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#33330 In reply to: ACDF Surgery Candidate ? |
Your report notes; “Significant degree of discs desiccation with reduced height noted at C5-C6
and C6-C7 levels….Disc osteophyte complex noted at C5-C6 level causing compression of
spinal cord mainly in center with an ill defined T2 hyperintensity (oedema / myelomalcia)…. Disc osteophyte complex noted at C6-C7 level causing compression of spinal cord mainly in center and towards left”.To interpret this, you have significant degenerative disc disease at C5-7, not uncommon. The compression of the spinal cord at C5-6 is significant which has caused cord injury (“ill defined T2 hyperintensity oedema / myelomalcia)” and still some compression at C6-7 is also present.
I agree with your neurosurgeon that you need an ACDF at C5-7 and you are not a candidate for an artificial disc replacement. Do not listen to your physical therapist about “needing more time”.
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.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.#33326Topic: ACDF Surgery Candidate ? in forum NECK PAIN |Hi Dr. Corenman,
I’m a 30 year old male (from India). I’ve been having experiencing constant (mild) muscle twitches in my right arm for over a year. Went to a few doctors and they diagnosed it as benign fasticulation syndrome. More recently I started experiencing a tingling sensation and twitching in my legs and stiffness in neck. Doctor recommended an MRI of cervical spine. My MRI report –
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Findings:
Cervical lordosis is obliterated with mild anterior angulation; however, alignment of cervical spines appears normal.Height of vertebral bodies appears normal. There is no evidence of any abnormal signal changes noted in vertebral marrow.
Cisterna magan appears normal. Craniovertebral junction appears normal. Clivus appears normal.
C2-C3, C3-C4 and C4-C5: The intervertebral disc space appears mildly hypo intense on T2WI. There is no evidence of any significant posterior bulging of the disc noted. There is no evidence of hypertrophy of uncinate process noted. Bilateral exit foramina appear normal. Spinal cord appears normal in size, shape and signal intensity. Paravertebral soft tissue appears normal.C5-C6 and C6-C7: The intervertebral disc space appears hypo intense on T2WI. There is evidence of disc osteophyte complex noted.no evidence of any significant posterior bulging of the disc noted. There is no evidence of hypertrophy of uncinate process noted. Bilateral exit foramina appear normal. Spinal cord appears compressed. Paravertebral soft tissue appears normal.
C7-D1: The intervertebral disc space appears mildly hypo intense on T2WI. There is no evidence of any significant posterior bulging of the disc noted. There is no evidence of hypertrophy of uncinate process noted. Bilateral exit foramina appear normal. Spinal cord appears normal in size, shape and signal intensity. Paravertebral soft tissue appears normal.
Impression:
1. Loss of cervical lordosis however, height and alignment of spines appear
normal.
2. Significant degree of discs desiccation with reduced height noted at C5-C6
and C6-C7 levels.
3. Disc osteophyte complex noted at C5-C6 level causing compression of
spinal cord mainly in center with an ill defined T2 hyperintensity (oedema / myelomalcia).
4. Disc osteophyte complex noted at C6-C7 level causing compression of
spinal cord mainly in center and towards left.
5. Exiting nerve roots appear normal.
6. Facets and facetal joints appear normal. No evidence of any intra spinal
space occupying lesion.
=============The neurosurgeon I’m consulting said I have moderate to severe compression and I’d need ACDF surgery but I can wait for a 1 month and strengthen my neck muscles if it helps in improving symptoms. He also stated that I’m not a good candidate for ADR
1 month later of physiotherapy my symptoms have not improved and I have a new symptom – slight loss in sensation in palms of my hand. Neurosurgeon said its a bad sign and recommended me to make a decision within a few weeks about surgery. Also, he wants a CT scan done before to determine if I need a discectomy or a corpectomy. Corpectomy being more invasive. My physiotherapist on the other hand asked me to wait for another month to finish strengthening my neck muscles. Wanted your opinion on my case and what would be the right course of action ? Can I avoid surgery ?
Thank you !
You note you “Re-herniated L5/S1 10 weeks after surgery. But symptoms have been totally different. MRI confirmed right sided protrusion again at L5/S1. Same size, displacing S1 similar to before….Symptoms following re-herniation have been mainly in back of both legs, and right heel/ankle”.
I assume that there is no left-sided shift to the recurrent herniation. You might have a condition called “cross-over phenomenon”. The pain tracts from the leg cross over to the opposite side at the spinal cord level (about T10-T11) before they ascend to the brain. This cross-over includes both sides (right to left and left to right). The area of decussations (cross-over point) is where the separate sided tracts come in contact with each other. The thought is that they can cause “feedback” where the right tract can induce left sided symptoms.
The nerve root on the left can also become inflamed from prior surgery or even from tension on the opposite side.
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.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Unfortunately “almost 4 months post op and all the symptoms I had pre-op are exactly the same if not worse”..”serve pain in my right buttocks when sitting”..”pain in my right foot (walking)”.
“Do I consider it as FBSS” (failed back surgery syndrome). No, not at this point but there is worry of nerve damage (https://neckandback.com/conditions/chronic-radiculopathy/). The better news is that there is mechanical component to your pain (pain that occurs when your are in different positions). This does not fully rule out chronic radiculopathy but can indicate there are still mechanical compressive possibilities which can possibly be addressed surgically.
At this point based upon your symptoms, you should consider a new MRI with gadolinium (IV dye) and X-rays with flexion/extension views to look for compressive pathology, instability and the rare possibility of a small fracture.
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.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.#33148 In reply to: L5-S1 discectomy 7 weeks post op |Good Morning again Dr. Corenman. Sorry for the delayed response. I am now 3.5 months post op and I am still having intermittent feelings of “numbness”, pins and needles in my right leg and foot. It feels as if my leg/foot is asleep and trying to wake up so to speak. It feels numb but I can feel any type of touch along my skin. These symptoms seem to dissipate during the night but as the day goes on returns in a waxing and waning fashion. I have very mild glute pain with certain movements that cause nerve tension. I have since follow up with my neurosurgeon and had an MRI a month ago which read as the following
“Status post right hemilaminectomy at L5-S1. There is bandlike enhancement in the laminectomy defect and in the right lateral recess with encasement of the S1 nerve root. Findings are concerning for fibrosis. Disc bulging with a superimposed left paracentral disc protrusion/extrusion otherwise contributes to mild bilateral foraminal narrowing and mild narrowing of the left later recess at this level”
I have been put back on neurontin 300mg TID for symptom relief and am supposed to follow back up in 2 months. My symptoms have not been touched at all by this and I really do not want to keep taking more meds if it can be avoided. Do you have any other suggestion?#33141 In reply to: ADR Heterotopic ossification cervical spinal canal |The problems with ADRs is that these devices allows motion and motion can induce new bone formation. The heterotopic ossification may or n=may not affect the spinal cord. It really depends upon the motion of the segment. With greater motion (translation), the spur could abut the cord and cause myelopathy. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
The best way to determine if this is a possibility is with flexion/extension X-rays. Make sure you fully flex and extend when the images are acquired.
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.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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