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  • Cervical stenosis - MRI results & surgical decision

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    Old 05-30-2012, 04:22 PM   #1
    foglark
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    Cervical stenosis - MRI results & surgical decision

    hi everyone,

    I've been having some neck/spinal problems that are affecting my arms and hands, and have found this site incredibly helpful to understand these a little better and to learn about others' experience with similar issues. I'm posting my first message after "lurking" and reading the message boards for the last few weeks, and would really appreciate any thoughts or insight you might have on my situation.

    To be honest, the idea of surgery is scary as hell to me, but the risk of permanent pain and problems and possible paralysis is certainly not better (I'm an active 42 yr old)! I saw a neurosurgeon last week, and incorrectly thought that was the first of at least a couple consultations I'd have with him to determine if surgery is the right course. I was a bit stunned when the appointment was over to be handed a brochure about cervical surgery and told to "give them a call when I've decided." I'm seeing at least one other doctor for an additional evaluation, but here's what I have so far:

    MRI results:
    There is reversal of normal cervical lordosis. The apex is at C3-4 level. Effacement of the anterior thecal sac is seen at C3-4, C4-5, C5-6 and C6-7 levels. At each of these levels, there is flattening of the cord. At C5-6 level, there appears to be effacement of the CSF space around the cord in addition to large disc osteophyte complex which projects into the left subarticular recess. There appears to be increased central cord signal an loss of discrimination of gray-white matter between C2 and C7 level suggesting myelomalacia. No syrinx is seen. No acute marrow signal abnormality is seen. Decreased T2 disc signal and disc space is seen at C3 through C6-7 levels. Posterior fossa structures appear normal. Precervical soft tissues are normal-appearing. The nasopharynx and oropharynx normal.

    And this is part of the assessment I rec'd from a neurosurgeon last week:

    MRI of the cervical spine obtained recently shows reversal of the normal cervical lordosis at C3-4 with some disc space collapse at this level as well as at other levels. There is fairly significant stenosis with disc/osteophyte complexes thickly at C5-6 and C6-7, but to a lesser degree at C4-5 and C3-4. Cord signal changes are noted from C3-C6 consistent with possible myelomalacia. Canal diameter is down to a proximally 7 mm at C5-6 and C6-7 which is quite tight stenosis.

    Thanks so much for passing on any thoughts you have!

     
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    Old 05-30-2012, 06:04 PM   #2
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    Re: Cervical stenosis - MRI results & surgical decision

    Welcome Foglark. You an I have a lot in common with all the spinal cord compression in your neck. I was down to 5-6mms at the worst and other areas around what you have....7mms. The norm for the spinal cord is 11-12mms so you can see that you do have significant stenosis. But we have people here with their cord down to 4mms. without surgery.

    The big question I'd have for the doc is what he plans to do about it. Surgery really is about your only option when the cord gets this compressed at so many levels. But I can tell you that fusions are the beginning of trouble for most. Once you fuse a part of the body that is mean to be moving, it makes for more and more trouble down the road.

    There is a fairly new surgery called a laminoplasty that opens the back of the spine and removes and reshapes the bone, then replaces the bone over the spinal canal, doubling the amount of room for the cord. The cord can then re-expand but a boney covering still protects the cord, unlike the older method that just removed the bone and left it off(laminectomy). A supporting strip of titanium is added to keep the neck stable while it heals. This is what I had done and it was amazing. Woke up knowing all my numbness was gone. Webdozer has also had it done. And NO fusion so you keep a good range of motion in your neck.

    If your neurosurgeon has not offered this option, then it's time to find one who does. It is new so that may be hard but it is worth it. If he's talking about a laminectomy, run the other way fast. Laminectomies are known for their failures and usually you end up with a full neck fusion. If he's talking about an ACDF, they remove a bad disk but do not guarantee that your cord will have enough room as disks can break off and get stuck. It also requires a full neck fusion. With the cord problems you've listed, the laminoplasty really is your best option.

    So what does his booklet list as options for you?

    You do have some time to wait and explore your options....you aren't down to where I was but once myelomalacia sets in, you don't want to wait long. But the 2 rules for cervical surgery are.....1)get the very best spine surgery you can get even if you have to travel for it....and 2)go for the surgery that leaves with the most range of motion...they can always fuse you later if it fails.

    In my case, I managed to break the bones at C6 some 12 weeks after surgery but it had nothing to do with the surgery. However, I had to go back into surgery and am now fused from C3 to T1. But it puts me in the strange situation of knowing how well the laminoplasty worked yet I also know what a fusion does to you. I can speak to both situations. Avoid fusions if you can.

