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    Old 03-18-2012, 03:25 PM   #1
    VinG
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    new to board... neck is a mess

    I have been reading the messages on this board for about two weeks. And now I think it's time for me to post a message.

    I have had pain in my neck for about two years and I've seen a few doctors both in New Jersey and in New York City. I am 48 years old and have used a wheelchair my whole life because of the condition that affects my muscles and my joints. The only part of my body that has not been affected was my neck.

    A surgeon at the Hospital For Special Surgery recommended surgery on at least my C5 and C6. I believe he wants to do a Laminoplasty? I am having an MRI this week which might reveal more extensive damage. So my surgery might be more involved.

    Here is the CT report from a month ago...

    There is straightening of normal cervical lordosis. Alignment is otherwise maintained. There are advanced multilevel degenerative changes. Disk space narrowing and osteophyte formation is evident.

    At the C2-3 level, there is minimal disc bulge and osteophytic ridge, which slightly flattens the ventral thecal sac. There is facet hypertrophy contributing to mild to moderate bilateral foraminal stenosis left greater than right.

    At C3-4, there is a broad-based disc bulge and osteophytic ridge, which slightly flattens the ventral thecal sac., contributing moderate to severe central spinal canal stenosis. There is uncovertebral joint and facet hypertrophy, contributing to my moderate to severe bilateral for foraminal stenosis.

    At C4-5 level there is broad-based disc bulge and osteophytic ridge, which flattens the fecal sac, contributing to moderate central spinal canal stenosis. There is umconvertibral joint hypertrophy contributes to mild to moderate bilateral foraminal stenosis left greater than right.

    At C5-6 level, there is a broad-based disc bulge and osteophytic ridge, which flattens the ventral thecal sac contributing to moderate to severe central spinal canal stenosis. There is a uncovertebral joint and facet hypertrophy, contributing to moderate to severe bilateral foraminal stenosis left greater than right

    At C6 7 level, there is a large disk Osteophyte complex, which severely narrows the central canal. Cord compression is suspected. There is uncovertebral joint and facet hypertrophy contributing to severe bilateral foraminal stenosis right greater than left.


    Hving the usual pain in neck, shoulders, and left arm, and tingling and weaknes in left arm.

    Any thoughts? Thanks in advance.

     
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    Old 03-18-2012, 04:29 PM   #2
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    Re: new to board...neck is a mess

    Looks like your neck has some major problems. When they see severe canal stenosis, that means your cord has most likely been compressed way down to about half normal thickness...similar to what I had and even the same levels...C4,5,6 and 7. When they do the MRI, the radiologist will be able to actually measure the cord thickness and you'll get an idea of how bad it is.

    The other major problem they see is that the nerves to the arms are also severely compressed at certain levels and that makes then liable to dying as well.

    The laminoplasty is a new surgery that just might be what you need. It's what I had and what Webdozer recently had as well. Standard surgery involves going in from the front, pulling out the disks and the using plates and screws to and bone grafts to fuse the neck. In the laminoplasty they address what the true problem is...a narrow canal. they go in from the back, remove the spinous process of the vertebrae(that part that looks like a stegasaurus back) and the they open the spinal canal and remove the bones around the back of it. These bones are then put back in a different arrangement along with a bone graft and the effect is that it almost doubles the amount of room for the spinal cord. This allows the cord to expand and stay away from the bone spurs and disk material. And...NO FUSION. the do add a strip of titanium to allow for some extra strength while the bones all heal but that really doesn't affect you after surgery whereas a fusion makes your neck rock solid and really decreases the amount of head movement you have. With the number of vertebrae you have in trouble, you'd lose almost 50% of your head movement.

    At the same time they are doing this surgery, they may be able to open the holes that are around the nerves to free up the nerves too.

    So it accomplishes the same thing as the anterior neck fusion without having to fuse anything. The cord gets to expand fully and the nerves can be freed.

    I went into surgery going numb form the neck down and came out with all numbness gone and recovered full function of my arms and leg. I had a laminoplasty done on C3 to C6 and a decompression of C7...they don't recommend a laminoplasty for C7. Webdozer has more info on why they don't do C7 than I have.

    Who have you seen a ***? I also went there for a consult but stayed with my doc in Boston as he had been doing laminoplasties even longer than the doc at ***.

