[lakegirlmn]

#22095

Hello Dr.
My name is Nicole. I am writing to you with hopes you can offer me guidance on how I should proceed/ (schedule a consult with ASAP) seeking a third opinion regarding treatment for my cervical spine issues.

To quickly summarize, I was advised to have immediate surgery by a neurosurgeon after suffering acute neck pain. I don’t feel comfortable with that recommendation in light of the fact that my symptoms have improved in the 3 weeks since my symptoms first appeared. I had prior neck and back issues over 10 years ago, having been in two car accidents. Overall I haven’t had many neck or back concerns for quite some time. I am a 33 year old single mother of a 14 year old son. I am also moving in less than one month. Proceeding with surgery right now will create many hardships for my son and I.
If surgery is a must, I will follow through, however I am not comfortable making that decision quite yet, despite still having discomfort, feeling a bit off balance.

My X-Rays and MRI state the following:

Cervical Spine X-Ray:
COMPARISON: 08/02/2009

FINDINGS: Multiple views obtained. No fracture seen. Stable reversal of the normal lordosis at C5-6 where there is also loss of disc height.

There is prominence of the prevertebral soft tissues superiorly which may be projectional. However, if there were a history of trauma, CT could be considered.

I was seen in consult by a neurosurgeon two weeks ago this Thursday and to my surprise was told I need to have a C5-7 anterior cervical discectomy and fusion as soon as possible. The doctor wanted to schedule surgery to be done immediately. He frowned at the idea of waiting one month, as he felt I would be at risk of having permanent nerve damage. He agreed to two weeks max. He was concerned by my report of feeling slightly off balance, increasingly worse penmanship, urinary urgency, decrease sensation in my left arm and hand sand inability to detect temperature of bath water with my lower extremities (for years) All the aforementioned were not sudden, abrupt symptoms. I had a positive spurlings sign aside from that my reflexes and exam was normal.

Last Thursday, I saw an orthopedic surgeon who did not feel I was an urgent candidate for surgery as my neurological tests were all normal. He didn’t feel surgery was necessary in his opinion. He reviewed my MRI and X-rays and performed a physical exam. He sensed that I was not comfortable with his opinion, so he advised I obtain a third opinion from another neurosurgeon.

I emailed the first surgeon and asked if surgery could be avoided as my symptoms have improved. His response was he recommends surgery sooner, rather than later.

I have surgery scheduled for May 13th. I am employed as a nurse so it is important that I make a decision ASAP! I don’t want to risk permanent nerve damage despite feeling somewhat better.

It is impossible for me to get a third opinion anywhere before next Friday when surgery is scheduled. I am feeling lost.

All I want to know is if surgery is inevitable, or do I have other options to stop the “rapid degenerative changes and progression of myelopathy?”

Thank you for your time
Nicole

[Donald Corenman, MD, DC]

#22097

What concerns me about the neurosurgeon’s rush to do surgery is that the radiological report does not note severe cord compression or cord injury (signal change or myelomalacia). The orthopedist’s comment that “my neurological tests were all normal” flys in the face of an urgent need for surgery. Myelopathy will cause signs of hyperreflexia, clonus, Hoffman’s sign and inverted radial reflexes. Without those signs or without an acute large disc herniation, you should slow down and take the urgency with a grain of salt. If however, your symptoms have significantly progressed in a short period of time, you might need surgery but all the information you have provided goes against that recommendation

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.

[lakegirlmn]

#30196

Well after visiting several neurosurgeons, I ended up having a C5-6 ADR with a Pro-Disc C on 11/1/16 at the University of Minnesota. Felt great for months after, but ended up with awful spasms and underwent trigger point injections. The day after the second set of injections I developed awful burning pain in my lower extremities, which progressed to my hands, feet and face turning bright red and hot. I underwent extensive lab workup, small nerve fiber biopsy, autonomic nervous system testing, genetic testing, MRI, fluoroscopy w/CT, and even patch testing to the device implant components. All was negative except a strong nickel allergy and mild titanium allergy. The neurosurgeon who performed my surgery concluded it was coicidential. I still have a C6-7 cord compression. I ended up being diagnosed with a condition called erythromelalgia, by the world expert in the disease at Mayo Clinic, Rochester. He believes it was all unrelated to my surgery as well. I still 100% regret having undergone surgery. My neck still hurts and my skin is on fire almost 24-7.

[lakegirlmn]

#30198

[Donald Corenman, MD, DC]

#30201

I can say that I don’t place artificial disc replacements (ADRs) in a level with severe canal narrowing and myelopathy as these ADRs do translate (shift) when they move-potentially compressing the canal even further. Also if there are bone spurs that form from the motion of the ADR (not uncommon), these can recompress the spinal cord. If you now have C6-7 cord compression to add to your problems, I would think your surgeons would consider a revision of the ADR to a 2 level ACDF, maybe without a plate if you really have titanium allergy but the chance of titanium allergy is suspect.

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.

[lakegirlmn]

#30203

Thank you for your reply. I will certainly try to locate another neurosurgeon who is familiar with Pro-Disc C and discuss other surgical options. I did seek another opinion from a well-renowned surgeon in my area who ordered the myelogram. He referred me back to my surgeon who performed the surgery and ordered patch testing. She was not very helpful.

I thought I had uploaded a pic of the Myelogram. I copied and pasted below if you’re interested. Thank you again

XAM: POST MYELOGRAM COMPUTED TOMOGRAPHY CERVICAL SPINE
CLINICAL INFORMATION: This is a 36-year-old woman with prior history of cervical disc replacement currently with neck and shoulder pain radiating into the upper extremities.
TECHNICAL INFORMATION: Computed tomography axial images were obtained through the cervical spine with 1.25 and 2.5 mm slice thickness after instillation of myelographic contrast media. Sagittal and coronal reformatted views were obtained.
INTERPRETATION: This exam is compared to prior MRI study dated 4/2/2018.
The digital scout radiographs demonstrate no lesions of the visualized skull. The prevertebral soft tissues are normal. Disc prosthesis is identified at C5-6 and there is mild focal kyphosis at this level. The craniocervical junction is normal.
C2-3: No cord deformity or central spinal canal stenosis. The foramen appear patent and the facet joints are unremarkable.
C3-4: No cord deformity or central spinal canal stenosis. The foramen appear patent and the facet joints are unremarkable.
C4-5: No cord deformity or central spinal canal stenosis. The foramen appear patent and the facet joints are unremarkable.
C5-6: Disc prosthesis with associated metallic beam hardening artifact which somewhat obscures the central canal. Uncinate spurring on the left with mild to moderate left foraminal stenosis.
C6-7: Right paracentral disc protrusion and marginal osteophyte causing mild ventral cord flattening and mild central spinal canal stenosis. Mild right medial foraminal stenosis.
C7-T1: No cord deformity or central spinal canal stenosis. The foramen appear patent and the facet joints are unremarkable.
CONCLUSION: Mild focal kyphosis at C5-6. Specific findings according to level include:
1. C5-6 disc prosthesis with uncinate spurring on the left and mild to moderate left foraminal stenosis.
2. C6-7 right paracentral disc protrusion with marginal osteophyte causing mild ventral cord flattening and mild central spinal canal stenosis. Mild right medial foraminal stenosis.
3. No significant change compared to prior MRI study dated 4/2/2018.

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