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    Old 02-25-2015, 04:08 PM   #1
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    Unhappy Possible ACDF needed ... help

    Iím new to the site and have tried to read other cervical spine posts in order to get informed. My problem is that my MRI results, to a degree, donít really mention spinal stenosis. I have had pain in my neck and shoulder; pain, burning, tingling and sometime numbing in my shoulder, arm and hand.

    My Rheumatologist wanted me to start PT and see a neurosurgeon, so I ďcould start building a relationship with himĒ. I have had problems with this for 7 years and whenever I do PT, the spasms and pain increase 10 fold, to where I can barely function. I also have fibromyalgia, therefore I have to deal with chronic pain and fatigue on a daily basis. I have also done pool PT.

    The neurosurgeon said that basically I have DDD and then went on to show me the ACDF surgery that he recommended, but I could also start with injections which will help pain that usually on help 20% of patients, but the injections will not make the problem go away.

    I donít really have a lot of core strength and I really donít think I could handle the recovery of this type of surgery and would really appreciate anyoneís feedback on what could help.

    MRI Results:

    C1-C2 level, mild degenerative changes are noted. Minimal nasal turbinate hypertrophy is noted. Mild mucoperiosteal thickening is seen in the sphenoidal and ethmoidal air cells.

    C2-C3 level, disc desiccation is noted but the AP diameter of the canal measures 1.35 cm or greater. The neural foramen are patent.

    C3-C4 level, central disc protrusion with disc osteophytic ridging narrows the canal to 9.8mm. Minimal cord contact is noted but no signal alteration is noted. Mild uncovertebral change with mild inferior foraminal narrowing left great than right is noted.

    C4-C5 level, disc osteophytic ridging narrows the canal to approximately 8.5mm. Minimal cord contact is noted. Uncovertebral and osteophytic ridging changes cause foraminal narrowing left greater than right.

    C5-C6 level, disc osteophytic ridging obliterates the CSF space anteriorly. The canal narrows to 7.1mm. Cord contact without signal alteration is noted. Disc osteophytic ridging changes and uncovertebral change cause mild inferior foraminal narrowing.

    C6-C7 level, disc osteophytic ridging changes, narrow the canal to approximately 8mm. Uncovertebral and osteophytic ridging changes cause foraminal narrowing right greater than left. Cord contact without signal alteration is noted.


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    Old 02-26-2015, 07:21 AM   #2
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    Re: Possible ACDF needed ... help

    Hi there, Welcome!

    Sorry to hear about your troubles.

    The MRI describes stenosis of the central canal in multiple places. A central canal is considered stenotic when the canal diameter is smaller than 13mm. However, the MRI did not mention cord signal changes- so that is good. Although the bone spurs are making contact with your cord. It also states formainla narrowing, which could be contacting the nerve roots.

    The pain you described could be from the foraminal stenosis or the central canal encroachment- or from neither.

    This is just my opinion- you would need to discuss this with a trained professional. But I recommend getting another opinion or two from highly qualified spine neuro or orthopedic surgeons - preferably fellowship trained.

    The treatment sought could also depend on your age, stability of the spine, any osteoporosis etc... I would also ask for an EMG to test your nerve roots.

    Again, not sure of the specifics but an ACDF on your spine would likely need to be multiple levels. I have similar issues and am scheduled for a laminoplasty.

    injections are very helpful to many people - but as you pointed out they are a Band-Aid. I've had friends who have had a single layer ACDF and they were not terribly fit.

    I have found relief, albeit short lived, with acupuncture, ART, PT, inversion table etc... Maybe if you tell us a bit more about yourself we could offer some more guidance.
    Good luck

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    cc778 (04-11-2015)
    Old 02-26-2015, 04:54 PM   #3
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    Re: Possible ACDF needed ... help

    You certainly do have stenosis both central canal (narrowing of the space for your spinal cord) and neuroforaminal (narrowing of the space for the nerve roots to exit). The radiologist gives measurements of the central canal narrowing, which is good. The narrowing at c5/c6 to 7.1mm is significant. I haven't seen your MRI but that narrowing would be enough to cause cord compression in many people. Cord compression can lead to myelopathy which affects the spinal cord and can cause neurological symptoms of varying degree. It can be a mostly silent condition meaning the feeling symptoms like pain, numbness etc may not be present or it can cause symptoms similar to what you are describing. Unfortunately the radiologist doesn't give a good idea of the severity of the neuroforaminal stenosis so it difficult to say how much that might contribute to your symptoms.

    I hope the neurosurgeon you are seeing is a spine specialist. They have specialized training in diseases of the spine and limit their practices to spine issues. It may not be a bad idea to get a second opinion from an orthopedic spine specialist. They will sometimes have different takes on the problem which valuable. Perhaps you could engage with a pt who has solid exprience with spine patients. Mine was excellent at figuring out thebline betweeen helping and aggravating. Traction can sometimes open up the space for the nerves and cord a bit but with central stenosis it has to be done carefully. Exercises can help strengthen surrounding muscles and slow the degeneration process. Steroids can be very beneficial if there is a significant inflammation component to your symptoms. It is true, however, that.none of the conservative methods will fix your problem. My personal opinion, which you should certainly validate with a spine specialist, is that even though you have some significant stenosis, there doesnt appear to be a huge rush to get surgery. That would only be a concern if you had more advanced myelopathy or radiculopathy symptoms like significant strength loss, balance and gait issues, hyperreflexia, bowel and bladder issues etc. Those might indicate a higher likelihood of permanent damage. So, I think you have some time to weigh your options and get.some more opinions if you like and perhaps try some more conservative treatments in the meantime.

    Good luck and let us know how you do...

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