66N HokieParticipantFebruary 25, 2020 at 7:31 amPost count: 2
Thank you for your reply to my post to your former patient, debbyrp. As mentioned in my post, I am scheduled to have a posterior laminectomy with fusion to treat canal stenosis resulting from degenerative anterolisthesis at C7-T1. The doctor plans to fuse from C6 to T2. I also have spondylosis/arthrosis at other levels resulting in canal and neural foraminal narrowing. I have some neck stiffness, but very little pain. I first became aware of problems with my neck approximately 10 years ago when I developed muscle weakness in my right arm, primarily affecting the triceps muscle. I had an MRI done at that time and discussed treatment options with doctors in Charlotte, NC and Iceland where I am currently living. We decided not to have surgery as I did not have any pain and the neurological deficit was considered to be very minor (I only noticed the muscle weakness in the gym when I isolated my arms). The situation has been stable since then and I have continued to be very active skiing, biking, playing tennis and lifting weights. I decided to have another MRI late last year in connection with my annual physical to see if anything had changed. The results of that MRI are below.
Impression: 1. Interval progression of diffuse spondylosis and facet arthrosis with apparent degenerative anterolisthesis at C7-T1 resulting in severe canal stenosis and bilateral neural foraminal narrowing. Clinical correlation for myelopathic symptoms recommended. 2. Uncovertebral and facet arthrosis at other levels resulting in canal and neural foraminal narrowing as delineated above.
Interpretation: There has been interval progression of the anterolisthesis at the cervicothoracic junction. This previously measured approximately 1-2 mm and presently measures approximately 5 mm secondary to apparent hypertrophic facet arthrosis at C7-T1 with
subchondral cystic changes and reactive marrow signal. No fracture evident. Multilevel cervical spondylosis has progressed with uncovertebral arthrosis as well, and discogenic endplate changes are noted primarily at C5-6 and C6-7. The imaged spinal cord
and posterior fossa structures maintain normal signal morphology. Paravertebral soft tissues are unremarkable.
C2-3: No significant central canal or foraminal stenosis.
C3-4: Hypertrophic facet arthrosis on the right. Uncovertebral arthrosis noted as well, disc osteophyte complex combine to cause right greater than left neural foraminal narrowing. No significant canal stenosis.
C4-5: Hypertrophic facet arthrosis on the right. Mild right neural foraminal narrowing from spondylotic ridging and facet arthrosis. Reactive marrow signal seen adjacent to the right C4-5 facet joint.
C5-6: Moderate canal stenosis from broad-based disc bulge and spondylotic ridging with uncovertebral arthrosis resulting in right greater than left neural foraminal narrowing. Mild facet arthrosis primarily on the right.
C6-7: Mild/moderate canal stenosis from right paracentral disc bulge and spondylotic ridging. Mild facet arthrosis on the right. No focal HNP or MR evidence of myelomalacia.
C7-T1: Severe canal stenosis present with AP diameter spinal canal measures approximately 7 mm on sagittal T2-weighted image 9. Bilateral neural foraminal narrowing noted which appears to be due, in part, to the anterolisthesis. No definite MR evidence
I would appreciate your thoughts about the appropriateness of the posterior laminectomy with fusion, along with any restrictions on activities after the surgery. Although the doctor doesn’t expect to fuse up to C5, he believes there is limited movement at this level. I am a very good skier and typically ski 15-20 days per season, mostly in Summit County (the direct flight from Iceland to Denver makes it surprisingly accessible!). I have a mountain bike and a road bike, but have mostly been riding on the road or dedicated paths in Iceland (not downhill mountain biking, which I wouldn’t expect to do after the surgery).
Thank you for hosting this forum and for any feedback you can provide on my particular case.
P.S. I can send you a couple of screenshots of my cervical spine, but don’t see where I can attach a file.Donald Corenman, MD, DCModeratorMarch 2, 2020 at 2:39 pmPost count: 8460
“C7-T1: Severe canal stenosis… Bilateral neural foraminal narrowing”. This level needs to be addressed.
“C6-7: Mild/moderate canal stenosis from right paracentral disc bulge and spondylotic ridging”. “C5-6: Moderate canal stenosis from broad-based disc bulge and spondylotic ridging with uncovertebral arthrosis resulting in right greater than left neural foraminal narrowing”. This level associated with “discogenic endplate changes are noted primarily at C5-6 and C6-7” makes me worry about severe degenerative disc changes and localized neck pain at both levels.
You then have to worry about C4-5 (“C4-5: Hypertrophic facet arthrosis on the right. Mild right neural foraminal narrowing from spondylotic ridging and facet arthrosis. Reactive marrow signal seen adjacent to the right C4-5 facet joint” and even C3-4 is not great (“C3-4: Hypertrophic facet arthrosis on the right. Uncovertebral arthrosis noted as well, disc osteophyte complex combine to cause right greater than left neural foraminal narrowing”).
It really depends upon your symptoms but if the stenosis is not too bad at C5-7 and your symptoms don’t focus on neck pain, you might be better off with an ACDF at C7-T1 and leave everything else alone for now.
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