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    Old 11-22-2011, 08:11 PM   #1
    4thof4
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    Is surgery a possibility for me?

    I was hospitalized in Sept after going to the ER with right sided weakness. Was told I had a TIA and was in the hospital undergoing numerous tests for 3 days. Was released with a TIA diagnosis and put on Lipitor and aspirin to thin the blood (have a history of DVTs). I've continued to have weakness in my right arm. The right leg weakness slowly improved...currently I don't have it nearly as bad in my right leg as I do my arm.

    Due to my right arm remaining very weak, the Neuro. ordered a cervical spine MRI with contrast. But my right arm will go numb completely (I notice this more when I'm not moving it around a lot...like sitting at the computer or watching tv)....and the upper back part of my right arm is completely numb. I could not feel a thing when the Neuro. poked me with a safety pin in the ER. I have numbing and tingling in my right hand daily...and sometimes I lose sensation of my right hand. I can hardly use my right arm without tiring it out. I often have to switch over to the left hand (I'm right handed) to finish tasks because my right arm tires so easily.

    Also, I was having pain and tingling in my upper back near the neck. I moved my head around trying to relieve the discomfort and when I looked up at the ceiling, I felt a sharp pain shoot down my right arm and then my right leg. I've since has episodes of this pain shooting down my right arm. I realize now that if I look up and bend my neck enough, I can make the pain shoot down my arm. I've also been diagnosed with migraines (in April of this year). I had another time in 2004 where I had right sided weakness...tingling and pain in my upper back. Saw Neuro. exam was normal as was MRI. Eventually it went away.

    I've been seeing the Neuro. since being released from the hospital and so far she's ordered an EMG and SSEP evoked potential. The EMG was normal but my evoked potential was abnormal. I don't have the official results back yet. She wants to wait and follow me and do another MRI in 2-3 mo. In the meantime to try OT and referred me for it. I don't think that will do a thing to help.

    Here is what the MRI report says:

    There is preservation of vertebral body height, alignment, and bone marrow signal. There is mild straightening of the cervical spine. Right temporal encephalomalacia is noted, unchanged compared to prior brain studies. The cervicomedullary junction is normal in appearance. The cervical cord is of normal signal. There is no cord syrinx.

    Segmental analysis:

    C2-3: No significant spondyloarthropathy

    C3-4: Left-sided unconvertebral degenerative changes contributing to milk left neuroforaminal stenosis. No significant central canal or right foramina narrowing

    C4-5: Bilateral unconvertebral degenerative changes with left foraminal disk osteophyte complex contributing to bilateral mild neuroforaminal stenosis. Central canal patent.

    C5-6: Baseline disk/osteophyte complex with central disk extrusions which causes moderate-severe focal central canal narrowing, loss of CSF space, ventral cord compression. Slight superior subligamentous extension of disk herniation. Bilateral unconvertebral degeneration contribute to moderate bilateral neuroforaminal stenosis.

    C6-7: Disk/osteophyte complex eccentric to the right with a superimposed right disk protrusion which has slight superior and inferior subligamentous extension. This causes moderate-severe right and mild left neural foraminal narrowing. Central canal is patent.

    C7-T1: No significant spondyloarthropathy.

    IMPRESSION:

    Cervial spondyloarthropathy most notably at C5-6 and C6-7. There is cord compression without discreet abnormal cord signal at C5-C6.


    I am supposed to go back to the Neuro. Dec 13 to discuss all of this. She said she's not ready to send me to the neurosurgeon yet. But I'm not sure how much longer I can take the weakness, pain, and numbness and tingling.

    Can anyone help me make any sense of this? Anyone here think surgery is likely? Not likely? Can anyone interpret that MRI report?!

    Thanks so much for the help!

    4th

     
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    Old 11-23-2011, 07:53 AM   #2
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    Re: Is surgery a possibility for me?

