-2009, 09:59 PM   #2
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    Re: After fusion and decompression

    I totally understand your husband's fear. But, it comes down to quality of life. If I was in his shoes I'd be asking the doctor to do the next surgery today and not wait around.

    Nerve damage can quickly become permanent and won't heal on it's own if there is truly disc material (or anything else) impinging on the nerves and/or the spinal cord.

    If he's truly miserable and not doing well - it doesn't appear it will get better on it's own.
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    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 02-13-2009, 08:42 AM   #3
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    Re: After fusion and decompression

    i would have to agree with AZ up there too. just how incrediby severe was his actual compression BEFORE surgery? it would have had to have been pretty severe to cause the extent of the myeolopathy and the hyperreflexia he had. honestly,he should have been placed into some level of a rehab facility post op,no going home,right to rehab. it sounds like a few things either took mild hits or were shocked into kind of deactivating themselves somewhat? this just can happen after any spinal cord surgery gets done. or there just was very direct damage to specific areas becasue of the level of severe compression he had,and appears to still have?

    as much as i KNOW this sucks for your hubby,honestly i really see no other options for him at this point BUT to have the surgeon go back in and clear out what is still affecting his cord right now,or he will face a much higher risk of paralyzation from what he still just has there. this is the unfortuante truth here given the extent of his compression and the different findings he had show up in that MRI too. i am sure this is not what you or hubby wanted to hear,but he really has a mess up there that has to get sixed or things will progress and become much worse than they are now.

    one HUGE thing here tho. immediately post op,as soon as he has healed enough,he HAS to be sent to a rehab facility in order for him to still regain what is possible to regain with what will be done and what he has already had done. this part was crucial for me to even get the use of my left hand back at all,or even begin to start walking again after my spinal cord surgery left me in a huge mess with reagrds to overall body function. some of those rehab facilitys really do know their stuff. this would be something to speak to his surgeon about. it really IS a must with his level of compression and how much true pain he will be in post op with just having that posterior apprach done at all. i don;t know if you want to mention that part to hubby or not,but that posterior approach is much more painful and a longer rehab than doing that anterior approach is. they just have to cut thru some thick heavy muscle to even get to that surgical area when going in from the back vs front that has not real muscle to have to cut thru,you know what i mean?

    i have had to have two anterior approaches done with one posterior,and the posterior was much worse for me to deal with. unfortunetly your hubby is in one very precarious spot.but this can be fixed and he can regain some losses with a good solid acute rehab program. this IS what made the true difference for me to be able to even regain the ability to walk,something i simply could not even do post op after my cord surgery was done. i could not even hold my own wight up post op,my left leg just crumbled underneath me. there was like nothing there to even begin to hold me up. but three weeks in actue rehab gave that back to me. there is always hope with this stuff. you really wont know for certain the true extent of his overall damage til the year kind of plays out post op. it just takes that long for certain things to occur within the cord to show themselves. does that report mention any myelomalacia going on at any level around the surgical/cord site? it would just tell some things thats all.

    unfortunetly i really do think just based upon what you have stated here that surgery is simply still needed. i know he probably doesn;t even want to think of that right now,nor you,but that area is still not fully stable with what he still has there,and it WILL progress,not reverese itself,it always progresses to a point,that is just the nature of spinal issues in most cases,espescially with what he still has going on in there. just wondering how you feel about your hubbys NS who did this surgery? do you trust him or feel he actually has hubbys best interest at heart in all decisions? Marcia
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    3-22-01,herniated C-6-7
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    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 02-13-2009, 04:26 PM   #4
    snowysand
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    Re: After fusion and decompression

    Thank you both for you replies. My husband was operated on by a orthopedic consultant not NS,I(I live in Uk, not sure if that makes a difference). He was sent home with no rehab or aids to assist. I had to purchase bath seat etc.
    I kind of accept he needs further surgery but its so scarey! He was unable to move for 3 days last surgery in Dec and before his surgery he was so much more mobile. They told us the decompression and fusion would stop him getting worse and now he is unable to walk unassisted. We are both scared that further surgery will leave him in a worse condtion. BUT I also can see that life for him is very tough now. He is unable to do much for himself and lying sitting around all day/night is no good for him. We have an appointment to see the consulatant at the start of March so I guess he has a few more weeks to come to terms with more surgery.
    Thank for your time in explaining this for me.

     
    Old 02-14-2009, 12:48 AM   #5
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    Re: After fusion and decompression

    Hi, for most people a central canal diameter <9mm will start pressing the cord. Your husband has 5mm so that is something that needs repair.What caught my eye is the multiple levels needing fixing, what is the name and exactly what levels of the surgery the doc is saying he needs now?

