[pebblebeach2]

Hi all. Several things I needed help on.

First of all I went for the "trial" Intrathecal Pain Pump a few weeks ago. It was a combination of Dilaudid and Bupivacaine. It worked wonders. The catheter was placed at T10 and was to help my mid back/lumbar. So we are onto the permanent implant on 1/11/13.

Now here is what I really need help on. My pain doctor also requested an MRI of the cervical and thoracic region. Here is the report.

It is a long post so please bear with me:

FINDINGS:
There are postoperative degenerative changes status post cervical fusion from C3-C5 as well as posterior cervicothoracic fusion with stabilizing rods and bilateral anchoring screws at C4, C5 & C6. Posterior elemembs have been resected from C3-C7. There is no acute compression fracture. Vertebral alignment is normal. There is an accentuated focal cervicothoracic kyphosis at the cervicothoracic juntion. There is sever disc space loss at C6-7. C2-3 and C7-T1 disc spaces are normal. Remaining levels are fused.
There are stable focal abnormal intreased T2 signal seen within the cervical cord at the C5 vertebral leve and also at the C6 and C7 vertebral level where there is corresponding focal cord atrophy. Findings likely reflect cord myelomalacia.
Findings at the individual disc levels limited due to susceptibility artifact from the fusion hardware.
C2-3: There is no significant disc abnormality neural foraminal narrowing or central canal stenosis identified.
C3-4 No disc abnormality post fusion. Bilateral uncovertebral joint spurring with mild foraminal narrowing on the right. No central cord stenosis.
C4-5 No disc abnormality post fusion. Bilateral uncovertebral joint spuring with mild foraminal narrowing. No central canal stenosis.
C5-6 No central canal or foraminal stenosis
C6-7 No central canal stenosis on the sagitall images. Evaluation nondiagnostic on the axial images due to susceptibility artifact
C7-T1 no central canal or foraminal stenosis. No disc abnormality

CONCLUSION: Stable exam with postoperative changes as detailed above. No central or foraminal stenosis. Stable cervical cord myelomalacia

THORACID MRI:

FINDINGS: bilateral stabilizing rods extend to the level of T5. The vertebral bodeis are normally aligned. The vertebral body heights are presevered. There is a T1/T2 bright hemangioma in the T11 vetrebral body. Focal dark signal is seen along the left anterior aspect superior endplat on T9 on T1 and T2 imaging with no corresponding signal alteration on the T2 fat saturation sequence. Similar appearing subtle sclerosis is seen in this region on prior CT from 11/4/2010. The visualized spinal cord is normal in signal.

Evaluation limited due to susceptibility artifact particularly at the T2-T3 and T4-5 levels.
There is a small right paracentral disc protrusion at T5-6 and a small central protrusion at T6-7 T7-8. MKinor disc bulging at T8-9 to T12-L1. No central canal or foraminal stenosis. No thoracic cord compression
The visualoized paravertebral soft tissue are unremarkable. There is a 1 cm cyst versus nodule in the right thyroid lobe.

IMPRESSION:
Postoperative changes in the upper thoracic spine. Small disc protrusions and disc bulging at multiple levels. No central or foraminal stenosis. No thoracic cord compression

Here are my symptoms. I have moderate to severe neck pain. Radiating pain bilateral to both shoulders, the left seems to be the worse. There is weakness in both upper extremeties. Tingling feeling at times in my fingers. Difficult at times carrying things due to weakness in my arms.
At times I feel like my spine is being crushed. It feels like my spine has been put into a vice and someone is turning the vice tighter and tighter.
I do have lumbar issues. I have peripheral neuropathy of both legs. Numbess in both legs, the left worse then the right. A burning sensation at times. Pins and needles feeling. At nighttime my legs really bother me especially at bed time.
An EMG did show severe nerve damage in the cervical and lumbar region, severe arthrititis an peripheral neuropathy probably both spinal and dieabetic in nature.

I am concerned about the loss of disc height/severe at C6-7.
My neurosurgeon who I have been seing for 7 years or so is afraid to cervical surgery on me because I am in kidney failure and diabetic. Plus he felt that in order to even get to the cervical area it would require going thru the sternum and he felt that would be a nightmare of a surgery.

So where do I turn? Any opinions on the mylomalcia; the focal cord atrophy, the loss of disc height and foraminal narrowing while it says it is minor I seem to have major issues on dealing with the pain etc.
Any opinons would be appreciated. Thank you

[ginnie]

I am really glad to hear the pain pump works for you. That is always fantastic news. I did read up on myelomalacia, and this really is something I would investigate if it were me. Maybe seek another opinion. Your case is complicated. Going through the front, for the cervial spine is what I did.
I did read that spinal stenosis can cause myelomalacia, and that it narrows the spinal cord. I sure am no doctor, but the condition may warrent another opinion. I hope you keep in touch with me and let me know how you are. Wouldn't the pain pump take care of the majority of your back pain? I hope that you get permanent good results, and that myelomalacia does not turn out to be anything bad to add to your troubles. If you google that word, there are many sites about the condition. I wish you all the best. ginnie

[Leesa]

I'll try to help -

Findings: CERVICAL


Post -operative degenerative changes C3-C5. Unsure what he means by that.
Then he just explains what has been done. There is an accentuated focal cervicothoracic kyphosis at the cervicothoracic junction. Kyphosis is an exaggerated outward curvature of the thoracic region resulting in a rounded back. There is severe disc space loss (the vertebra are getting closer together due to flattening of the discs) at C6-7 C2-3. C7-T1 are normal. Remaining levels are fused.