    I think you probably need a bi-level (C5-6 and C6-7) ACDF. Please note the word "severe", which is radiologist-speak for "DO SOMETHING about this".

    I also think you need a new neuro. To put you off like that when all she knows are your symptoms is one thing. To put you off when she has that MRI in hand is unconscionable. The only reason to delay you three weeks is if your symptoms might improve on their own which, given that MRI, looks very unlikely. Instead, they are more likely to worsen, or to become permanent.

    Please keep in mind that I'm nothing more than an "experienced" amateur. (but seriously, take that MRI and get another opinion)

    Last edited by WebDozer; 11-23-2011 at 07:55 AM.

     
    Old 11-23-2011, 09:31 AM   #3
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    Re: Is surgery a possibility for me?

    Having had a neck worse than yours and also having has 5 small strokes, I'm wondering what they did to locate and treat the stroke? Did you have CT's and did they show the area of the stroke so it is confirmed? TIA's don't show in the scans but strokes do.....did anything show up? By the continuing symptoms, it should have. This is no TIA...it's a stroke when it lasts this long. My neurologist traditionally does both a CT and an MRI to find the area of a stroke.

    Your neck is not good but I suspect it is the stroke and that takes time to recover from, if you get back the feeling. You will eventually need neck surgery but not right now as you are recovering. It could cause another stroke.

    I've had strokes involving my entire left side, mixed areas on right and left, and speech and I've recovered almost completely with each and everyone but it does add up over time. If it was in the base of the brain (a lacunar stroke)it may take 3-4 months to go away. You need to get the factors contributing to the strokes under control before you do anything. Let's put it this way...a bad neck can cause all sorts of problems but strokes kill. You deal with the stroke issues first and foremost.

    Yes, you have neck problems and anything listed as severe is not good but you only have 1 area listed as moderate to severe with your arm and the cord is also listed as moderate to severe and may account for the leg problems but a stroke trumps all and a good neurosurgeon may be able to tell you which is which. An EMG should be done as well to tell you what is spine and what is brain. I battle this all the time and have found a really good doc can figure it out and advise you what to move forward with fixing, if anything.

    Jenny

     
    Old 11-23-2011, 09:57 AM   #4
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    Re: Is surgery a possibility for me?

    Thanks so much WebDozer! I've been reading here for a little while and I see you are always willing to help others (and I see Jenny does too!) so thank you! I giggled at your suggestion to get a new Neuro. because I am beginning to wonder if anything is ever going to be fixed...instead of taking a wait and see approach. So, if she doesn't do something at my next appt, I will definitely seek another opinion. I get the feeling that she is not as concerned about it and is waiting to find out what else happens. I just don't know myself what should and shouldn't be happening so it's difficult to make the call, ya know? That's why I posted here for advice! ; )

    Jenny - thanks for the help! I have a very long history and so it would take some time to go into it all...but the long and short of it is....when I had a TIA, they did a CT scan first in the ER. It was normal. Then they did an MRI...and it didn't show an infarction but based on my symptoms and exam in the ER they wanted to admit me for more testing. They also gave me the option to go home. I stayed because I wanted to make sure. The TIA was on the left temporal area. While admitted, I had another more extensive MRI of my brain to check the vessels in my neck and brain. It was normal. I had a bubble echo of my heart done and it was also normal. I had an eval. by OT and PT and both said I didn't need it. So, I can't seem to get straight answer from them about whether I actually had a TIA or not. I honestly don't think I did. I asked the Neuro. last week if I could discontinue the Lipitor and aspirin because that's how strongly I feel I didn't have one. She said to stay on it until they figure out exactly what is going on. Fine. : )

    I have been followed by Neuro since this happened but also by Hematology and Rheumatology. They suspected an autoimmune disorder based elevated ESR, CRP, and a mildly positive ANA.....but the Rheum. said no so far (to lupus) but MS has not been ruled out by anyone (these autoimmune issues have come and gone over the years and I've been having symptoms again that's why they were looking at lupus etc.). They are waiting to see what else develops as far as symptoms etc. They were going to do a lumbar puncture but since I was feeling better, they decided not to.

