It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Spinal Cord Disorders Message Board

  • Cervical laminoplasties question

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 08-24-2011, 07:25 PM   #1
    Dayzd
    Newbie
    (male)
     
    Join Date: Aug 2011
    Location: Ca
    Posts: 2
    Dayzd HB User
    Cervical laminoplasties question

    Hello everyone,
    Unfortunately I am new to this board. Here is what happened.
    My drunken brother in law (I hate what beer and vodka can do to a person) came over to me while I was sitting on a chair. He, with his 180 lb body bent down and without warning put his whole weight on me and hugged me (while bending my head all the way back) and told me he loved me very much. When he did that, I felt electricity all the way down to my arms, fingers, legs and toes.
    I went to the ER because of the pain I was feeling in my neck and they took an x-ray. They said nothing was wrong. Days later I persisted with my regular doctor and he ordered an MRI.
    Then the surgeon said he wanted to see me. I went a few days ago and he told me that he recommends a Cervical laminoplasties for C-4, 5, 6, 7. He also said that without the surgery, he expects that I will become fully paralyzed or dead within 3 years or sooner. To me, and the way I feel now I can’t believe that is true. My surgeon did a laminectomy L-4, 5 seven months ago and It was great.
    My surgeon is a Kaiser surgeon and I have had problems with Kaiser in the past.
    I have pain in my neck and shoulders, numbness and pain in my hands and fingers, sometimes can’t walk straight, a little trouble getting completely dressed and occasionally drop things.
    I have read that the recovery can be very painful and sometimes the surgery causes other permanent problems.
    I would like to know what to expect and how successful or unsuccessful this operation could be. I have also heard of some titanium plate they can put in and it causes fewer problems. Any opinions?
    Thank you, and sorry to burden you with my problem.

    Here is the report added 8-25-11
    Ok. Here is the MRI report.
    History: Pain and fasciculations in the upper extremities with numbness after hyperextension of the neck 2 months ago. Evaluate for nerve impingement or spinal stenosis.
    Findings:
    Cervical spine MRI was performed on a GE 1.5 Tesla magnet without IV gadolinium.

    There is moderate C4-5 disc degeneration with endplate edema and moderate circumferential disc bulge. There is grade 1 retrolisthesis at C-4, 5. The fact that this area is sclerotic on the radiographs from May 13, 2011, suggests that represents endplate sclerosis rather than a discitis. There may be ligamentous instability at this site. There is mild high T-2 signal within the cord at C-4, 5.

    Axial images show the following:
    C-2, 3: Mild thecal sac compression due to broad disc-osteophyte complex. There is moderate left and mild right neuroforaminal narrowing due to unconvertebral spurring and left-sided facet joint arthropathy.
    C3-4: Mild thecal sac compression due to broad disc- osteophyte complex. There is moderate bilateral neuroforaminal narrowing due to unconvertebral spurring and mild facet joint arthropathy.
    C-4, 5: Severe thecal sac compression due to broad disc-osteophyte complex, ligamentum flavum thickening and grade 1 retrolisthesis. The spinal cord is decompressed with high T2 signal focally. There is moderate bilateral neural foraminel narrowing due to unconvertebral spurring and facet arthropathy.
    C-5, 6: Moderate thecal sac compression due to broad disc-osteophyte complex. There is mild to moderate bilateral neuroforaminal narrowing due to unconvertebral spurring.
    C-6,7: Mild thecal sac compression due to small central disc protrusion. There is mild bilateral neural foraminal narrowing due to unconvertebral spurring.
    Impression:
    1. There is SEVERE thecal sac compression at C4-5 with cord compression and high T2 signal within the cord secondary to grade 1 retrolisthesis, disc-osteophyte complex, and ligamentum flavum thickening. There may be ligamentous instability at C4-5 given the extensive endplate edema and retrolisthesis.
    Recommend referral to spine surgery.

    2. The remainder of the mid and lower cervical spine shows moderate disc and facet joint degeneration resulting in at most moderate thecal sac compression at C5-6. There is moderate bilateral C3-4 and left C2-3 neuroforaminal narrowing.
    Thank you.

    Last edited by Dayzd; 08-25-2011 at 05:27 PM. Reason: To add MRI report

     
    Sponsors Lightbulb
       
    Old 08-25-2011, 08:42 AM   #2
    jennybyc
    Inactive
     
    Join Date: Feb 2009
    Posts: 3,892
    jennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB Userjennybyc HB User
    Re: Cervical laminoplasties question

    One person here, Webdozer, is currently recovering from a laminoplasty...all the same levels I think.

    I had laminoplasties on C3 to C6 with a partial decompression of C7. Due to previous injuries, I tore a ligament 3 months after and broke several bone grafts and lamina bones and ended up with a full fusion from C3 to T1 . But for those 3 months, the numbness was gone, I could walk normally and stopped dropping things...it was great while it lasted. But when things went wrong, it went really wrong.

