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  • Avatartaketwo
    Participant
    Post count: 3

    Hi Dr. Corenman,

    I’m a 30 year old male (from India). I’ve been having experiencing constant (mild) muscle twitches in my right arm for over a year. Went to a few doctors and they diagnosed it as benign fasticulation syndrome. More recently I started experiencing a tingling sensation and twitching in my legs and stiffness in neck. Doctor recommended an MRI of cervical spine. My MRI report –

    =============
    Findings:
    Cervical lordosis is obliterated with mild anterior angulation; however, alignment of cervical spines appears normal.

    Height of vertebral bodies appears normal. There is no evidence of any abnormal signal changes noted in vertebral marrow.

    Cisterna magan appears normal. Craniovertebral junction appears normal. Clivus appears normal.
    C2-C3, C3-C4 and C4-C5: The intervertebral disc space appears mildly hypo intense on T2WI. There is no evidence of any significant posterior bulging of the disc noted. There is no evidence of hypertrophy of uncinate process noted. Bilateral exit foramina appear normal. Spinal cord appears normal in size, shape and signal intensity. Paravertebral soft tissue appears normal.

    C5-C6 and C6-C7: The intervertebral disc space appears hypo intense on T2WI. There is evidence of disc osteophyte complex noted.no evidence of any significant posterior bulging of the disc noted. There is no evidence of hypertrophy of uncinate process noted. Bilateral exit foramina appear normal. Spinal cord appears compressed. Paravertebral soft tissue appears normal.

    C7-D1: The intervertebral disc space appears mildly hypo intense on T2WI. There is no evidence of any significant posterior bulging of the disc noted. There is no evidence of hypertrophy of uncinate process noted. Bilateral exit foramina appear normal. Spinal cord appears normal in size, shape and signal intensity. Paravertebral soft tissue appears normal.

    Impression:
    1. Loss of cervical lordosis however, height and alignment of spines appear
    normal.
    2. Significant degree of discs desiccation with reduced height noted at C5-C6
    and C6-C7 levels.
    3. Disc osteophyte complex noted at C5-C6 level causing compression of
    spinal cord mainly in center with an ill defined T2 hyperintensity (oedema / myelomalcia).
    4. Disc osteophyte complex noted at C6-C7 level causing compression of
    spinal cord mainly in center and towards left.
    5. Exiting nerve roots appear normal.
    6. Facets and facetal joints appear normal. No evidence of any intra spinal
    space occupying lesion.
    =============

    The neurosurgeon I’m consulting said I have moderate to severe compression and I’d need ACDF surgery but I can wait for a 1 month and strengthen my neck muscles if it helps in improving symptoms. He also stated that I’m not a good candidate for ADR

    1 month later of physiotherapy my symptoms have not improved and I have a new symptom – slight loss in sensation in palms of my hand. Neurosurgeon said its a bad sign and recommended me to make a decision within a few weeks about surgery. Also, he wants a CT scan done before to determine if I need a discectomy or a corpectomy. Corpectomy being more invasive. My physiotherapist on the other hand asked me to wait for another month to finish strengthening my neck muscles. Wanted your opinion on my case and what would be the right course of action ? Can I avoid surgery ?

    Thank you !

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7849

    Your report notes; “Significant degree of discs desiccation with reduced height noted at C5-C6
    and C6-C7 levels….Disc osteophyte complex noted at C5-C6 level causing compression of
    spinal cord mainly in center with an ill defined T2 hyperintensity (oedema / myelomalcia)…. Disc osteophyte complex noted at C6-C7 level causing compression of spinal cord mainly in center and towards left”.

    To interpret this, you have significant degenerative disc disease at C5-7, not uncommon. The compression of the spinal cord at C5-6 is significant which has caused cord injury (“ill defined T2 hyperintensity oedema / myelomalcia)” and still some compression at C6-7 is also present.

    I agree with your neurosurgeon that you need an ACDF at C5-7 and you are not a candidate for an artificial disc replacement. Do not listen to your physical therapist about “needing more time”.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatartaketwo
    Participant
    Post count: 3

    I really appreciate your feedback Doctor. I had some more questions:

    – In your experience how are the outcomes for this procedure ? Online literature tells me that ACDF at two levels results in high probability of adjacent disc degeneration and a rework might be needed in 10 years. Is there a fair probability of me leading a normal life without future surgery ?

    – What are possibly some things I should clarify with my neurosurgeon. Is choice of instrumentation something I should be concerned about ? He mentioned using a plastic spacer (with bone powder maybe?) and a titanium cage

    – Post operation what are somethings I should do to prevent this from happening again or other levels ? My MRI report mentions discs at all levels in my neck are “mildly hypo intense”. Does this mean degeneration is happening at all levels ?

    Thank you !

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7849

    There is a high probability of a normal life after a two level fusion (ACDF). I’ve performed hundreds of these and patients are generally really happy. There is a 2.5%/year chance of adjacent-level breakdown (ASD) which means in 10 years, you have a 25% chance of needing the next level surgical repair. However, there is a high rate of ASD even if you leave the two levels alone and simply watch C4-5 over 10 years.

    I personally don’t like titanium cages as they can easily hide a lack of fusion (pseudoarthrosis) and distort future MRI findings. The use of PEEK (plastic) cages with a titanium coating on the bone interface surfaces is a much better way to go in my opinion. A plate is necessary and I don’t think that the cages with integrated screws are as good as the noted PEEK cage and separate plate.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatartaketwo
    Participant
    Post count: 3

    Hello Dr. Corenman,

    Its been more than a month since my surgery which was successful. However, I have a new symptom – gushing noises in my eardrums and more recently a constant ringing noise in my ears(tinnitus). My Doc says its unrelated and recommended me to consult an ENT. Have you come across something like this ?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7849

    Probably not related to your surgery. I agree an ENT consult would be recommended.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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