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    Old 03-24-2012, 08:08 PM   #1
    braveneck
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    Need advice

    This is a 15 year saga of pain. I was supposed to have a fusion but I chickened out. I used to be a gym rat and loved being in shape. I haven't been able to workout in years.
    Here are the results of the old MRI's:
    2-6-96
    Degenerative changes C5-6, bilateral foraminal encroachment.
    7-15-99
    C2-3 mild nf narrowing
    C3-4 nf narrowing, facet joint hypertrophy
    C4-5 broad based extradural defect, foraminal narrowing
    C5-6 broad based extradural defect, encroachment upon the rt. nf related to unconvertebral joint hypertrophy
    C6-7 broad based extradural defect, etc.
    Impression
    Multilevel cervical spondylosis, foraminal narrowing marked at C5-6 and other levels.
    10-26-07
    C3-4 broad based posterior spur indenting anterior cord, mild spinal stenosis, facet degenerative changes, nf narrowing.
    C4-5 same
    C5-6 rt unconvertebral hypertrophy, mild stenosis, severe rt. neural foraminal narrowing, superior endplate cyst.
    C6-7 broad based posterior spur 1-2 mm disc bulge.
    Impression
    Small broad based posterior spur slightly indenting anterior cord. Mild stenosis.
    6-6-08
    C3-4 posterior disc height loss, small disc osteophyte complex 1-2 mm disc bulge. Bilateral facet arthropathy, mild central canal narrowing with bilateral nf narrowing.
    C4-5 Moderate disc height loss with diffuse osteophyte complex, 2mm disc bulge. Bilateral facet arthropathy. Mild to moderate central canal narrowing with AP thecal sac 8mm. Severe rt. nf narrowing.
    C5-6 Moderate disc height loss, etc. Severe disc height loss with subchondral cystic formation along rt. C6 border. Severe rt. nf narrowing.
    C6-7 Posterior disc height loss, 2mm disc bulge, annular tearing.
    Impression
    Multilevel degenerative disc disease worse at C5-6, severe rt. side disc height loss, . Severe rt C5-6 and mod to severe C4-5 nf. narrowing.
    Small osteophyte complexes, etc.

    I tried to abbreviate, hope it's understandable.
    This has pretty much ruined my life. I'm not in pain all the time, but when it acts up it's excruciating. I can't do anything at all with my upper body. Even a few pushups will mean SEVERE pain.

    I decided against the surgery after reading so many horror stories here, and then a friend also told me that I would be setting myself up for a series of surgeries, and that after a fusion the discs above and below usually blow out as well.

    So, I suffer. I ruined my stomach taking pain meds, so now I can't take anything at all for the pain. Just nexium for my stomach. PT did not help at all. Massage seems to help somewhat, but the pain still comes.

    I noticed a new procedure mentioned here called "laminoplasty." Am I a candidate for this? What's the best thing for me to do at this point? The pain is now in my right arm, which is a new development in the last year. It used to be limited to the neck and down into the right shoulder, so it's spreading and getting worse i guess.

    I'd appreciate any advice and thanks in advance.

     
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    Old 03-24-2012, 10:21 PM   #2
    WebDozer
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    Re: Need advice

    I'll comment, but keep in mind that I'm a self-educated amateur - with some personal experience - and, of course, nothing I say should substitute for a competent professional's opinion.

    It's easy enough to zero in on the severe foraminal narrowing at C4-5 and C5-6, and the radiologist who read the '08 MRI clearly did the same. This could cause pain in your neck, and a variety of symptoms in your right shoulder, arm and hand. Many years ago, the operation to deal with this would have been the ACDF (diskectomy/fusion). That's assuming the narrowing is due to bulging disks and accompanying bone spurs ("osteophyte complex"), which would be removed by this operation.

    Today, though, there are several versions of an operation called a "foraminotomy", where the surgeon comes in diagonally from in back and specifically targets the foramina, clearing away the obstructions that are narrowing them. This operation may be quite minor, as these things go. I had one at C5 eight years ago. It turned into an outpatient procedure, and I never bothered to fill out the pain meds prescription. Whether or not a foraminotomy is the thing for you, I do not know, but it's worth checking out.

    I'm a little puzzled by C3-4, where cord indentation was noticed in '07, but apparently not in '08. I doubt that something big enough to dent the cord would have just gone away. Were two different radiologists involved? Was this the level where the original ACDF was proposed, or was it to be multi-level?

    As for your reasons to not get surgery....

    ""I would be setting myself up for a series of surgeries""

    Maybe you will need multiple surgeries, but that would be because your condition is extensive by nature, and not because you'll set yourself up for them. Just because b follows a, does not mean that b is caused by a.

    ""and that after a fusion the discs above and below usually blow out as well""

    I don't think that's true, although it's a subject of some disagreement, even on this board. That would be called Adjacent Disk Syndrome and a couple of studies have been done to quantify it, both of which concluded that there is no follow-on effect at adjacent levels, and that what may later occur at adjacent levels can be explained simply by pre-existing conditions gradually worsening on their own. That is to say, there is a correlative effect, but not a causative one. For myself, I had a C3-4 ACDF in 1996. My C2-3 is still fine, and C4-5 is a little out, but not severely, and that took 15 years to happen.

    As for the laminoplasty, my third surgery was a C4-5-6 laminoplasty last summer. I talk about the decision process in a thread here called Cervical Laminoplasty Chronicle. I don't have enough information to suggest that it's the procedure for you, but I wouldn't rule it out.

    For now, you need a new MRI, and you need a spine surgeon to look at it. Then, you need to get another spine surgeon to look at it, then another. Armed with three opinions, you can proceed. On the one hand, you of course don't want to be used as a guinea pig, or for some surgeon to learn on. On the other hand, you don't want to be stuck with an ACDF just because the first surgeon you see doesn't know how to do anything else.

    So.... get on it, and please report back.

    Last edited by WebDozer; 03-24-2012 at 10:27 PM.

     
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    Old 03-25-2012, 12:20 AM   #3
    braveneck
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    Re: Need advice

    Thanks so much. Yes, I'm sure that it was different radiologists, since time passed between each MRI. I was supposed to get the two level fusion ACDF, but I read so many horror stories here, like I said, I chickened out. But this pain is ruining my quality of life so I have to do something. I don't know if my insurance will allow three opinions, but we'll see.

     
    Old 03-25-2012, 05:21 AM   #4
    WebDozer
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    Re: Need advice

    Your insurance probably will not allow three opinions. Mine did not, so I paid for the second and third out of pocket. They aren't cheap. Still, it is just foolish to go with the first opinion. If you don't get the results you want, you will regret it for the rest of your life. It may take time to get appointments, so I'd recommend lining them up in advance, maybe one every several days.

     
    Old 03-25-2012, 10:38 PM   #5
    ariz4me
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    Re: Need advice

    I agree with Web Dozer. I would suggest that you do research to locate the top doctors in the field so that you receive opinions from those who are extremely experienced and have produced wonderful results. Going to a top doctor is the key. I went to a top doc and had 7 level posterior laminectomy, foramenectony & fusion. Like you I read all the horror stories and was not in continuous pain. However, I had left arm weakness and it was spreading to the right with the intermittent pain. I went for 3 opinions - all said surgery. I ended up selecting the doc whom I had the most confidence in. Now I'm a little over 4 months post op and all is going well. It's a long healing process but I'm so glad I did it. My doc told me that issues above or below the levels fixed occurs about 10% to 15% of the time. Those odds are a lot better than living the way I was living.

    In closing, find a great doc who will order the necessary tests. All will be well.

     
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