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  • Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

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    Old 03-31-2014, 10:07 AM   #1
    sif
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    Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Hi all. I have been reading many of your posts for some time now, but never posted until now. I have decided to have neck surgery and I want to share my situation and invite your thoughts and comments.

    Iím a 47 year old male. For nearly two years, I have had intermittent numbness/tingling in my right forearm, hand and 3rd and 4th fingers (along the path of the ulnar nerve). There really has been no pain, only a nuisance, so I am fortunate. This normally occurs when I'm in a normal sitting position such as driving or working at the computer. After coming up empty with a hand/arm ortho (who sent me for an EMG/Nerve Conduction test, which showed no damage), I realized that the symptoms abated somewhat when I put my chin to my chest. Thus, there appeared to be some nerve impingement in my neck.

    Fast forward to treatment with my orthopedic surgeon, the top cervical/spinal/ortho guy in my city. Several months of physical therapy, traction, etc. gave no positive results. MRI results are as follows:

    * Reversal of normal cervical lordosis throughout the cervical spine, as a result of degenerative disease. No focal bone marrow singal abnormality is seen. The spinal cord is normal in course and caliber without signal abnormalities.
    * At C3/4, there is uncovertebral disease with a centraal disc herniation. The central canal is moderately stenosed. The neural foramina are mildly stenosed.
    * At C4/5, there is bilateral uncovertebral and facet arthropathy. There is a central broad disc osteophyte complex. The central canal is moderately stenosed and left neural foramen is mildly stenosed.
    * At C5/6, there is bilateral uncovertebral disease and alarge left paracentral disc osteophyte complex that distorts the spinal cord. There is moderate central canal stenosis and severe bilateral foraminal stenosis.
    * At C6/7, there is bilateral uncovertebral disease with a large left paracentral disc osteophyte complex. The central canal is moderately stenosed. The left neural foramen is severely stenosed. The right neural foramen is mildly stenosed.
    * at C7/T1, there is uncovertebral and facet disease causing moderate central canal stenosis and severe bilateral foraminal stenosis.
    IMPRESSION: Severe degenerative disease throughout the cervical spine causing moderate central canal stenosis at multiple levels and scattered areas of severe foraminal stenosis.

    Because of the severe impingement of the nerves at multiple levels, and because of the pressure/distortion of the spinal cord at C5/6, my surgeon strongly recommends a C3-T1 cervical posterior laminectomy and fusion. Obviously, this is major surgery, so I obtained a second opinion from another top doctor in town.

    The second doctor agreed that the laminectomy recommendation is reasonable and that given my situation, I would not be crazy to take that path. As an alternative, he offered a minimally invasive technique to deal only with the troubles at C7/T1, which probably would resolve my tingling/numbness. However, the other levels would still require attention in the coming years, perhaps sooner rather than later. He said it all came down to whether I want to take care of everything at once, or do it more incrementally.

    I have decided to do the larger surgery, and am scheduled for mid-June. In my mind, even a minimally invasive procedure is, by definition, invasive, so I donít want to have to keep going back to do more if not absolutely necessary. And I want to resolve/remove the pressure and distortion on my spinal cord now, before something worse happens.

    Iím sorry for the long post, but I wanted to give the background and then ask for any thoughts, comments, opinions. Any thoughts on going for the laminectomy/fusion vs. the minimally invasive? Thoughts on 5 level fusions after laminectomy? Thoughts on the MRI results? What can/should I expect in the surgery and recovery?

    Thanks in advance.

     
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    Old 04-06-2014, 06:31 PM   #2
    Keriflys
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Hi, I just had a posterior laminectomy with fusion on 3-7. My surgery was on march 27. I was in the hospital for 6 days. I posted a couple of weeks ago on here asking about the pain after the surgery. I don't want to scare you and I do think everyone has different pain tolerance. But, for the first 5 days after surgery there was not one second I didn't feel any pain. No matter what they gave me the pain still won. Being in that much pain nonstop for that long was pure torcher! I had been on norco pain killer for about 6 months prior to surgery so maybe that caused me to have a higher tolerance level to pain meds, I'm not really sure. Anyway the first week is horrid! If I would have done only half of the surgery first, I would have refused the second half to be honest. So I am glad I have it all done at once.