    I had a cardiac ablation in June 2010. 4 days after, I went to the ER with SOB and chest pain. Had 2 DVTs. Was admitted, put on Cumadin for 3 mo. clots were gone and they took me off of it. Had some repeated episodes of SOB and chest pain and off to the ER I went. This is what started the search with all of the specialists to try and figure out how I ended up with clots! I've had brain surgery before (as well as a few other surgeries) and have never had a clotting problem. I had blood work done to rule out a clotting disorder as well as factor five. They were neg. So, the hematologist said the clots were caused my the catheters they used during the ablation and I am not at risk for clots any longer. In other words, I'm not at any greater risk than the average Joe, of getting clots now.

    We are just now getting to a point that we feel I'm safe for surgery again (I'm looking at an abdominal lap surgery in Jan.).......but this arm issue has been the priority to figure out.

    Oh and I had an EMG done a few weeks ago. It was normal.

    I hope this helps clear some things up. Let me know what you think now that you have this info. : )

    Thanks!

    4th

     
    Old 11-23-2011, 10:26 AM   #5
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    Re: Is surgery a possibility for me?

    I will bow to Jenny's superior knowledge in this. I was concentrating too much on the cervical MRI, which is something I understand, to the detriment of understanding the context in which that MRI was ordered. That said, I would be very surprised if your cervical spine problems are not causing symptoms and I have little doubt that you need - or soon will need - surgery for them.

    HOWEVER.... stroke concerns have to come first, and I suspect your neuro is thinking so, even if she didn't make it clear to you.

    Last edited by WebDozer; 11-23-2011 at 10:33 AM.

     
    Old 11-23-2011, 10:32 AM   #6
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    Re: Is surgery a possibility for me?

    I agree....I think the cervical spine issue is definitely what is causing my arm issue. And I think the Neuro. is thinking this too....which is why she has shifted her focus to my arm and not the supposed TIA.

    I think I'm out of the woods as far as TIA or other health issues are concerned. According to all of the specialists I've seen, anyway. How important is the abnormal evoked potential to the cervical spine issue? I think I need to get this addressed because one of the other Neuros said to be very careful to not get whiplash, get in any biking accident, support my head at all times etc etc. So how can they not do something about this yet warn me that an accident could do serious harm?!

    I needed the help with the cervical spine issue and interpreting the MRI so thanks for the help!! : )

    4th

     
    Old 11-23-2011, 10:56 AM   #7
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    Re: Is surgery a possibility for me?

    <<How important is the abnormal evoked potential to the cervical spine issue?>>

    Sorry, I don't know what you mean by "evoked potential", which means I can't answer that.

    <<I think I need to get this addressed because one of the other Neuros said to be very careful to not get whiplash, get in any biking accident, support my head at all times etc etc. So how can they not do something about this yet warn me that an accident could do serious harm?!>>

    That is a VERY good question

    BTW, a right temporal lobe problem could not cause right-arm weakness, could it? When you speak of weakness, does it seem like some muscles work OK, but others do not? Like, for example, the triceps is fine but the biceps is weak?

     
    Old 11-23-2011, 10:57 AM   #8
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    Re: Is surgery a possibility for me?

    The evoked potential is a test they did to see if the message from the arm to brain is getting interrupted and it is (in the cervical spine). I'm not good at explaining that test though...sorry. It was abnormal. It is a little like the EMG test. I don't have the official results yet. She just let me know it was abnormal.

    They thought/think I had a TIA on the left side of my brain which would cause the right sided issues.

    I describe my arm weakness as: my whole right arm feels very heavy. Like a weight. It feels very weak.....tires very easily. I notice the weakness mostly in my deltoid and bicep area. I get numbness and tingling all down my arm...but mostly in all 4 fingers on the hand. It's really annoying!

