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  • Thistle
    Member
    Post count: 5

    Dr. Corenman, I am to have multi level arthrodesis in cervical 3 through 7. on August 28th. 2012. I also have a lot of stenosis. I am petrified. Everything I have read about the metal plate is bad. People choking, gagging, and breathing problems, sometimes years post op. All because it is placed behind the esophagus. Are all of the plates 2.4 mm? Is a plate necessary? Can it ever be removed? Please help.
    When they are finished with that, in time, my lumbar (with 2 rods, screws and a cage) and a portion of thoracic needs to be done again: FBSS times 2
    I am in excruciating pain 24/7.
    Thank you,
    Mary

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    A long fusion like you are describing does have some indications but I would be concerned about the length of fusion. If the surgery is being performed for stenosis, there may be some other possible surgeries to be considered. However, if the surgery is for nerve compression from bone spur, this surgery may very well be needed.

    In general, do not worry too much about the thickness of the plate. Normally, with a fusion of that length, there are anterior bone spurs that are thick (anywhere from 2-4mm). These are removed before the plate is placed. If you consider the anterior longitudinal ligament (1mm thick) which is removed and spur removal (2-4mm), the plate placed in the anterior neck is thinner than the spur and ligament it replaces.

    Yes- a plate is needed.

    Dr. Corenman

    Thistle
    Member
    Post count: 5

    Dr Corenman,
    I am a 60 year old female.

    The surgeons want to do my neck first as they are fearful of my becoming paralyzed even from a fall. Please see the following:

    MRI:date 3/30/12

    Cervical: w/o & w/contrast:
    1. spondylosis C3-4 through C6-7 with moderate to marked bilateral foraminal narrowing, moderate to marked C4-5 canal stenosis, moderate C5-6 canal stenosis and mild C3-4 and C6-7 canal stenosis. there is mild cord compression at C4-5.
    2. advanced C3-4 through C6-7 DDD
    3. mild thoracic dextroscoliosis with straightening of the cervical lordosis.

    Cervical xrays:
    1. far advanced C3-4 through C6-7 DDD
    2. prominant bilateral sponylosis at the same four levels with associated foraminal encroachment.

    Thoracic: without contrast:
    1. moderately advanced ddd in the mid and lower thoracic spine.
    2. small central disc protrusions at the three lower thoracic levels with mild thecal sac compression with mild disc bulging at three mid thoracic levels.
    3. mild dextroscoliosis

    Lumbar: w/o & with/contrast:
    1. far advanced chronic DDD L1-2 associated with chronic loss of stature of the L1 vertebral body
    2. moderately severe L1-2 canal stenosis with prominent bilateral foraminal narrowing secondary to sponylosis, disc bulging and facet hypertrophy.
    3. status-post fusion L2-S1, decompressive laminectomy L3-4 to L5-S1, and intervertebral body fusion L4-5 with a stable mild anterolisthesis.
    4. moderate levoscolosis

    Lumbar x-ray:
    1. status post paired pedicle screw and rod fusion L2-through S1.
    2. chronic compression fracture of L1 with advanced chronic DDD at L1 subchondral sclerosis and large marginal spurs.
    3. status post intervertebral body fusion L4-5 with grade 1 anterolisthesis and no sign of instability on flexion or extension.
    4. moderate levoscoliosis

    My first surgery in 2001 was for a small herniation in L-4 L5. The surgeon left the spine unstable…..did a hemilamie (spelling)
    My spine shifted like a stack of plates.

    The second was in 2003 for stabilization by fusion, by another surgeon.
    He put what others are saying was wayyyy to much hardware and went into thoracic to “explore”. Thus RFA was unable to be utilized.

    Over these painful years, I was told not to have any more surgery. Now, I am told there is no choice. But I can see and feel that for myself.

    In the interim, my thyroid had to be destroyed with 30 mci radioactive iodine. I was told it was toxic, but not why.
    I am now learning to ask questions, (too bad, after the fact) but in many cases, I do not get answers…they are evaded.

    I also had to have a complete hysterectomy in 1995. Just saying.

    I feel cursed. And definitely scared to death!

    I appreciate your help.
    Thank you,
    Mary~”Thistle”

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    You do have central cervical stenosis as noted by the radiologist. One of my questions is whether you have symptoms or signs of myelopathy. See the section on myelopathy to see if you fit with any of the descriptions.

    You do not note your symptoms in your neck. Do you have neck pain, shoulder pain or arm pain? See the section regarding how to describe your symptoms so I can gain a better understanding of your complaints.

    The levels at C3-4 and C6-7 note “mild central stenosis” “Mild” is a descriptor that does not quantify how significant your stenosis is. Is there CSF around the cord at these levels- at least on one side? If there is CSF present, the cord is not significantly deformed by the canal narrowing and and you do not engage in activities that place your neck at risk, maybe you only need the C4-5 and C5-6 levels surgically decompressed.

    Your lumbar spine is an entirely different story. We need to keep on track with the cervical spine in this thread as not to confuse individuals reading this. We can address your lumbar spine on another thread.

    Dr. Corenman

    Thistle
    Member
    Post count: 5

    There is stenosis on both sides of the spinal cord. And it is significant On both sides there is very little CFS in 3-4, 4-5 I believe. There is pain at times. Mostly stiffness, muscle spasms. Also the feeling and sound of bone rubbing bone. My neck feels stiff and tense when I turn my head to the left or right. Sometimes pain like nerves being pinched at times. No pain, numbness or tingling down arms. No shoulder pain. When I read “myelopathy”, nothing seems to fit that description.

    Thank you,

    Mary~Thistle

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Without symptoms of myelopathy and no shoulder or arm pain, you most likely do not have radiculopathy. Your pain sounds more likely to be originating directly from the degenerative discs.

    To open a narrowed canal, there are two ways to do that; from the front or from the back of the canal. Opening from the back of the canal does nothing to make the neck pain disappear as this technique simply makes more room for the spinal cord. This technique however does not have to fuse the neck so range of motion is left intact. You could add a fusion posteriorly to help eliminate the neck pain, but this now compares to fusing in front with the ACDF.

    The frontal fusion (ACDF) is generally a more superior technique than the posterior fusion as it has a better healing record and addresses the nerve hole narrowing (foraminal stenosis) much more thoroughly than the posterior surgery does.

    The number of levels addressed during surgery is a decision process that you need to make with your surgeon by sitting down and discussing pros and cons of adding additional levels or the risks of leaving those levels alone.

    Dr. Corenman

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