Jellyhall

Thank you for your reply Dr Corenman.
I have now had a telephone appointment with another of the registrars of the consultant that I am under. I deal with a different one at each appointment, so neveer know how much of my file they have read and there isn’t time to go through everything during the appointment, which is 15 minutes long, because we are talking about the whole of my spine.

This latest neurosurgeon said again, several times, that doing surgery on my spine would be “extensively complicated and invasive”. He also said that “any surgical intervention on my spine would be associated with significant morbidity and would not guarantee reversal of symptoms and could make them worse. In fact, there is no surgical target for the back pain.” He said it would be a last resort and is sending me to Pain Management to try spinal injections. I was referred for this in August 2019, but by the time my name got to the top of the list, I had one appointment but the Covid shutdown happened, so I never moved on to have the Medial Branch Block injections he wanted to do to check which levels were pain generators before doing Radiofrequency Ablation there. I am still waiting to receive a reply to a letter I have sent asking to move forward with my treatment.

I now have numbness in the little finger and half the ring finger on my left hand, that doesn’t go away. Sometimes it is worse than others, but it never completely goes away. The neurosurgeon said he wasn’t worried about this because the EMG/nerve tests I had done a year ago didn’t show any evidence of left ulnar neuropathy. I hope he is right. My Mri report done in November 2019 states there is right exit foraminal narrowing at C4/5 and C5/6 and minimal left exit foraminal narrowing at C6/7.Flexion and extension cervical x-rays done in November 2019 showed a grade 1 anterolisthesis of C2 on C3 which reduces slightly on extension.

The MRI report from November 2019 mentions there are small disc osteophytes (?) in the mid and lower thoracic spine as noted previously in 2018. These are at T12/L1, T8/9, T9/10 and at T2/3.
It also says there is straightening of the lumbar spine and minimal retrolisthesis at L2/3. It also says there are disc-osteophytes noted at L2/3, L3/4 and L5/S1 levels.
I asked him if the straightening of my lumbar spine was going to be a problem because I suppose the spine isn’t loaded correctly now. He said yes it would and that it would be part of the reason I was in pain.

He also mentions that my MRI scan done in November 2019 showed acute effusion in both cervical and lumbar previously operated sigments. Also that there is extensive degenerative spine disease along the whole spine.
They will have another telephone appointment with me in 12 months time.

Dr Corenman, I would be extremely grateful if you could comment on this, especially the points that I have put in bold. I know that there is a lot here, sorry.

Remembering mostly what I wrote;
Thank you for your opinion Dr Corenman,
I also felt that the radiologist wasn’t committing as to whether my neck was fused or not. It sound to me like neither level is completely fused, with C4/5 being the worst. This is after 7 years! A real surpirse to me, although I have never had relief of my symptoms and they are getting worse and more frequent. It is a shame that the radiologist doesn’t qualify the amount of osseous bridging, either as a percentage or whether it is inside the spacer or outside the spacer as I have read that less than 50% fused, or only osseous bridging inside the spacer indicates pseudarthrosis.

I am hoping to have the flexion/extension x-rays done before the end of November. My appointment to really hear if I am fused or not is not until February next year.

Am I correct in my thinking about the statement “The combination of uncovertebral and facet joint degeneration seen to cause narrowing of the neural exit foramina on the left at C3-4 and C6-7 as well as bilaterally at C4-5 and C5-6”? On x-ray images that were taken about 10 weeks after surgery, it looks to me that behind the spacers, and on the coronal view the openings for the nerve roots, have all been cleared and opened up. Am I right in thinking that the fact that the degeneration of uncovertebral and facet joints are causing narrowing of the neural exit foramina, indicates that the surgical levels of C3/4 and C4/5 are unstable? I would think that if they are solidly fused, there would be no movement and so osteophytes would not form at those levels.

Comparing the x-rays done 10 weeks after surgery with the flexion/extension x-rays done a year ago, it appears that there has been osteophyte growth on the vertebra above the C4/5 spacer which looks to have pseudarthrosis, making it look like that vertebra is hanging over the one below by quite a bit.

I really appreciate you sharing your opinion with me.

I have just read my post above and realised that I didn’t tell you which level the grade 1 spondylolisthesis that moves slightly was at. It is at C2/3, the level above my top fused level.