This is confusing: There are stable? focal abnormal? increased T2 signal seen within the cervical cord at the C5 vertebral level and also at the C6 & 7 where there is corresponding focal cord atrophy. Findings likely reflect cord myelomalacia. I don't know what he means by "stable" and then "abnormal" but signal means that there is activity in individual neurons in the nervous system; and it's a measure of activity in nerve is indicated by frequency of discharge. And for the life of my I can't remember what myelomalacia is.

C2-3 Looks fine

C3-4 Bilateral joint spurring with mild foraminal narrowing on the right. The foramen is one of the holes the nerves pass thru to get to the spinal cord.

C4-5 Same as above

C5-6 Looks fine

C6-7 Evaluation nondiagnostic due to possible artifact

C7-T1 Looks fine


FINDINGS-- THORACIC

Evaluation is limited at T2-3 and T4-5 -- the way I understand it is they couldn't magnity it enough to see the artifact clearly - I'm probably wrong.

There is a T1-2 hemangioma on the T11 vertabral body. A hemangioma is a benign tumor of blood vessels that typically occur as purplish/reddish elevated areas of tissue/skin. I cannot really comment on the rest of this paragraph as I don't understand it.

There is a small paracentral disc protrusion (herniation) at T5-6 and also at T6-7 and T7-8. Minor disc bulging at T8-9 thru T12-L1. There is a 1mm. cyc nodule on the thyroid lobe.


Everyone loses disc height, as that is a part of aging. Degenerative disc disease is what it's called. The discs dry out, and that causes the discs to flatten and bulge/herniate. That in turn causes the vertebra to "come closer together/lose disc height -- in short, we become shorter in height! I used to be 5'4" tall, and I'm now 5'2". Isn't that awful! But it's a fact of life, so don't worry about it. Some of us have it worse than others, unfortunately, and some of us have PAIN with it, while others just fly thru life with NO PAIN! DRAT THE LUCK!!!

Your foraminal narrowing is minimal, and you don't have to worry about it now. As long as it doesn't get any worse, you don't have to worry about it. Right now it's just fine.

I wish I understood myelomalacia, or I might be able to help you on the focal cord atrophy, but I can't remember for the life of me what it IS. If I find it amongst my notes, I'll be sure to let you know!!

As it stands, you will be an EXCELLENT candidate for the PAIN PUMP!!! I'm so glad that it worked for you in the trial! I tried it and it worked for me too, but I was too small. I had the SCS too, but it worked itself out of me. And since the pump is bigger than the SCS, I couldn't have the pump. Please let us know your progress after you get the pump, will you? I REALLY want to know how you're doing, okay? God bless and please take care. Hugs, Lee

[pebblebeach2]

Thanks for the responses.

I am not sure why the medication/pain pump would NOT help the entire spine. I was told they could only help the worst area. So that is why they decided to put the catheter at T10 level.

But it was strange that while I had the temporary implant in my entire spine felt relief. While the midback/low back was the prime target the cervical area was getting secondary relief. I dont know if when I have the permanent implant done whether I will get the same results or not. Time will tell. But also I have peripheral neuropathy in both legs. I found that while I still felt the numbness it didn't seem as severe when the trial portion of the implant was being done.
Unfortunately after the trial was over it didnt take long before I went back to having some really rough days with pain.

As to the myelomalacia yes it concerns me too. My neurosurgeon was concerned about that and the focal cord atrophy which was all in the same area. But again with all considered surgery was not suggested because of risk factors.

But beyond that I am also concerned about the "SEVERE loss of disc height at C6/7"

The slight narrowing of the foramen and bone spurs I am sure are adding to the factors of the way I feel. Not sure what the doctors would recommend in doing. But I think everything in my case increases my pain leve.

I am thinking of a 2nd opinion. But it is a matter of who to use. About a year or so ago I wanted to see one of the top neurosurgeons in the area so I sent him my records at a prelimianry. He wouldnt even see me. Guess he figured he is not going to do surgery on me for whatever reasons so wouldnt even talk to me to discuss what my options are.

My pain doctor who is doing the implant thought I should be seen at John Hopkins or Hospital for Special Surgery in NY, but they are not on my plan so financially going there would be an issue.

When I see my pain doctor for the implant hopefully we will discuss the MRI results as well and I will get some feed back on what he thinks of the whole report.

What also concerns me is that while some of my pain will be controlled what can be done to stop the progressiosn of the issues. Not sure what the answer is or if I will even find an answer. But I can't give up hope.

[Leesa]

That's strange that you felt relief in the cervical area with the trial pump. But it's great -- and i hope you get the same results with the permanent implant!

Yes, you will get relief in both legs with the pump. That's what its best at, peripheral neuropathy. When I had the trial done, my right leg (which was the culprit) had NO PAIN at all! It was wonderful, as I'd been in such severe pain that often I'd vomit from it. So having no pain was such a treat! Drat the luck I couldn't have it tho. I PRAY this all works out for you. It will be just wonderful for you.

I'm not sure much can be done for progression of any of our spinal issues. I'm now deemed inoperable -- nothing can be done for me anymore. No surgery, no nothing, but medications.

God bless and keep us updated, okay? Hugs, Lee

[pebblebeach2]

Leesa:

Thank you for your words. This has been a journey for me since 1988. I never expected my life to go down this path.

I know I cant predict the future, all I can do is hope for the best. The pain pump is being done on 1/11/13, so just under 2 weeks away. I cant say that the pump will work as well as the trial did. I am prepared in that I know there may be some days that I have to deal with some off days. But if overall I get even a 50% relief from the pump then I am better off then not getting any relief at all.

As to where I am headed with the cervical/thoracic issues that is still up in the air and will deal with that in due time.

You ended your post about finding happiness. I have been struggling with this for such a long time. Trying to find happiness within in spite of what I am feeling physically and emotionally. But I will never give in my search for happiness.