Complicated Cervical Case – anti-fusion

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  • mtn_runner
    Participant
    Post count: 2
    #24814 |

    Dr. Corenman,

    I have severe foraminal stenosis, facet hypertrophy, and severe disc degeneration from C4-T2 with a bulging disc T1-T2. I also have severe uncovertable joint hypertrophy and an osteophyte complex which abuts the cord at C6-C7, plus numerous anterior bone spurs.
    I had debilitating symptoms on the right side – arm, shoulder blade, hand, fingers — which were helped by a posterior laminoforaminotomy in 2015. According to the MRI I still have the severe stenosis on the right side, but it seems to be less symptomatic. However, in the last 9 months, I have had severe symptoms on the left — sharp arm pain, tingling, hand malfunctions, neck stiffness, shoulder blade shooting pain. I’ve had 3 facet injections and 2 epidural spinal injections just to be able to still go to work. I’m now getting aggressive with looking for operative treatment again. I’m very active — mountaineer, mountain biker, ultra runner (and haven’t been able to do any of these activities in almost a year) and depression is getting bad so I need to get this taken care of. My surgeon is talking about a complete neck fusion and I just don’t think that’s the answer considering it is obvious that I am genetically prone to disc degeneration since I have all these problems and am only 39.

    I was wondering what you can suggest. I’ve been doing alot of research and I’m wondering about endoscopic foraminotomy to get rid of bone spurs and maybe part of that bulging disk. If fusion is required to reinforce structurally, I’m wondering about interlaminar implants or other devices. I’m willing to go to Europe where they have better hardware and more experience, but I just don’t know what I’m looking for.

    Thanks,

    Stephanie

    Dr. Corenman
    Moderator
    Post count: 5105

    There are many questions that need to be answered. How bad is your degenerative disc and facet disease? Do you have a localized kyphosis (anterior angulation due to degenerative disc disease)? Do you have a degenerative spondylolisthesis (worn facets causing anterior slip-see website). Do you have instability of any level (more than 3.5mm of forward/backwards motion at any one level on flexion/extension x-rays)?

    Is there any specific level worse than any other levels in the way of foraminal stenosis or central stenosis? Does the physical examination note focal compression at any particular nerve root noted by weakness of that motor group (or spinal cord compression with long tract signs and myelopathy-see website).

    I’m going to assume that you probably need a reconstruction of your neck and the endoscopic foraminotomies are not going to be enough to repair your neck based upon the very limited information I have. You can determine what range of motion (ROM) you might lose based upon flexion/extension x-rays and measurement of ROM of the specific levels that might be addressed by reconstruction surgery.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    mtn_runner
    Participant
    Post count: 2

    Reconstruction….lovely.

    While I can’t positively answer your questions, I do know that my neck is currently very stable. That always comes out in the “look on the bright side”.

    I do have foraminal stenosis worse at some levels than others, however, it’s just a matter of time until the less severe levels become severe. I don’t know exactly how bad the discs have degenerated (percentage wise), the MRI just always says “Severe”.

    What would neck reconstruction consist of? I did a google search but it doesn’t tell me too much since most people get it once they have tumors removed. I’m guessing multiple surgeries over multiple years? What would be the least committing way to start out — ie could I attack two of the worst levels first and then see if that holds me over for a few years? The thing that keeps me a little hopeful is that even though the MRI states that the right side is horrible in terms of stenosis and hypertrophy, I don’t have horrible symptoms on the right anymore. Only nagging pains. Finally…who would I see about this since I’m guessing not just any ortho spine person could handle this case?

    Thanks for all your advice. Now I have more things to look into. It’s all about figuring out what you don’t know, right?

    -Stephanie

    Dr. Corenman
    Moderator
    Post count: 5105

    To reconstruct the neck, a number of questions have to be answered. Mainly, what structures are causing the most pain by history, physical examination and imaging.

    An example is if you might have 50% neck pain and 50% right arm pain. The right arm pain is caused by foraminal stenosis of C5-6 and C6-7 and these discs are collapsed (less than 50% of normal height left) with Modic changes (endplate fractures of the C5-6 and C6-7 vertebral bodies). Most likely the neck pain is generated for the most part from the C5-7 levels. The C4-5 level is “OK” and C7-T1 does not have a significant slip. You would be a candidate for a 2 level ACDF at C5-7. If the discs still had greater than 50% height, you could be a candidate for a two level ADR (artificial disc replacement). This is how the surgical plan is put together.

    I know you don’t want a fusion but if the flexion/extension X-ray views note little to no motion at the most significantly degenerative levels, fusion of those levels should not cause diminished range of motion.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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