    Hope this helps you and please, ask whatever you need to ask.

    gentle hugs..............Jenny

     
    Old 05-30-2012, 06:19 PM   #3
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    Re: Cervical stenosis - MRI results & surgical decision

    Hi,
    I read your post and can truly relate to how you feel about surgery. I had a laminectomy from C-3 to T-2 with fusions. Like you, I had cervical stenosis. I also had foraminal stenosis. I agree with Jenny to get the best surgeon- even if it means you have to travel for it. Fortunately, I had an excellent surgeon in my area but it still didn't stop me from getting three opinions. All said I needed surgery or risk paralysis. As it stands, I do have heavy duty nerve damage due to nerve compression in my left arm. I am now 7 months out from surgery and progressing. Although it w scary, I am glad that I had it done. Keep asking questions that's how I learned what was the right thing to do. Good luck to you.

     
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    Old 05-30-2012, 06:56 PM   #4
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    Re: Cervical stenosis - MRI results & surgical decision

    Thank you both so much for your responses! I have been plagued with back probs since I was a kid, but they've always been in my lower, lumbar area. These issues in my cervical spine only emerged fairly recently -- and though I knew something serious must be going on due to the symptoms, I was stunned when I learned just how serious this may be.

    My friends and family don't really seem to get what's happening, and before I started understanding it, I thought I was crazy myself for having these problems in my arms and hands. It's felt a bit lonely in this the last few months, and discovering this board has certainly helped.

    Jenny, I've read several of your posts and thought we might have similar problems, though yours sound like they were more severe. The neurosurgeon and I did not discuss specific surgery procedures he would recommend, and he ask that I get some flexion and extension x-rays of my cervical area for him to evaluate things further. His written analysis states that if surgery is option taken, "This would most likely involved decompression and fusion to correct stenosis and her kyphotic deformity."

    I'm so glad to learn about the procedure you had -- laminectomy. I am not committed to the neurosurgeon I saw, though multiple people (health providers) I trust have told me he is one of the best in Calif. I will certainly ask him and any other surgeon I see about the option you had. Thanks for letting me know about it.

    And Ariz4me: I'm so sorry to hear you still have nerve damage in your arm. Is this going to go away eventually? How long did you have problems in your arm before you had your surgery?

    Thanks again for responding! I'm so grateful.

     
    Old 05-30-2012, 07:30 PM   #5
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    Re: Cervical stenosis - MRI results & surgical decision

    Foglark - You need two more opinions. If you are in So Cal, let me know, and I will give you two docs who've operated on me and whom I would recommend. You need two more opinions. Make appointments for both, now, a couple of days apart, so you get it done quicker. Did I mention that you need two more opinions? Don't hesitate to pay out of pocket. I know it's expensive. Myelomalacia is not something to meditate on. Remember... two.

    Last edited by WebDozer; 05-30-2012 at 07:32 PM.

     
    Old 05-30-2012, 08:00 PM   #6
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    Re: Cervical stenosis - MRI results & surgical decision

    Thanks, webdozer -- I'll definitely follow your wise advise. I'm in No Calif. and am scheduled to see an orthopedic surgeon in SF next who specializes in spine issues and is supposed to be very good. Would y'all consult with an orthopedic surgeon or stick solely with neurosurgeons? Also, is there a strong reason to have appts within a couple of days of each other? This may be difficult for me to do for logistical and geographical reasons, but I would try to do it if it's important.

     
    Old 05-30-2012, 08:05 PM   #7
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    Re: Cervical stenosis - MRI results & surgical decision

    I want a spine specialist. I don't want a neuro OR an ortho who does spines "on the side".

    I say make the appointments a couple of days apart because the lead time can be so long in getting an appointment. Make them a couple of hours apart if you think that'll be enough time to digest what the first guy says and be able to use it in talking to the second guy.

     
    Old 05-30-2012, 09:21 PM   #8
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    Re: Cervical stenosis - MRI results & surgical decision

    Thanks, WebDozer! The neurosurgeon I saw and ortho surgeon i'm planning to see both specialize in spinal issues, though the neurosurgeon also does some brain surgeries as well. Did you get opinions from one or both -- and who did your surgery? A neuro or ortho surgeon?

     
    Old 05-31-2012, 06:14 AM   #9
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    Re: Cervical stenosis - MRI results & surgical decision

    I think they were neurosurgeons, but the fact that I'm not sure underlines how unimportant I think the distinction is, as long as they are SPINE specialists.

    I guess I'd lean in the direction of neurosurgeons, though, but only if they spend most of their time doing spines.

     
    Old 06-01-2012, 05:47 PM   #10
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    Re: Cervical stenosis - MRI results & surgical decision

    Thanks again for your response, webdozer. i'm in the process of getting appointments with two more drs.-- both who specialize in spine issues and seem to be highly respected.

    I've been reading some more on this board and elsewhere about the various words associated with my condition (i.e. spondylosis, myelopathy, stenosis, etc) and I feel like I now have at least a basic grasp of these -- except one: myelomalacia. Webdozer, you mentioned that this is something that is not to be ignored and to address sooner rather than later.