    Thank you!

    4th

     
    Old 11-23-2011, 11:37 AM   #9
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    Re: Is surgery a possibility for me?

    Interesting... in 2004, I suffered a very sudden loss of 1/2 - 3/4 of the strength in my left biceps and deltoid. They didn't FEEL any different, but they just didn't WORK very well. Triceps was fine.

    This was cleared up by a foraminotomy (C5, I think) to clear out bone spurs growing into the foraminal opening and impinging on the peripheral nerve as it left the spinal cord (radiculopathy). In your case, though, the foraminal impingement seems to be caused by herniated disks coming in from in front, so an ACDF would be the most likely solution, ONCE YOUR DOCS DETERMINE IT'S OK FOR YOU TO HAVE SUCH A SURGERY.

     
    Old 11-23-2011, 11:38 AM   #10
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    Re: Is surgery a possibility for me?

    Are there other problems that can arise from these cervical spine issues? Like other side effects that don't involve the arm or hand?

    Could this get worse over time?

    If they had to do surgery tomorrow, I would not worry about any past history of mine, including clots. We seem to have cleared all of that up now.

    Thanks!

    4th

     
    Old 11-23-2011, 11:59 AM   #11
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    Re: Is surgery a possibility for me?

    <<Are there other problems that can arise from these cervical spine issues? Like other side effects that don't involve the arm or hand?>>

    Of course there are. Almost anything from your neck on down. A problem affecting the peripheral nerves (foraminal obstruction of some kind) would affect anything on the path from your neck down to your hands. If you are having trouble with your legs, or some kind of incontinence, then it's either a CORD problem in your neck, or a problem lower down in the spine.

    Keep in mind that your problems will not necessarily present themselves in the form of sensations. You can have loss of strength, or loss of mobility, with no sensation at all.

    Last edited by WebDozer; 11-23-2011 at 11:59 AM.

     
    Old 11-23-2011, 01:06 PM   #12
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    Re: Is surgery a possibility for me?

    Ok thanks!

    When I saw the Neuro. who told me to avoid whiplash (as if I plan to have an accident)....he also asked me if I had incontinence. I don't....however.....I notice that sometimes I have hesitation before urinating. Notice it more when my bladder is not full....when it's ok-I-gotta-go-now full, it doesn't happen. I just want to make sure I make note of other issues incase it's all related.

    It sounds like I need a new Neuro ASAP...these issues aren't going to get better right? I had an episode of right sided weakness in 04...here I am again with it. Only now my MRI and other tests are showing things.

    Thanks!

    4th

     
    Old 11-23-2011, 01:10 PM   #13
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    Re: Is surgery a possibility for me?

    <<these issues aren't going to get better right?>>

    Anything is possible, I guess. If your arm troubles are caused by cervical spine problems, those are unlikely to get better. If you had a similar episode of weakness earlier, that went away, then I'd guess something else is causing it.

     
    Old 11-23-2011, 01:21 PM   #14
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    Re: Is surgery a possibility for me?

    I really don't know what caused it in 04. But this time it's different in that it's lingering and affecting my arm. Didn't do that before. I remember before, it all just gradually went away. Certainly didn't have this shooting pain down my arm and tingling. I am getting more and more tingling though. And numbness.

    My arm has been like this non stop since Aug.-Sept.

    I guess I'll see what we do next. But I'm not going to pursue OT. I can see that aggravating it more than anything.

    Thanks for the help!!

    4th

     
    Old 11-26-2011, 06:10 PM   #15
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    Re: Is surgery a possibility for me?

    Today I am having weakness in my right leg as well as my arm. I am finding it difficult to use my right side. I've had this for 3 mo now and it's getting worse.

    Is it normal for the leg weakness to come and go like that? Arm has remained weak (and getting worse).

    Thanks!

    4th

     
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