     
    Old 04-07-2014, 05:51 AM   #3
    sif
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Keriflys, thanks for your response and I'm sorry to hear you have been suffering with such pain. I certainly don't discount the possiblity (likelihood) of significant pain throughout my recovery, but it does seem like you may have built a tolerance to the pain killers that limited their effectiveness for you. Having said that, what do I know? I hope you are improving. Your comments do echo my thoughts about doing all of the surgery in one fell swoop, though. Thanks for that.

     
    Old 04-12-2014, 08:17 PM   #4
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Hi , I had surgery on February 10. There was a good deal of pain but the pain meds helped a lot. What bothered me at times was the muscle spasams . I took Valium or flexeril which helped . Basically take the meds the doctors prescribe to help with the pain and spasms . I was also on a med called neurotin which helped with nerve pain. After 10 days I had the staples out which made me feel so much better . I started therapy after 6 weeks which was when I could take the collar off; that was wonderful. Btw I had cervical laminectomy with fusion from C3 to T2. I'm back to work at my landscape company and doing well . I do a lot more pointing then I used to but I'm taking it slow . I've found just walking around I'm exhausted at the end of the day. If you have any questions let me know .

     
    Old 04-13-2014, 10:24 PM   #5
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    I am having a cervical laminectomy and fusion of C4 to C6 in 2 weeks. My spine is fused everywhere else from ankylosing spondylitis. I have a terrible time with morphine making me itch to the point of scraping my skin, so I'm really worried about the pain medication, and since I have been on prescription narcotics including hydrocodone, oxycodone, and nucynta for over 2 years, I'm worried about tolerance. My pre-op is this Friday so hope to talk it over with the anesthesiologist, and maybe try fentanyl instead of morphine.

     
    Old 04-14-2014, 06:58 PM   #6
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    @Jeffntate
    After my surgery they had me on morphine, it never took my pain completely away, then the nurses would be late giving me the next dose. The doctor then put me on a morphine drip and this button thing I could push every 20 minutes for a little more. I felt no pain relief from it at all and I think my body didn't accept it at all! The moment the dr removed the machine and gave me a Percocet and tramadol and a Valium all in pill form I finally felt some relief from pain and felt better mentally as well. But like I said in my post above I had taken norco on a regular basis for about 6 months before my surgery and I don't know for sure if that had anything to do with the pain I was feeling and not getting relief from at all. I actually have always had a very high tolerance for pain. The pain from this surgery was traumatizing for me. One nurse had told me in the hospital that this surgery is one of the most painful that's done and she said the pain killers aren't necessarily going to take all the pain away. So, from my experience I would have to say that slowing down on the pain killers (with dr permission of course!) before surgery is prabably the way to go.

     
    Old 04-14-2014, 06:59 PM   #7
    Keriflys
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    @Jeffntate
    After my surgery they had me on morphine, it never took my pain completely away, then the nurses would be late giving me the next dose. The doctor then put me on a morphine drip and this button thing I could push every 20 minutes for a little more. I felt no pain relief from it at all and I think my body didn't accept it at all! The moment the dr removed the machine and gave me a Percocet and tramadol and a Valium all in pill form I finally felt some relief from pain and felt better mentally as well. But like I said in my post above I had taken norco on a regular basis for about 6 months before my surgery and I don't know for sure if that had anything to do with the pain I was feeling and not getting relief from at all. I actually have always had a very high tolerance for pain. The pain from this surgery was traumatizing for me. One nurse had told me in the hospital that this surgery is one of the most painful that's done and she said the pain killers aren't necessarily going to take all the pain away. So, from my experience I would have to say that slowing down on the pain killers (with dr permission of course!) before surgery is prabably the way to go.