    The laminoplasty tries to fix the problem of cord compression without fusion and it can be good. You haven't said what the primary problem is...nerve compression, cord compression, herniated disks or what. Can you be more specific? Laminoplasties are for cord compression as it enlarges the canal by about twice the space. They don't remove herniated disks when they do this but allow the cord to move away from the bad disks. If you have primarily bad disks, then you can consider an ACDF where they remove the disks from the front and fuse the vertebrae but you'd be looking at a fully fused neck like mine...C3 to T1. You lose about 50% of head movement. A laminectomy is the least favorable as it leaves you with no cord protection to your entire neck from head to shoulders and leaves you vulnerable to really bad paralytic injuries from something like a hit to the upper back. You don't want a laminectomy if you can avoid it. That is why they now do the laminoplasty instead.

    And even then, you may end up with some vertebrae fused down the road to give stability and I know I am headed for surgery from the front as 1 disk keeps on migrating backwards into the expanded canal.

    Let's put it this way. You have a massively injured neck and by doing the work piece meal like this, you don't have to go right into a massive fusion right away. They can manage it and do what needs to be done a little at a time to keep you moving as best they can. Not too long ago you'd be looking at a full laminectomy and fusion and nothing covering your cord and tons of problems for life. A small laminectomy on your back does not expose the cord...your cord actually terminates at about T12 to L1 but in the neck, you have all the nerves to your body, including your breathing and if someone gives you a slap on the back, you could end up bruising the cord and if it's high enough, stop breathing. Now they can do more managing the injury to give you the greatest amount of movement and function for as long as possible.

    A guess drunken driving and drunken hugs can be almost fatal, can't they? Sue the idiot. Maybe he'll stop drinking.

    Jenny

     
    Old 08-25-2011, 09:17 AM   #3
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Cervical laminoplasties question

    Dayzd... I have never heard of a surgeon issuing such an emphatic and dire warning. Usually, they say that paralysis COULD happen, not that it WILL. My first thought is that you REALLY need to get a second opinion. Will Kaiser allow that? If they don't, then I suggest you just kiss $300 goodbye and pay for it yourself. It's worth the expense, for peace of mind if nothing else. Get your drunken in-law to pay for it (since he loves you so much). Not that your problem, which sounds like canal stenosis, is really his fault.

    Would you happen to be in SoCal? If you are, I can give you two excellent docs, one who favors laminoplasties and one who does not.

    About that C7... at least two studies have been done which strongly suggest that C7 laminoplasties be AVOIDED, if possible, due to damage/displacement of important muscles that anchor in the C7 spinous process. I wouldn't be surprised, if you pressed the issue, that your doc will agree that C7 is not necessary, or will do something else at C7, like maybe some kind of a laminotomy (cutting away the inside of the lamina, for example, but leaving the structure - and the spinous process - intact).

    Anyway, not much more anyone here can say w/o reading the radiologist's report, which I urge you to post, if you are willing.

    BTW, if you want to read more about my thinking, leading up to a laminoplasty, it is here >>> http://www.healthboards.com/boards/showthread.php?t=853183

    Last edited by WebDozer; 08-25-2011 at 09:34 AM.

     
    Old 08-25-2011, 05:25 PM   #4
    Dayzd
    Newbie
    (male)
     
    Join Date: Aug 2011
    Location: Ca
    Posts: 2
    Dayzd HB User
    Re: Cervical laminoplasties question

    Here it is. Had to go to Kaiser today to get it.
    Ok. Here is the MRI report.
    History: Pain and fasciculations in the upper extremities with numbness after hyperextension of the neck 2 months ago. Evaluate for nerve impingement or spinal stenosis.
    Findings:
    Cervical spine MRI was performed on a GE 1.5 Tesla magnet without IV gadolinium.

    There is moderate C4-5 disc degeneration with endplate edema and moderate circumferential disc bulge. There is grade 1 retrolisthesis at C-4, 5. The fact that this area is sclerotic on the radiographs from May 13, 2011, suggests that represents endplate sclerosis rather than a discitis. There may be ligamentous instability at this site. There is mild high T-2 signal within the cord at C-4, 5.

    Axial images show the following:
    C-2, 3: Mild thecal sac compression due to broad disc-osteophyte complex. There is moderate left and mild right neuroforaminal narrowing due to unconvertebral spurring and left-sided facet joint arthropathy.
    C3-4: Mild thecal sac compression due to broad disc- osteophyte complex. There is moderate bilateral neuroforaminal narrowing due to unconvertebral spurring and mild facet joint arthropathy.
    C-4, 5: Severe thecal sac compression due to broad disc-osteophyte complex, ligamentum flavum thickening and grade 1 retrolisthesis. The spinal cord is decompressed with high T2 signal focally. There is moderate bilateral neural foraminel narrowing due to unconvertebral spurring and facet arthropathy.
    C-5, 6: Moderate thecal sac compression due to broad disc-osteophyte complex. There is mild to moderate bilateral neuroforaminal narrowing due to unconvertebral spurring.
    C-6,7: Mild thecal sac compression due to small central disc protrusion. There is mild bilateral neural foraminal narrowing due to unconvertebral spurring.
    Impression:
    1. There is SEVERE thecal sac compression at C4-5 with cord compression and high T2 signal within the cord secondary to grade 1 retrolisthesis, disc-osteophyte complex, and ligamentum flavum thickening. There may be ligamentous instability at C4-5 given the extensive endplate edema and retrolisthesis.
    Recommend referral to spine surgery.

