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  • advice on cervical surgery

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    Old 01-29-2012, 01:17 PM   #1
    GJW
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    Angry advice on cervical surgery

    My latest mri impression states: Degenerative disc & joint desease present at C4-5 & C5-6. The readings on report are as follows: No alignment, disc height, bone marrow, or signal issues are evident. However, mild degenerative disc desease present throughout facets and uncovertebral joints. C2-3: minor disc osteophyte complex without central canal stenosis. mild left foramen narrowing. C3-4: minor disc osteophyte complex without central canal stenosis. mild right foramen narrowing. C4-5: asymmetric to the right disc osteophyte complex causing mild canal stenosis measuring 9mm from anterior to posterior. moderate left foramen narrowing and severe on right. C5-6: disc ostoephyte complex and ligamentum flavum hypertrophy present. mild canal stenosis measuring 9mm from anterior to posterior. severe bilateral narrowing of neural foramina. C6-7: minor disc osteophyte complex without canal stenosis. moderate to severe bilateral narrowing of neural foramina. I have pain in neck, shoulders, arms, hands. Along with weakness, shaky hands, arm and hand numbness, trouble walking, migranes, vertigo/dizzyness. My current family doc says these findings couldn't be causing the symptoms I'm having. We have tried physical therapy, epidural injections meds, but still the symptoms persist. A neuro-surgen said he has not seen this before,and when I ask to see an osteo- surgen for a second opinion, my doc refused to refer me to one stating that they would want to operate and she did not deem it necessary. I would appreciate any thoughts or advice on this matter. Thank You...

     
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    Old 01-30-2012, 06:37 AM   #2
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    Re: advice on cervical surgery

    I don't know where to start.... good grief.... The doc won't refer you because someone who probably knows better than she might disagree? Are you in some kind of plan (or some country) where you are stuck with her opinion?

    Could you be more specific about the NS's statement that he has "not seen this before"? Not seen what?

    As for your symptoms, ALL the symptoms in your neck-to-hands region could be caused by the SEVERE foraminal narrowing. The nerves coming out of your spinal cord are being SEVERELY constricted. What part of the word SEVERE is your family doc having trouble with? That word is radiologist-speak for DO SOMETHING!

    I don't know about the migraines and vertigo, but the trouble walking is a red flag. You shouldn't have trouble walking. This COULD be caused by cord compression at just about any level, or by foraminal compression in your lumbar spine. Is the trouble worse on one side than the other? Do you have exaggerated reflexes (e.g. knee jerk) on one side?

    Your radiologist report does, in fact, look rather strange, and that may be what the NS is talking about. You have multi-level, bilateral, moderate-to-severe foraminal narrowing with no clear indication of what's causing it. For example, at C6-7 you have a MINOR disk osteophyte complex, but SEVERE foraminal narrowing. Makes we wonder if
    1) the d/o complex isn't minor, at all
    2) something else entirely is causing the foraminal narrowing (e.g. uncovertebral hypertrophy?)
    3) there is something unusual about the structure/dimensions of your spine that lends itself to foraminal problems
    ... whatever the reason, the radiologist should have been MUCH more descriptive

    As for surgery, an aggressive approach would be to do a bi-level ACDF at C4-5 and C5-6, especially if removing the d/o complexes would clear out the foramina. That could be followed by specific foraminotomies for the "severe" areas.

    Another approach might be to do a laminoplasty, possibly C3-4-5-6. That would not directly address the d/o complexes, but would allow the spinal cord room to move backward and away from them. Foraminotomies would be done at the same time. This would also take care of that swollen ligamentum flavum, which is pressing on the spinal canal from behind.

    I'm guessing, though, that you are not in an area or situation that would seriously consider laminoplasties.

    Please keep in mind that all of the above is from an interested but only slightly educated amateur, and should not substitute for advice from COMPETENT medical professionals.

    Last edited by WebDozer; 01-30-2012 at 06:40 AM.

     
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    Old 01-30-2012, 04:22 PM   #3
    capatga
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    Re: advice on cervical surgery

    My spinal issues are very similar ti yours ,only worse, I had severe stenosis in the neck , c5-t1 , cord edema ,oseoarthrits, djd,ddd, along with lumbar stenosis, radiopathy and about 10 other things

    I never had a great deal of pain with my cervical stenosis ,but my mri's were horrific , it showed some cord compression , this is where things get a little serious because I could have lost the ability to sense when I needed to go to the bathroom

    pain is a way of telling the body that, hey ,I'am broken and I will hurt until I'am fixed

    sometimes it means surgery and sometimes not , my neuro was not a surgeon and recommended me to one that eventually did the surgery

    I would have my doctor break the mri report down to layman's terms and then get a second opinion

    although my neuro did not do my surgery, she did recommend a well respected collegue of hers for me to talk to, so that was almost like having a second opinion and besides that ,over the years doctors were telling me the same thing

    I have lumbar stenosis with spasticity and pain and numbness and have a consultation with my surgeon next week

    If you are having spasticity ,its getting serious and possibly causing damage ,and the longer it goes untreated the more damage cause and this will affect your daily routine

    I am not advocating that you get surgery ,but the sooner that you address it the less damaged involved

    BTW I had cervical disectomy fushion c5-t1 in 2002

    good luck

     
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    Old 01-31-2012, 08:28 AM   #4
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    Re: advice on cervical surgery

    Perhaps find a few good Orthopedic Spine Surgeons in your area. Narrow it down to 1 or 2 that take your insurance, call your insurance and see if a referral is required. I have a PPO plan and I don't need my primary care to refer me (though I often ask him for recommendations). I've referred myself in the past, most recently to a foot and ankle surgeon.
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    Old 01-31-2012, 08:42 AM   #5
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    Re: advice on cervical surgery

    I have encountered docs like this who don't think anyone should spinal surgery unless you are actually paralyzed or close to it. the may have had someone in their practice or family who did badly with spinal surgery and are very prejudiced against spine surgery.

    And to be honest, after watching my neighbor fall apart after lumbar surgery where the doc did more damage than he fixed and insisted on additional surgery that left this 75 year old man in chronic pain...I hesitated to have it myself. As of age 82, this man has a full time urinary catheter as he can't pee and wears diapers as he has fecal incontinence. His problem was that he had a bad surgeon...not that spine surgery is bad for you.

    Any neurosurgeon that says he hasn't seen this problem before is trying to tell you that he doesn't want the case...plain and simple....."NS blow off".

    Here is what I would suggest. Ask your GP for referral to a neurologist and see what the neurologist says needs to happen. That is what I did...saw a neuro who did more tests said I needed surgery ASAP and then she made the referral and got me into a top notch surgeon. A neuro can do more testing and give you a better idea of what the likelihood of permanent nerve damage is. Sometimes MRI's can show a problem where the symptoms don't seem to match. Additional tests like an EMG/NCS(electromyelography and nerve conduction studies)can show just how compromised the nerves really are. I am becoming increasingly convinced that no one should have surgery based solely on an MRI...they can be wrong.

    If your GP balks at a neuro referral, then tell her that if you end up with permanent nerve damage, she be held responsible for it(sue her)......she'll give you a referral fast(and maybe dump you as a patient but you have to speak up for yourself). You have the right to see someone else and a neurologist would be the way to go, not another kind of surgeon. You still don't know if you need surgery.

    Jenny

     
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