[kohemeng]

#9860

My father was diagnosed with compression in his spinal cord (C6-7, T1) and the doctors have recommended an ACDF procedure to mitigate it. He is 82 years old and is in very good health. His symptoms are weakness/numbness/jelly-like feeling in his left leg, numbness in his right foot, and a tingling sensation in his right tricep. Because of that he now uses a cane. We have been told that surgery is his the only option, and if he doesn’t do it, he will ultimately lose use of his legs. Are there any other treatments besides surgery, and is this a procedure that is recommended for an 82 year old?

Below are report summaries of the MRI’s he’s done:

MRI C-Spine Report of May 13 2013.
REPORT
Serial Sagittal T1 as well as axial T1, T2 images of the cervical spine show discs dehydration at all levels.
Images show evidence of subluxation at C7/TH1. The change is seen with a slip of about 6mm. The change is seen with an underlying disc herniation observed to cause focal canal stenosis and cord compression. Images also show subtle disc prolapses at C4/C5, C5/C6, and C6/C7. These changes are also seen to cause relative canal narrowing with cord compressions. Cuts are seen to show nerve roots compressions that show prominence on the right at C4/C5 and C5/C6, but of about equal magnitude at C6/C7. The change at C7/TH1 is also seen to show prominence on the right that observes to involve both sides. Images also show fatty degeneration of bony marrow at C5, C6 and C7. There is no appreciable bony change.
IMP
Degenerative disc disease with multiple discs prolapses seen to cause nerve roots and cord compressions with a severer herniation seen at C7/TH1 following subluxation which is seen to cause severer cord compression with severe bilateral nerve roots compressions and evidence of an underlying or attendant myelopathy.

MRI L-Spine of April 26 2013
REPORT
Serial axial T1 and T2 weighted MRI images of the lumbar spine show generalized disc dehydration and posterior herniation of the L4/L5 as well as the L5/S1 discs with resultant spinal canal stenosis. Bilateral L4 and L5 neural foramina stenosis with likely compression of the in dwelling nerve root is also noted. Normal vertebral body heights, posterior vertebral elements and paravertebral soft tissues. The spinal cord ends at the level of the L2 vertebral is normal in appearance.
IMP
1. Spinal canal stenosis due to disc prolapse as described
2. Likely bilateral L4 and L5 nerve root compression as described

MRI T-Spine of April 26 2013
REPORT
Serial axial and sagittal T1 and T2 weighted MRI images of the thoracic spine show mild osteophytosis and generalized dehydration of the intervertebral disc. No significant posterior disc herniation or spinal canal stenosis is however noted and there is no evidence of cord compression. No significant neural foramina narrowing is noted. The spinal cord is normal in signal and appearance.
IMP
Mild spondylosis of the thoracic spine. No evidence of coed compression noted.

[Donald Corenman, MD, DC]

#9861

Your father’s age doesn’t prevent him from undergoing surgery, especially if he is in good health.

He does have what appears to be significant narrowing of the spinal canal at C7-T1 associated with a slip (degenerative spondylolisthesis) compressing the cord and causing cord injury (myelopathy). From my take on this reading, the other levels are mild according to this radiologist.

Myelopathy will cause imbalance with walking and loss of hand fine motor skills (picking up a thin coin, zipping a zipper or putting a key into a lock). The physical examination will demonstrate long tract signs (see myelopathy on this website). I would imagine that both signs and symptoms are present and your father needs surgery to decompress his spinal canal. I cannot tell you how many levels need to be involved in surgery but from the impression I obtained from the radiologist report, the C7-T1 level is the worst level. This level probably needs to have an ACDF (see website)

Your father also has stenosis (narrowing) in the lumbar spine central canal as well as in the foramen (again-see website for these descriptions). His leg symptoms could originate from his neck but he probably also has symptoms from compression in the lumbar spine.

A good history and physical examination will go a long ways to differential these two conditions and identify the areas of the spine that are causing the greatest havoc. If there is any questions, a nerve block of the lumbar spine will help to differentiate these pain sources.

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.

[kohemeng]

#9865

Thank you very much for the feedback. Very much appreciated.

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