shanegMemberJuly 12, 2012 at 9:54 pmPost count: 1
I have sought 2 opinions re: a herniated C5-6 disc which is causing severe central spinal cord compression. I am a physician also, and can see the CT myelogram myself (unable to get MRI due to implanted metal). The first opinion (and radiology report) says the extruded disc has subligamentous extension behind the body of C6. The compression looks to me like this as well (compressed at least half way down behind the vertebral body…if not more). He suggests a corpectomy (C6) with titanium cage and removal of the disc above and below. He feels this is the only way to know the disc is fully removed and the compression fully relieved.
The second opinion said that he thought he may be able to get the disc out without corpectomy, and was planning to also take the C6-7 disc since it is bulging slightly. He is telling me he will be able to see through the disc space once the disc is out and know if the compression is relieved. Since they differ significantly on the opinion of whether or not they will know if the disc (and therefore compression) is fully relieved, I am not sure which is more likely to be correct. Their experience level is probably similar, although the second opinion works at a place that does more surgery than the first.
My main concern is not wanting a second surgery if the compression isn’t fully relieved. I would also rather know going into it if I will end up with corpectomy or not, but think it may be worth an attempt at discectomy if it is possible since the recovery is much faster. Could you offer a suggestion on whether it is possible to actually tell given the degree of subligamentous extention behind the vertebral body.
SGDonald Corenman, MD, DCModeratorJuly 13, 2012 at 11:23 amPost count: 8465
In general, large disc herniations that sequester behind the vertebral body are not difficult to remove without a corpectomy as long as the herniation is not too old. The visualization of the back edge of the disc is actually quite good under the microscope.
The PLL is removed allowing direct visualization of the dural sac. This dural sac will be pushed away from the edge of the vertebral body by the disc herniation. It is normally a simple matter to use a nerve hook or nerve probe (longer reach) to indirectly free the fragments and remove them.
Normally, the dural sac will then approximate to the back edge of the disc space which indicates the fragment has been removed.
If the herniation is old, the nuclear fragment can adhere to the PLL making removal somewhat more difficult.
If the only problem is C5-6 and C6-7 is not compressing the cord or any nerve roots, I would leave C6-7 alone as there is no indication for surgery at that level unless a corpectomy is performed. I do not like the titanium cages for a corpectomy as they obscure visualization on an X-ray and the metal is inert (not biologically active so as to not contribute to the fusion surface area).
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