    Hope this helps and I'm sorry you had to come here at all

    hugs..............Jenny

     
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    Old 03-18-2012, 04:47 PM   #3
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    Re: new to board...neck is a mess

    Jenny,
    I saw Dr. Federico Girardi. He is very nice and is confident that he can help me. At first he couldn't see me until May, but I emailed him directly and told him about my other orthopedic issues and he fit me in within the week. He also mentioned that if it was only the 2 verts, he could do it anteriorly, if it's more, he will need to go in the back. Another thing that scares me is that because I have sleep apnea, he may recommend keeping me asleep for a day or 2, intubated, until swealing starts to go down.

    Thanks for you reply.

     
    Old 03-18-2012, 05:07 PM   #4
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    Re: new to board... neck is a mess

    He's good. I was also told that I might be kept under for a day or so until all neck swelling went down but it wasn't necessary. But they do caution you. And with your sleep apnea, it would help to protect you if they did. Just means you're in the recovery room and intubated and sedated heavily until they know you won't have any trouble breathing.

    If you need neck mobility, then this is the surgery to have. I was back to work in only 2 1/2 weeks(part time at first)...it's a fast healing surgery too. More painful than going in from the front as they cut muscles but it is so worth it.

    But in all honesty, I later broke my neck and am now fused from C3 to T1 so I can tell you that if you go the fusion route, you will lose a lot of movement. And it sets you up for additional surgery down the road. Fusions beget more fusions.

    Webdozer wrote a chronicle of his surgery experience if you go back in the pages until you see Webdozers Laminoplasty Chronicle...might give you an idea of his experience.

    *** is the #1 ortho hospital in the US and probably the world and if they can't do it right, no one can.

    Jenny

     
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    Old 03-18-2012, 06:31 PM   #5
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    Re: new to board... neck is a mess

    Even though I'm a "fan" of laminoplasty (for the time being, at any rate), I'm not going to jump in and say it's ideal in this case. We just don't have enough info, based on the CT transcript. Seems like there are some pretty large disk bulges, and I'd guess that many surgeons would suggest ACDF's instead of laminoplasty.

    A couple of notes about laminoplasty (all recapped in my Cervical Laminoplasty Chronicle):

    1 - Laminoplasties are counterindicated by kyphosis. While "reversal of lordosis" is not exactly kyphosis, it is heading in that direction

    2 - Studies have shown that laminoplasties that include C7 result in a much larger occurrence of long-term neck pain, probably because of the much larger muscles attachments at that level. The severe stenosis that you have at C6-7 makes it certain that, if you do have a laminoplasty, you will have C7 included. My surgeon did not seem to think that doing C7 would be a problem, so it could be that they've figured out how to get around the muscle-attachment problem. Just something to keep in mind...

    I'd also add that, whatever surgery you have done should address as much of the foraminal narrowing as possible. Laminoplasties can be combined with foraminotomies, but I'm not sure that they can get at the uncinate hypertrophy, which is coming from in front, and is on the wrong side of the spinal canal for a surgeon doing a laminoplasty.

    I hope you will forgive my saying that your condition is "interesting". Please keep us updated.

    Oh, one last thing... "mess" is the word my orthopedist used to describe my neck when he got my MRI back.

    in edit... ONE more thing. If your C6-7 is so bad, I have to wonder about your C7-T1. Wasn't that on the MRI report?

    Last edited by WebDozer; 03-18-2012 at 06:37 PM.

     
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    Old 03-19-2012, 08:09 AM   #6
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    Re: new to board... neck is a mess

    My C7 is not too bad. Only "mild" involvement. Went to my pain management Dr. today for some percocet to get me to the surgery.

     
    Old 03-19-2012, 12:35 PM   #7
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    Re: new to board... neck is a mess

    Do you have a date for a surgery? Which surgery, and at which levels? Is he going to do anything about the foraminal stenosis?

     
    Old 03-19-2012, 01:18 PM   #8
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    Re: new to board... neck is a mess

    Not sure about any of your questions. I will have more answers after the MRI this week. He said that if it's only C5 & C6 he will do a laminoplasty, and "clean up the rest". I figure I will ask him a bunch of questions once he sees the MRI. You both have helped me with formulating a few of the questions. Thank you very much.

