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Cervical surgeries; what works, what doesn't?


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Old 11-04-2013, 05:42 PM   #1
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Question Cervical surgeries; what works, what doesn't?

After having 2 lumbar surgeries last year, I know from experience that there are some lower back surgeries which work and some that are a waste of time. I have had one of each.

I now need a neck operation due to foraminal stenosis on the left side. I have had C6 nerve compression for 4 years now which has been getting worse.

I have talked to one doctor so far and have appts. with a few others. The doctor I have talked to can open up the foramen microscopically through metal tubes. This would be the minimally invasive approach where the least is done.

However, does it last? Does the foramen grow more bone and close up again? I don't want to have two surgeries again because the first one didn't work - I just went through that. I also have an enlarged facet joint which I hope can be reduced in size to ease the stenosis.

Any help from someone who has had neck surgery for stenosis would be greatly appreciated so that I don't make another mistake. Thanks for any feedback!

 
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Old 11-11-2013, 06:26 AM   #2
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Re: Cervical surgeries; what works, what doesn't?

I've had ACDF, laminoplasty and foraminotomy (what your doc is talking about). The foraminotomy was on left C5, nine years ago. I think it has worked fine. My left arm is not as strong a my right, but it's much better than it was pre-surgery, and besides, it probably never was as strong.

I'm afraid, though, that waiting so long means you may have substantial permanent damage. No reason not to go ahead, though. in my amateur's opinion...

 
Old 11-11-2013, 08:02 AM   #3
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Re: Cervical surgeries; what works, what doesn't?

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Originally Posted by WebDozer View Post
I've had ACDF, laminoplasty and foraminotomy (what your doc is talking about). The foraminotomy was on left C5, nine years ago. I think it has worked fine. My left arm is not as strong a my right, but it's much better than it was pre-surgery, and besides, it probably never was as strong.

I'm afraid, though, that waiting so long means you may have substantial permanent damage. No reason not to go ahead, though. in my amateur's opinion...
I have had a hard time finding a surgeon to take it seriously, as EMG testing shows no cervical radiculopathy. I do not have nerve pain down the arm; I get stiffness, muscle guarding and a dull pain behind the scapula and difficulty turning my head to the left. One EMG test showed activity of the C6 nerve near the scapula and the rhomboid.

I think the nerve compression is minor and not bad enough to have progressed down the arm yet, so hopefully opening the foramina will take care of it. One facet joint is very enlarged. I am basically loaded up with bone in that area and am stiff.

 
Old 11-12-2013, 08:05 AM   #4
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Re: Cervical surgeries; what works, what doesn't?

I believe a foraminotomy actually removes part of the original facet in order to get at the foramen. In your case, if the problem IS the facet - as I believe it was with me - then maybe they don't have to really get into the foramen, they just need to remove the overgrowth of the facet.

For me, this turned into an outpatient op, and I never even took pain meds. Someone else here recently reported something similar.

Your symptoms may not be "there" yet. I has loss of 3/4 strength in biceps and deltoid...

 
Old 11-12-2013, 08:09 AM   #5
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Re: Cervical surgeries; what works, what doesn't?

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Originally Posted by WebDozer View Post
I believe a foraminotomy actually removes part of the original facet in order to get at the foramen. In your case, if the problem IS the facet - as I believe it was with me - then maybe they don't have to really get into the foramen, they just need to remove the overgrowth of the facet.

For me, this turned into an outpatient op, and I never even took pain meds. Someone else here recently reported something similar.

Your symptoms may not be "there" yet. I has loss of 3/4 strength in biceps and deltoid...
I think that exactly describes my problem. The doctor told me as we were reviewing my MRI images that I had a huge, nasty looking facet joint at one level, so I think it just needs to be reduced in size.

Was your surgery done as an open surgery, or microscopically through tubes? I wonder if that makes a difference in recovery time.

 
Old 11-12-2013, 08:15 AM   #6
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Re: Cervical surgeries; what works, what doesn't?

Sure it makes difference. Posterior surgeries have to get thru a lot of muscle. The less disturbance the better. As far as I know, all foraminotomies are minimally invasive,, but I'm no expert.

Anyway, many foraminotomies are done to remove intrusions coming from in FRONT of the foramen, so they have to remove part of the facet to get at them. If that's not the case with you, all the better....

 
Old 11-12-2013, 08:29 AM   #7
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Re: Cervical surgeries; what works, what doesn't?

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Originally Posted by WebDozer View Post
Sure it makes difference. Posterior surgeries have to get thru a lot of muscle. The less disturbance the better. As far as I know, all foraminotomies are minimally invasive,, but I'm no expert.
My surgeon explained two options. 1) Using metal tubes that spread the muscle to insert micro-instruments with which she operates under fluoroscopy, with images projected via a camera so that she can see them; i.e, an endoscopic procedure. 2) open surgery where she cuts through muscle if she has to reduce bone at 3 levels in the spine, i.e, if 3 of my facet joints needed shaving down. Healing is not as easy as in the first procedure. Both approaches are posterior.

However - many doctors have not mastered or even tried the microscopic technique with tubes under fluoroscopy, especially many older docs. Where I live I think there are only 1 or 2 surgeons in the area who do this on necks. It's more prevalent in the lumbar area.

I have found the term "minimally invasive" is being used more and more for operations that are really still open surgery. I guess techniques and instruments have improved a great deal.

Last edited by CT06405; 11-12-2013 at 08:31 AM.

 
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