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    Old 06-22-2012, 11:02 AM   #1
    Lazlouz
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    Need help!

    After 1 1/2 year of physical therapy, 3 cervical epidurals and pain, anti-inflammatory and anti-spasmodic medications, I continue to suffer with neck, shoulder and bilateral arm pain and parasthesias to the fingers and also left shoulder blade.

    I was in Pt 3 days a week, but couldn't advance beyond a beginner in terms of strengthening exercises. Any increase always aggravated my symptoms and made me feel worse. My upper extremity pain would increase and worsen into the neck and left shoulder region. I have been off PT for over a month now, and some of my symptoms have improved....because I am only laying around, avoiding everything that increases symptoms. Any activity or pt exercises makes my upper extremities shake all the time. I develop more parasthesias down both arms into the fingers with nerve pain, also.

    I cannot tolerate the pain medications as I get such adverse reactions. I have tried a combination of Tramadol 100 mg. 3 times a day with Flexeril 10 mg. 3 times a day and Celebrex 100 mg. 2 times a day. I felt horrible! I started weaning off the meds to see what was causing the reactions, and slowly started Tramadol again. I cannot stomach it though! When I take it, I have 24 hour nausea, dizziness with vomiting and a severe headache and shallow breathing. Flexeril makes me real drowsy and lethargic, gives me a dry mouth hoarse voice. Prior to this combination, I have tried Naproxen 550 mg. 2x day, but I had severe reactions when I took it with Flexeril.

    I am desperate to get better, but wonder if there is another procedure that can alleviate my symptoms and improve my lifestyle. I am frightened, because it is open surgery (right sided anterior surgical approach with a 3 inch incision) The procedure that has been recommended to alleviate my symptoms is a 2 level fusion to C5-6-7 with discectomy (using artificial discs, titanium hardware...plate, screws, bolts). If I choose to proceed, 3 surgeons will be doing the procedure, my spine surgeon, neurosurgeon and physician's Assistant.

    By looking at the CT report below, can you help me understand this more clearly. I see that I have an abnormal disc at C4-5, too. That abnormal disc didn't show up on the MRI w/o contrast a year ago. What happens if they fuse the C5-6-7, but leave C4-5? This CT image was taken immediately following my Discogram. The discogram confirmed that C5-6 and C 6-7 were my pain generators. C4-5 was my control disc that didn't show significant pain like the typical pain confirmed at the C5-6 and C6-7 levels

    I would appreciate any suggestions or advice and help in understanding my case. Does anyone suggest or know anything about a less invasive endoscopic surgery with the Laser Spine Institue in Florida?

    CT SPINE WO CONTRAST

    Technique: CT of the cerical spine was performed in the axial plane Coronal and sagital reformats were reviewed

    Findings: There postprocedural changes related to recent discogram cervical curvature and alignment are anatomic Vertabral body and intervertebral disc heights are preserved. There is no evidence of fracture

    At C2-3 and C3-4, there is no significant spinal canal or foraminal stenosis

    At C4-5, there is right asymmetrical uncovertebral spurring. There is resultant mild right spinal canal stenosis. There is opacification of the interverebral disc without evidence of annular fissure.

    At C5-6, there is a mild shallow left paracentral disc protrusion and uncovertebral spurring. There is no significant foraminal stenosis. There is extension of contrast material from the nucleus pulposus into the periphery of the left posterior aspect of the disc, approximately 90 degrees, consisitent with Dallas grade 4 annular fissure. Contrast material does not extend beyond the annulus.

    At C6-7, there is a mild, broad posterior disc osteophyte complex. There is flattening of the ventral thecal sac without significant spinal canal stenosis. There is no significant foraminal stenosis. There is extension of contrast maternal nucleus pulposus into the periphery of the posterior aspect of the disc, approximately 180 degrees, consistent with the Dallas grade 4 annular fissure. Contrast does not extend beyond the annulus.

    At C7-T1, there is no significant spinal canal or foraminal stenosis.

    There is no abnormal paraspinal soft tissue mass.

    Visualized lung apices are unremarkable.

    Impression:
    Mild degenerative changes in the cervical spine, most prominent at C5-6 and C6-7 levels.

    At C5-6, there is a mild shallow left paracentral disc protrusion with resultant mild left-sided spinal canal stenosis. At the left posterior aspect of the disc, there are findings of Dallas grad 4 annular fissure.

    At C6-7, there is a mild broad posterior disc osteophyte complex with flattening of the ventral thecal sac, but no significant spinal canal stenosis. At the posterior aspect of the disc and other findings of Dallas grade 4 fissure.

     
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    Old 06-22-2012, 12:03 PM   #2
    WebDozer
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    Re: Need help!

