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  • Dropping more than just hints!

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    Old 01-19-2015, 01:05 PM   #1
    Lionor
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    Dropping more than just hints!

    Hi,

    Quick question(s) - how concerned were you, would you be, to start dropping more and more things. Things just slip through my fingers more and more everyday.

    Just wanted to get your thoughts on that "symptom" and if there is anyway to predict what symptom will be next? (Already have neck, shoulder, arm pain, fatigue, leg heaviness, hyper reflexior in legs and occasional numbness in hands)

    Cheers!

     
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    Old 01-19-2015, 06:29 PM   #2
    ChuckStr
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    Re: Dropping more than just hints!

    That's a tricky symptom. The reason I say this is that is one of those that can be "perceived". You are looking more for it, and therefore think it is happening more. I'm not saying that is the case with you but I think it can happen. That said, if that were happening for real to me, and I had the other symptoms you mention, I would definitely be concerned.

    There isn't any way I know to tell what the next symptom might be. Some possibilities are not good : bowel/bladder issues, gait disturbances, footdrop etc. The course of myelopathy varies considerably with about 75% having stepwise advancement/improvement, 20% having slow, constant degradation and 5% fast degradation. The red-flag symptom for me, would be the hyperreflexia. That indicates upper motor neuron involvement.

    I hope that you are under the care of a spine specialist ortho or neuro surgeon that can monitor all this. I assume you have some sort of pathology compressing your spinal cord, and if so you may need surgical intervention at some point.

    Good luck and let us know how things go...

     
    Old 01-20-2015, 12:26 PM   #3
    Lionor
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    Re: Dropping more than just hints!

    Hi Chuckstr,

    Thank you for your concern and for your response. Yes I am under the car of a Neurosurgeon. It's been almost 8 years of deterioration. Looks like I'm in for a laminoplasty in the coming months for C4-C7.

    As far as dropping things: It's not so much as "dropping" like a glass, more of thinner things, paper, card, the lip of a bowl etc that when I carry it, it just seems to slip out of my fingers. Roughly 10-15 times over a weekend.

    I know you're well versed in this "stuff" so I wonder - do you know if the double door laminoplasty is routinely done in the US? right now I'm looking at a traditional single hinge laminoplasty. But I have foraminal stenosis on both sides, so I'm trying to research to see if DDL would be more useful.

     
    Old 01-20-2015, 02:51 PM   #4
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    Re: Dropping more than just hints!

    The "French door" laminoplasty (double-door) procedure is fairly widely practiced from what I've read. There are variations that span the gapped lamina with spacers made of various material instead of leaving it open; I don't know how often any of those are done. Double-door laminoplasty has the advantage of the decompression coming directly posterior to the cord which can lesson the problems associated with the cord being "caught" etc. and can also work better when there is compression on both sides as in your case. It is technically more demanding and takes longer than a single hinge, which can increase complications.

    I would assume that the pathology causing the compression is located posteriorly (toward the back of your neck). If not, then laminoplasty may be the wrong surgery. If you have any spinal instability that would also contraindicate laminpoplasty. Also, with neck pain, which you say you have, you should be aware that a laminoplasty is unlikely to address that and in some cases axial neck pain is increased after laminioplasty due to the amount of trauma to the large muscles and other structures in the back of the neck. That said, I would assume the type of procedure done would be indicated by the expertise of your surgeon. That is, I don't think I'd want a laminolpasty done by someone who wasn't *very* experienced in doing exactly the type they were doing to me. It's a complex procedure and relatively easy to mess up from what I've read. In my experience, which is limited of course, most surgeons do not favor laminoplasty. I consulted with 5 surgeons, only 1 had ever done a laminoplasty other than as part of their specialty training. One guy, who is a world renown surgeon (whatever that's worth), did many of them early in his career but stopped due to the high amount of complications, specifically persistent neck pain.

    If you end up going for a laminoplasty, be aware that there is some evidence that C7 attachments to larger muscles and ligaments is a major cause of persistent axial pain. There are various techniques such as excluding C7, modifying the procedure at C7 etc. There is an article that discusses this and other laminoplasty details - laminoplasty techniques for the treatment of cervical stenosis.

    If it were me, I'd get a couple of opinions perhaps from both a neuro and ortho spine specialist. The training between these is similar and in many cases now, the spine specific training is the same, but they tend to have different takes on solutions to the problem.

    Good luck!

     
    Old 01-21-2015, 12:46 PM   #5
    Lionor
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    Re: Dropping more than just hints!

    Thanks again,

    Yes I have multiple opinions. 9 in fact over the years. I recently got the opinion of 5 surgeons, two ortho and three neuro. One said acdf on two levels and one level replacement (but later a laminoplasty), one said three level fusion, one said do nothing and two said laminoplasty.

    Neck pain is more on the sides and at the base of the neck. Regardless, the thought behind not doing ACDF is due to my age. I'm 33 and they don't want to fuse me for fear of a) mobility and b) subsequent damage above and below. So they feel the laminoplasty is best - albeit extensive. The surgeon I have picked is a neuro - is fellowship trained and does roughly 50 laminoplasties a year. He is with a well known and large facility.

    I have concerns - who wouldn’t- but it’s the position I am in.

    Problem is I am congenitally stenotic and have impingement from front and back. As I am 33, don't smoke, am fit and healthy they seem to think I should do well with this surgery. But have said if this doesn’t do it they can always do ACDF is need be - but not the other way around.

    Thanks again for your advice and info on the procedure.

     
    Old 01-21-2015, 02:44 PM   #6
    ChuckStr
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    Re: Dropping more than just hints!

    Looks like you've done your homework! There are a couple of people at least who have had successful laminoplasties and are on this board (although they may be inactive).

    I do wonder about a couple of things. I assume you don't have spondylolistehsis (vertebral slippage). If you do, the laminoplasty can make that worse. Also, will they address the front impingement? I have mostly front impingement and a little rear impingement that my surgeon said could be addressed with ACDF. I assume the "opposite" could be done in laminoplasty but I might check, if it were me. If they don't address that pathology it will obviously get worse over time and may require further surgery.

    Other than that, your surgeon sounds great and I wish you the best of luck and a speedy recovery!

     
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