JellyhallParticipantMay 29, 2012 at 12:02 amPost count: 90
I recently saw my neurosurgeon to discuss a 2 level ACDF on C3/4 and C4/5.
When explaining the risks of this surgery, there was something that he mentioned that I haven’t heard of before. He told me that after a spinal cord has been compressed for a while, sometimes after the compression is removed, the cord can’t cope with the extra flow of blood and paralysis or extreme weakness can happen.
Could you please explain this to me and also, is it likely to be a temporary thing, or could it be permanent?
Is a problem with swallowing more likely at these higher levels than lower down in the neck?
What are the other risks that you tell your patients about?
Do you give them what the chance of each problem is?Donald Corenman, MD, DCModeratorMay 29, 2012 at 12:44 amPost count: 8465
Please see the risks section of the website to understand more about the general risks of ACDF.
As far as cord injury after decompression from vascular injury, this would be highly unusual. First, there has to be significant cord compression and not just nerve root compression. Then, the decompression of the cord has to be performed precisely. Injury could occur from aberrant placement of a small tool while decompressing the cord (very rare). This would not be a vascular injury but a mechanical one.
After this decompression, there is some revascularization of the cord. This can change the blood flow pattern in the cord as the cord has adapted to the previous compression. It is theoretical that this revascularization phenomenon could cause cord dysfunction and injury.
Dysphagia (difficulty swallowing) after ACDF is not uncommon but typically disappears after 2-6 weeks.
Dr. CorenmanJellyhallParticipantMay 29, 2012 at 2:10 amPost count: 90
Thank you for your reply Dr Corenman,
I have looked at the risks section of your website in the past. I will take another closer look.
I believe that I do have significant cord compression in my neck, in addition to nerve root compression. I have numerous symptoms in my neck and shoulders, but also in my arms, wrists and hands. I also have symptoms in my legs and feet and get daily involuntary stiffening spasms which cause both my legs and feet to stiffen and sometimes the muscles around my abdomen also stiffen causing my back to arch up off the bed.
I am being tested for MS and some other neurological conditions to make sure that all my symptoms are coming from my cord compression. I have had a brain MRI scan and various blood tests. I am waiting to hear from the neurologist to see if he wants to do more testing, or if he has reached his diagnosis.
I have no spinal cord fluid on either side of my cord and my cord is being indented. However, there is no visible high signal on my MRI scan. I have been ‘watched’ for the last 18 months, but now surgery is being suggested by a second opinion neurosurgeon. The first neurosurgeon referred me to a neurologist to rule out MS.
I believe that once we are sure what is causing my numerous symptoms, we will schedule surgery. I hope that we have not increased the chance of post surgical complications by waiting for so long. I do not want to be in a worse position after surgery than I am now.Donald Corenman, MD, DCModeratorMay 29, 2012 at 8:28 amPost count: 8465
I am glad that your surgeon is looking into more than myelopathy. Symptoms of MS can mimic myelopathy including the physical examination signs. Do you have signs like Hoffman’s sign, hyperreflexia, Lhermitte’s sign, as well as Rhomberg’s sign (imbalance) and weird pins and needles sensations? I would assume that you know what those signs are as you seem well informed but I can explain them if you need.
Surgery for cord compression without signal changes within the substance of the cord is generally better news than if those signals were present. I assume you are also getting an MRI of the brain to rule out MS.
Dr. CorenmanJellyhallParticipantMay 30, 2012 at 2:03 amPost count: 90
Yes the brain MRI scan was to check for MS. I don’t have the results of that yet. I have had several MRI scans of my spine at all levels, including my thoracic that showed 2 herniated discs, one slightly indenting the cord. I have already had a fusion of my L4/5 for isthmic spondylolisthesis. No-one mentioned any lesions on these scans, only osteophytes, hypertrophic facets and disc problems. My neck from C3 to C7 is very degenerated with disc herniations and osteodiscal ridges, but it is C3/4 and C4/5 that are concerning them, as there is significant cord compression.
I do have hyperreflexia in my arms and legs but no Hoffman’s. I have unequivocal Babinski as there is no movement of my toes apart from a very slight flaring of my 2nd to 5th toes. I don’t have Lhermitte’s sign although I do get occasional shooting electric shocks out of the blue. I had no Rhomberg’s sign although I do sometimes feel off balance, especially if I turn. I do get frequent pins and needles, stabbing and burning in my arms and legs especially my hands and wrists and my feet and ankles. I don’t appear to have Clonus. I get twitching, fluttering and cramping, particularly in my legs and feet, but also have twitching in my right arm. I get a feeling of a mobile phone on vibrate in my right leg which is also starting to appear in my left arm, and a frequent feeling of having cold water splashed on my arms, legs and abdomen.
The symptoms that bother me the most are the frequent headaches and these stiffening spasms in both legs and sometimes around my abdomen as I wake in the morning or when getting up after sitting for a long time. My right foot turns inwards strongly with my big toe sticking up when I have these spasms. Then the first steps of walking are very stiff, but I loosen up as I get moving.
I am very interested to hear what you think of all this.Donald Corenman, MD, DCModeratorMay 30, 2012 at 4:12 amPost count: 8465
Your symptoms could be from a demyelinating disorder or from myelopathy. Most individuals with your intensity of symptoms and stenosis have cord signal changes but not all. If the brain MRI is normal, then more likely than not, these symptoms would be from the cord compression. Nonetheless, there are other neurological disorders that can cause these symptoms. A thorough neurologist can help to differentiate this.
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