     
    Old 02-14-2009, 02:44 AM   #6
    snowysand
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    Re: After fusion and decompression

    What caught my eye is the multiple levels needing fixing, what is the name and exactly what levels of the surgery the doc is saying he needs now?
    02-13-2009 07:26 PM


    Thank for reply. all my husband was told that the surgeon would go in to his neck via the back and clean up around the cord? Nothing else has been mentioned, I guess this is something I can mention when he has his appointment in March

     
    Old 02-14-2009, 09:25 AM   #7
    feelbad
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    Re: After fusion and decompression

    just what exact certifications does this ortho have to do spine surgeiries within that canal? its just not 'usual" or normal for most ortho surgerons to be able to actually go into the spinal canal without some very very direct and specific training(posterior approach WOULD be within that canal,no doubt). i seriously,for the best possible outcome here,would look at getting a second opinion from a neurosurgeon. it could be more difficult since he has already had surgery since most surgeons are very reluctant to take over that liability,but i REALLY cannot stress enough the very real need to at least consult and have and eval with a real neurosurgeon for this. his spinal cord is just in a very dangerous posistion,he NEEDS that level of expetise and knowledge of a good neurosurgeon right now. i just assumed he had the surgey done by an actual neurosurgeon and not an ortho. but like i said,alot depends upon THIS particular orthos overall certs and training too. check into that,and still obtain that second opinion too. you want to be as safe as possible for your hubbys surgery. this is doing just that. he will also need intraoperative monitoring for this level of surgery,speak with his surgeon about that,just asking him about all safety precautions. this type of monitoring kind of prevents the surgeon from going too far in the wrong places and being able to back off from a particular spot BEFORE any true damage gets done in there. its just kind of crucial when any work is being done that close to the cord and that much compression is being relived too.

    this is just going to be a very major delicate operation,and you want and need the best person for that job. in my own personal opinion,unless this ortho has some amazing credentials/training,a neurosurgeon really would be the ideal way to go here. this just,and some of what the other surgery much have entailed, sounds so way above most orthos heads to me. this could be why he did not do the full job the first time,ya know? just start checking his actual level of training and seek out the opinion of a good knowledgable neurosurgeon. i just really do think that second opinion is crucial BEFORE anymore surgery gets done. please keep us posted. good luck SS. marcia
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    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 02-14-2009, 11:00 AM   #8
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    Re: After fusion and decompression

    Hi again,
    Sorry last night I was on my blackberry and couldn't type. Feelbad has the same kind of concern for your husband that I do. I don't want to add to your concern but what you wrote makes me a little nervous.

    I don't understand how a surgeon operated on your husband and put him through that trauma and left him with 5mm at the level he operated on and also left some moderately severe problems in the surrounding level. That would just be unheard of here in the US. The first surgery would have addressed the whole situation. So it leads me to believe a) it was some emergency and he just went in to buy time for a bigger surgery, b) surgeon didn't plan out correctly, or c) surgeon didn't do his homework before surgery running all the tests and stuff to make sure he fixed the problem.

    There are many orthopedic surgeons who are expertly trained to do the same spine surgeries that neurosurgeons do. They have a higher level or training through a "Fellowship" , its like an additional training and certification over their orthopedic training under a program that is all for spine where the neurosurgeons that do spine are also trained. One of my doctors is an orthopedic spine surgeon and he is very well trained and known, but I also have a neurosurgeon on my case.

    If it were me (I don't know how it works in the UK) I would be trying to get a neurosurgeon to look at the case. Your husband is having some problems with the cord. Neurosurgeon would help decipner what is going on with all the swelling and stuff.

    We aren't doctors so there very well could have been reasons that things were done the way they were, but it just doesn't fit the "norm" of what we are used to seeing. Your husband does need help - he can't stay this way, damage will progress so you are going to need to work to get this figured out.

    Good luck - we will be around here for you.

     
    Old 02-14-2009, 12:13 PM   #9
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    Re: After fusion and decompression

    Make sure the doctor is an Orthopedic Spine Surgeon. That is the type of doctor I've used for both Cervical and Lumbar surgeries. In both cases Spine surgery is the ONLY type of surgery the Orthopedic Spine Surgeons I used do - they don't do knees, hips, elbows or any other joint.
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    Old 02-21-2009, 03:12 PM   #10
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    Re: After fusion and decompression

    As someone who has had a spinal compression to below 6mm, I understand what your husband is experiencing. He is slowly becoming paralyzed. If the disk was part of the problem, then starting with the anterior disk removal was a good place to start but if the arthritis is still compressing his spine to 5.5mm, then they will probably do a laminectomy. This is the removal of part of the bone on the back of the vetebra that will allow his spinal cord to expand. There is a new surgery called a laminoplasty that removes the bone, things it out and then replaces it that also works well. At the same time they can open up the areas on the sides of the vertbrae that are impinging on the nerves exiting his vertebrae(forminotomy).

    Many ortho who do spine surgery will have a neurosurgeon in the OR with them if they are getting close to the cord....ask.

    But he NEEDS the surgery ASAP. 5.5mm is very low and he is risking permanent damage to his spinal cord. The big problem is that he has about a 3% chance of being paralyzed by the surgery as well. But left unattended, he has a 100% chance of paralysis. This can only be done from the back.

    There is a new procedure for fusion of multiple levels from the back. It involves placing the screws first(always the biggest problem) and then attaching a rod to each side to hold everything in place. It's considered the first modular fusion system and I have found it quite good as I'm fused from C3 to T1.

    I'm sorry your hubby had so many complications but they do happen. I also had major complications and had a second surgery and am now facing a third to extend the fusion. I almost died after the second. But with I can tell you that if he doesn't have the surgery to take the pressure off his cord, he will be paralyzed from the waist down and his hands and wrists. I am no longer working but I can still do most of the things I used to do. My pain and numbness has become very manageable. But don't ask me to shovel snow!

    Any questions or concerns you may write me through the private message forum or post here. I'm here for you and your hubby. I've been where you are.

    gentle hugs to you both...............Jenny

     
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