    I don't get it. As far as impingement of the foramina or the spinal canal, I don't see anything in that MRI that warrants any surgery. The annular fissures don't look bad, either, but what I know about annular fissures wouldn't fill a sentence.

     
    Old 06-23-2012, 02:22 PM   #3
    Lazlouz
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    Re: Need help!

    That was a quick cat scan following my Discogram. My MRI report I supplied below might be more helpful in explaining my problem. It just looks like it didnt pick up the abnormal disk at C4-5 level.

    MRI Cervical Spine without infusion

    Technique: Multiplaner multisequentual imaging of the cervical spine was performed without contrast.

    Findings:
    The alignment of the cervical spine is intact. Vertebral body heights are maintained. Disk dehydration is present diffusely. The cervical medullary junction and visualized spinal cord are unremarkable.

    At C2-3, C3-4 and C4-5, no focal disk herniation or compromise of the thecal sac is present.
    At C5-6, there is a left paramedian disk protrusion asymmetrically indenting the ventral thecal sac. There is mild central spinal stenosis. Mild foraminal narrowing is patent.
    At C6-7, there is a central disk protrusion indenting the central thecal sac. There is no significant central spinal stenosis. Mild foraminal narrowing is present.
    At C7-T1, no focal disk herniation or compromise of the thecal sac is present.

    The paraspinal soft tissues ate unremarkable.

    Impression:
    1. C5-6, left paramedian disk protrusion asymmetrically effaced the ventral thecal sac and results in mild central spinal stenosis.

    2. C6-7, small central disk protrusion without significant central spinal stenosis. Mild bilateral foraminal narrowing.

     
    Old 06-23-2012, 03:14 PM   #4
    babbey
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    Re: Need help!

    hi. I had similar MRI results, I held off of surgery until the pain and loss of movement got the better of me. I was so scared about neck surgery. I had an ACDF, anterior cervical disk fusion at the c4-c5, c5-c6. Being fused at two disk sites that connect, I was told of possible loss of range of motion of my neck. They surgery was successfully done in 2007 and I was pain free for 4 years. My neck is going thru changes again, and the pain is back.I wouldn't have changed my mind about the surgery even if I knew the relief was only for 4 years. Spinal cord impingement is why most doctors operate. Either to prevent it before it happens or to catch it before it gets too bad. Only you know how much you can take as far as your pain levels, the depression and confusion that goes with those levels. I was against surgery for 4years when my symptoms started, after 4 years of debilitating pain, I was frightened but willing to have it end with the surgery. I have a 3 inch scar across the front of my neck and a teenage girl thought I had tried to slice my own neck in a suicide attempt. Listen to your body. Good Luck.

     
    Old 06-23-2012, 03:53 PM   #5
    Lazlouz
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    Re: Need help!

    All I can say is that It's been quite debilitating. Being a Newbie on this site, I was just hoping to hear if ACDF is recommended or discouraged. If so, if there was a less invasive procedure that could correct my problems. I also would like help understanding the MRI and Cat scan readings as well. It helps to know that you were glad you did surgery 4 years ago, but I am sorry you are in pain again. Are ypur symptoms related to the ACDF that you had? If so, will you require additional treatment to address your symptoms?

     
    Old 06-23-2012, 04:08 PM   #6
    WebDozer
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    Re: Need help!

    There are two main surgical alternatives to ACDF - foraminotomy and laminoplasty - but I still don't see anything in those reports that indicates which type of surgery would be best, or even indicates that surgery is needed.

    I suppose that the radiologist(s) are misreading the images, or understating the problems. Was it the same guy both times?

    I really think you need TWO more opinions from spine surgeons. Seriously.... TWO.

    Last edited by WebDozer; 06-23-2012 at 04:09 PM.

     
    Old 06-23-2012, 04:16 PM   #7
    babbey
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    Re: Need help!

    I am 46 years young in an old body (hahaha). I had issues with my other cervical disks that did not require surgery at the time. spinal stenosis, forminal stenosis, reversal of the cervical lordosis, bone spurs. When the surgeon did my ACDF he opted not to use the hip bone graft. He said he had another way of doing it. I concluded it would be from cadaver bones. My surgeon supported Medtronic and graduated with their support. My device that was "sponged" with graft material was not FDA approved for any area other than lumbar due to the side effect of unwanted bone growth. My graft worked but abnormal bone growth has developed inside the cage and above the cage causing me pain.There is a lawsuit but, right now, my pain is a 4 compared to the 10 plus I felt prior to the surgery. For now, I will deal with it. The risk behind a ACDF is minimal. I checked out my surgeon on the internet to see how "routine" my surgery would be for him. I don't regret having the surgery done. I can drive, turn my neck, use my arms and dress myself, and comb my hair. Before surgery, I dreaded all the above. Good Luck and stay strong, Have faith that your decision and your decision alone will be the best one for you.

     
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