     
    Old 03-19-2012, 01:24 PM   #9
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    Re: new to board... neck is a mess

    OK.... one thing that the surgeon can do in conjunction with a laminoplasty is a procedure called a laminotomy, where he shaves some off the inside of a lamina, but leaves the lamina in place. That might be part of what "cleaning up the rest" means, although he's more likely referring to the foramina.

     
    Old 03-22-2012, 10:45 AM   #10
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    Re: new to board... neck is a mess

    Going for my MRI on Monday to see the full extent of my "mess". I'm a little anxious because it's my first MRI...ever. I was concerned about my motorized wheelchair and the fact that I'm no spring chicken. I called Hospital For Special Surgery MRI dept. and the woman was very nice. She said that I will be using the new "ultra short, ultra wide" MRI (I think they named it after me), and they will wheel the table out to me so I don't have to bring my chair by the magnet.

     
    Old 03-22-2012, 02:54 PM   #11
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    Re: new to board... neck is a mess

    Sounds like a cool MRI...but you'll have to get out of the wheelchair, I assume.

    I am turning you over to Dozer as I have back surgery on Monday so good luck and I'll catch up with you later. Just know that *** is probably the BEST ortho type hospital in the world and if anyone can help, they can.

    Good luck.........Jenny

     
    Old 03-22-2012, 06:52 PM   #12
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    Re: new to board... neck is a mess

    Thanks Jenny, Good luck on Monday.

     
    Old 03-29-2012, 12:41 PM   #13
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    Re: new to board... neck is a mess

    So here is my MRI report. I'm not sure if it is worse or better than the CT report... see above.

    C1-2: alignment is anatomic
    C2-3: moderate left neural foraminal stenosis. Left facet arthrosis
    C3-4: disc degeneration. Severe central canal stenosis. Minimal spinal cord compression. Severe neural foraminal stenosis
    C4-5: very small posterior midline disc protrusion. Mild to moderate central canal stenosis. Moderate to severe left Neural foraminal stenosis
    C5-6: small broad-based posterior midline disc protrusion impinges the spinal cord disc degeneration with moderate central canal stenosis. Severe left Neural foraminal stenosis.
    C6-7: disc degeneration. Posterior endplate proliferation to the right of midline causes mild spinal cord compression. Severe Central canal stenosis. Severe neural foraminal stenosis.
    C7-t1: small posterior midline disc protrusion causes minimal spinal cord compression. Mild to moderate central canal stenosis. Moderate left neural neural foraminal stenosis.

     
    Old 03-29-2012, 02:06 PM   #14
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    Re: new to board... neck is a mess

    I'm rather puzzled...

    You have broad-based canal stenosis, SEVERE at two levels and moderate at the two levels in between, but only MINIMAL to MILD cord involvement?? That the canal can be severely narrowed without the cord being much affected would imply that you have a very healthy amount of space in between the thecal sac and the cord. That does not square, imo, with the surgeon wanting to do a laminoplasty (or laminectomy, either), as that operation is specifically for people whose cords are severely affected due to an original lack of free space.

    You've got a real problem with the foraminal stenosis. The radiologist doesn't bother to say WHAT is causing the stenosis at several levels. However, you have so much severe foraminal stenosis that there's a decent chance that it's the cause of your neck pain.

    Some questions I would have...

    1. How can I have such severe CANAL stenosis and so little apparent CORD involvement?

    2. What is causing the stenosis, both of the canal and the foramina, at each level?

    3. Will foraminotomies take care of the foraminal stenosis?

    4. Why is a laminoplasty recommended when there is so little cord involvement?

    I think you need to have a decent conversation with the surgeon, and not let him ride roughshod over you. For that, you'll need to understand as much as you can, going in. To that end, if you have any questions, by all means ask.

    Please keep in mind that I'm just a self-educated amateur with a fair amount of experience, so my opinions should never substitute for competent professional advice.

    Last edited by WebDozer; 03-29-2012 at 02:07 PM.

     
    Old 03-29-2012, 02:51 PM   #15
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    Re: new to board... neck is a mess

    MD is away this week...hopefully I will talk with him next week. I have a feeling laminoplasty won't be an option. I'm no radiologist, but viewing the MRI pictures, it looks like the cord is being compressed at these levels. I have a feeling that he's going to recommend fusing everything.

     
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