    Can any of you explain if and why myelomalacia may make surgery more of a probability for me -- and/or point me towards some resources to understand better? Jenny mentioned someone on this board had or has stenosis down to 4 mm w/o opting for surgery. Does the fact that I quite possibly have myelomalacia increase the argument for having surgery, even though my stenosis is "only" down to 7 mm?

    Most of the severe symptoms I started having (after a fall and snapping my head backwards) have diminished. I started having problems BEFORE that fall that have NOT gone away (one arm going numb and neck/shoulder pain) and that definitely worries me, but it's still a little difficult for me to believe I could be facing major spinal surgery. I'm terrified of having surgery and super squeamish about anything that involves needles, scaples or blood. Am I being delusional to think that NOT having surgery may still be a viable option for me?

     
    Old 06-01-2012, 07:16 PM   #11
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    Re: Cervical stenosis - MRI results & surgical decision

    << Can any of you explain if and why myelomalacia may make surgery more of a probability for me >>

    Myelomalacia is permanent cord damage. If you CAN correct whatever is causing that damage, then you need to do so before it causes even more. I don't know if the disks that are flattening your cord are causing that myelomalcia, but if they are, they need to be fixed. At any rate, this is my amateur understanding of it.

    << Jenny mentioned someone on this board had or has stenosis down to 4 mm w/o opting for surgery. Does the fact that I quite possibly have myelomalacia increase the argument for having surgery, even though my stenosis is "only" down to 7 mm? >>

    Jenny believes that the speed with which the stenosis occurs has some importance. That is, a cord that is compressed down to 5mm over many years may not be in as bad shape as one that's compressed to 7mm more quickly. Besides, this is not just a matter of measuring millimeters. It's a very complex and dynamic situation, and even MRI's are just blunt tools for diagnosing it.

    << I'm terrified of having surgery and super squeamish about anything that involves needles, scaples or blood. >>

    No reason to fear surgery itself. They sneak the anesthetic into your IV without even telling you. One moment you've been wheeled into the operating room and the next moment you wake up in post-op with little idea what happened. A moment later you wake up in the recovery room. If there's something to fear, it's not the surgery, but the recovery.

    << Am I being delusional to think that NOT having surgery may still be a viable option for me? >>

    I don't know, and neither do you, until you see those two other docs. You may as well chill out until then.

    BTW, your MRI report refers to "loss of normal lordosis", which could be anything from minor to very serious. The NS, however, mentions "correcting the kyphotic deformity", which is somewhat stronger language, as kyphosis is the opposite of lordosis, and can be quite serious. Does your neck have a forward (kyphotic) bend? Spend a lot of time looking at your feet, and find it difficult to look up? If so, and if this can be addressed surgically, you'll want to consider it.

    Last edited by WebDozer; 06-01-2012 at 07:23 PM.

     
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    Old 06-01-2012, 07:58 PM   #12
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    Re: Cervical stenosis - MRI results & surgical decision

    Thanks, WD. Yes, I do show that I have "a reversal of the normal cervical lordosis at C3-4." I was actually going to start a different thread asking if you or others believe that may make laminoplasty less of an option for me (if surgery is route taken), after reading one of your (webdozer's) posts on this saying this may contraindicate that option. And to give you an idea on just how squeamish i am about surgeries and the like, I honestly thought I might either pass out or vomit after reading webdozer's description of the procedure and his experience after the surgery. Am I a wimp or what?!

     
    Old 06-01-2012, 08:15 PM   #13
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    Re: Cervical stenosis - MRI results & surgical decision

    Sorry to pose yet another question, but WD you wrote:

    <<I don't know if the disks that are flattening your cord are causing that myelomalcia, but if they are, they need to be fixed. At any rate, this is my amateur understanding of it.>>

    I do have compression and disc space collapse C3-4 to C6-7 (the only area I've had an MRI taken of or evaluated, btw), but I also have pretty thick bone spurs through this area as well. Could the bone spurs be causing myelomalcia, or what else would be causing it from your understanding? All input welcomed -- I'm trying to get as much info and be as informed as possible for my next appointments -- esp. since I really did not feel equipped for my initial one. Thanks!!

     
    Old 06-01-2012, 08:48 PM   #14
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    Re: Cervical stenosis - MRI results & surgical decision

    The disk space collapse would not cause myelomalacia, as that is a strictly vertical phenomenon. The disk-osteophyte complexes are more likely to blame.

    I suppose it's also possible that the acute injury you suffered caused myelomalacia, and that this cause has since gone away. Unless it's clear that the d-o-c's are to blame, you may never know.

    And yes, kyphosis would be considered contraindicative to a laminoplasty. What's even more contraindicative is that not that many surgeons know how to do them.

     
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