    2. The remainder of the mid and lower cervical spine shows moderate disc and facet joint degeneration resulting in at most moderate thecal sac compression at C5-6. There is moderate bilateral C3-4 and left C2-3 neuroforaminal narrowing.

    Thank you.

    Last edited by moderator2; 08-25-2011 at 06:02 PM.

     
    Old 08-26-2011, 06:27 AM   #5
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Cervical laminoplasties question

    Thanks for taking the time to obtain and transcribe the radiologist's report. I have to say that this report makes me better understand why some surgeons ignore radiologists' report. Not that there's anything wrong with the report (that kind of judgment is way beyond my "pay grade"). It's just that this guy seems to have his own style of describing problems, which is a little different than the norm of what I've seen.

    Of course, it could just be that it's your condition - and not his description - which is outside the norm.

    Retrolisthesis means a "backward displacement", and usually refers to the vertebrae, not the disks. The "endplates" are the upper and lower borders of the disks. It would seem that, in your case, it's not so much that the vertebrae are displaced backwards as that the endplates have grown backward (osteoarthritis due to overuse, perhaps?).

    Anyway, as I'm sure you can see, the place to look is C4-5. You're getting it from the front (endplates, sclerosis, disc osteophytes) and from behind (swollen ligamentum flavum).

    OK, let me go back on what I said earlier.... I do NOT think this radiologist did a good job, and here's why: he SHOULD have given the dimensions of the problems, expressed in millimeters. He SHOULD have said how big the osteophytes are, how MUCH the ligamentum flavum is swollen, and how FAR the cord is compressed at C4-5.

    I'll use my own case to explain why the measurements are important. Before my latest surgery, I has a 1-2mm bridging osteophyte at one level, and a 1-2mm swelling of the ligamentum flavum at the same level. So things were maybe a total of 4mm out of whack (that's a technical term). If I had a healthy spinal canal, let's say an 18mm canal enclosing a 10mm spinal cord, then losing 2mm in front and 2mm in back probably would not have mattered. Because I have congenital canal stenosis, though, I have maybe a 9mm cord that's crammed into a 10mm canal. Therefore, ANYTHING impinging on the canal (thecal sac) also impinges on the cord, and losing 4mm is a BIG DEAL. In fact, my cord was compressed down to 5mm, which is NOT GOOD.

    So what I would want to know, if I were in your situation, is this: IS MY PROBLEM PRIMARILY DUE TO (CONGENITAL) CANAL STENOSIS? That is, do I have a bunch of problems that might not matter so much if I had healthy canal dimensions, but DO matter because I don't have any LEEWAY for things to go wrong?

    If the answer is YES, then laminoplasty is the procedure specifically designed to address this.

    Now, as to the laminoplasty itself, I would be most concerned about two things:

    1. Is the C7 REALLY necessary? From the report, it would not seem to be. You might want to read up on the two studies (one Japanese and one Korean) that addressed this. I did so, and told my surgeon that I was very concerned about it, and wanted to avoid doing the C7. He said that he hadn't been planning to do the C7, but he didn't think that doing it would had been a problem. This all comes down to the question of neck musculature, which I will get to in a moment.

    2. How much EXPERIENCE does this surgeon have with laminoplasties? You do NOT want someone who's learning on you. Once again, this is mostly a question about the muscles.

    OK, regarding the muscles... doing a posterior approach may seem more direct than an anterior approach, but the problem lies in the many muscles that are intertwined between the shoulders and the lower head. Many of these are anchored in the cervical spine, and some are anchored in the spinous processes, which likely would be removed in a laminoplasty. The surgery has to go through all these muscles to get to the spine. You can watch an online video of a laminoplasty done at Cleveland Case, and it will give you some idea of the extent of the difficulty.

    I do not know for sure, but I suspect that the biggest difficulty in an extensive posterior surgery like a laminoplasty is not dealing with the spine itself, but dealing with all the muscles involved, and that the possible negative consequences of laminoplasty are largely muscular. That's why you really want to get someone who knows what he's doing, who really is up on the latest ways of handling the muscles, and who will refer you to prior patients who can vouch for him.

    Last edited by WebDozer; 08-26-2011 at 06:52 AM.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    cervical stenosis: laminectomy vs laminoplasty TXTorrie Spinal Cord Disorders 11 09-08-2011 10:47 AM
    4 Level Cervical Laminectomy or laminoplasty hilt Spinal Cord Disorders 15 07-21-2011 08:02 PM
    Cervical Laminoplasty Chronicle WebDozer Spinal Cord Disorders 14 07-10-2011 01:04 PM
    Cervical spine laminoplasty digiguy Spinal Cord Disorders 17 06-07-2011 05:19 AM
    Cervical spine advice requested DRAGON2009 Spinal Cord Disorders 2 10-17-2009 01:16 AM
    does surgery fix cervical spinal stenosis memerri Spinal Cord Disorders 1 06-06-2009 06:22 PM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 11:05 AM.





    2019 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!