     
    Old 04-14-2014, 08:27 PM   #8
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Quote:
    Originally Posted by Keriflys View Post
    @Jeffntate
    After my surgery they had me on morphine, it never took my pain completely away, then the nurses would be late giving me the next dose. The doctor then put me on a morphine drip and this button thing I could push every 20 minutes for a little more. I felt no pain relief from it at all and I think my body didn't accept it at all! The moment the dr removed the machine and gave me a Percocet and tramadol and a Valium all in pill form I finally felt some relief from pain and felt better mentally as well. But like I said in my post above I had taken norco on a regular basis for about 6 months before my surgery and I don't know for sure if that had anything to do with the pain I was feeling and not getting relief from at all. I actually have always had a very high tolerance for pain. The pain from this surgery was traumatizing for me. One nurse had told me in the hospital that this surgery is one of the most painful that's done and she said the pain killers aren't necessarily going to take all the pain away. So, from my experience I would have to say that slowing down on the pain killers (with dr permission of course!) before surgery is prabably the way to go.
    I'm 14 days away from surgery so not much time to wean off, and I've been on Norco 10 mg x 4 daily for 18 months, then before that I was on Percocet 7.5 mg for 6 months. How does that compare to your pre-op Norco that you took?

    Morphine makes me itch so bad, after hip replacement, I woke up with scrape marks all over my body where I had clawed myself overnight, so they took me off morphine and put me on Percocet 5 mg x 2. The morphine worked well for me, but I can't stand the itching. But, as you say, the pain of this surgery might be so brutal that I'll do anything to stop it.

    If you don't mind saying, did you have your surgery done by an orthopedic spine surgeon or neurosurgeon?

    Last edited by jeff557; 04-14-2014 at 08:29 PM.

     
    Old 04-15-2014, 11:02 AM   #9
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Had my surgery done by chief neurosurgeon. My incision now looks beautiful compared to others I've seen and I'm healing very well. It was just the pain med situation that was bad for me. And sometimes I feel very chlosterphobic with the neck brace but that's pretty normal I suppose. The first week is horrid the second week a bit better and the third week I was clear headed and felt a bit normal again. Everyone is so different though!!!

     
    Old 04-15-2014, 11:44 AM   #10
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Hi, the collar is annoying , how long do you have to wear the collar. I was 6 weeks in mine

     
    Old 04-15-2014, 02:20 PM   #11
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    They told me three months : (
    I'm hoping it won't be that long!!!!

     
    Old 04-15-2014, 03:38 PM   #12
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    I guess it depends on the severity and ones own doctor. Although it was very weird having it off. The first week I couldn't wait to get home and put it back on. The best was not having to wear the collar to sleep. Have you had very many of those nasty spasams ?

     
    Old 04-15-2014, 03:53 PM   #13
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    Question Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    Yeah I know what you mean, when the physical therapist comes to my house and takes my collar off to massage my shoulders I freak out for a minute!! Haha so yes I want it off but at the same time I understand what your saying about running home to put it back on !!! The spasms have been awful. At first I would consider them right up there with labor contractions (three kids I have) I found myself breathing through them just like I did labor contractions!! Haha now i am 19 days post op and am having spasms not in my shoulders any more but the sides of my neck!! Ouch!! I guess it's the muscles building back up??? I will have to ask about that. They probably already told me but there is so much info to know during this whole thing it could be overwhelming at times !! How long did it take you to feel normal again after you got your collar off???

     
    Old 04-15-2014, 05:48 PM   #14
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    It only took a week it so but I'm still stiff and slightly hunched. Therapy is helping a lot with my range of motion. For me it's all good considering I couldn't walk without a crutch due to weakness. Still some weakness , numb areas and pins and needles but I'm getting around very well . Once in awhile I get the spasams but not as painful.

     
    Old 04-15-2014, 07:07 PM   #15
    Keriflys
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    Re: Multi-level Posterior Cervical Laminectomy and Fusion - Thoughts?

    How long ago did you have the surgery?? You still get spasms?? Oh geez that stinks!! I also have numbness in my right hand and very weak right arm, worse after surgery than before! I had weakness and heaviness in my legs too but not quite to the point of using a cane the dr gave me just in case! And my legs are much better after surgery too!! Sometimes I wonder if I gave up my arms for my legs to work right ??? Ugh!! I'm so glad to hear your legs are better from using a crutch!! That's pretty amazing!!! The time with this whole thing is dragging on and I am not even to the halfway point yet!!! How did you get through those down times?? I went from being a mom of three and a CNA in a dementia/alzheimer care unit busy all the time to just sitting here doing nothing. Some days I feel like I'm going to go bat sh&$ crazy!!

     
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