Cervical Spine MRI and 2 Surgical Opinions in hand...help?
 

Good morning! Knowing you all are not physicians, I do find that you offer terrific advice having been there and done that!

Over the past six months, I've had three sets of epidural at three levels, one round of facet injections at three levels, rhizotomies at three levels, and one purely diagnostic facet block injection at C6-7.

The following are my MRI results:

Cervical vertebral stature is preserved, with no acute marrow signal abnormalities. There are predominantly fatty (Modic type II) endplate degenerative signal changes especially at C4-C5 and at C6-C7, and there is anterior disc bulging/osteophyte formation at these 2 levels. No Chiari malformation is seen. There is degenerative disc signal loss at C3-C4 through C6-C7, with diminished disc stature especially at C4-C5 and C6-C7. The slightly small C2-C3 disc most likely is anatomic in nature. There are facet degenerative changes at several levels, most notably at the upper-mid cervical levels on the right. Straightening of the cervical lordosis could be related to patient positioning, muscle spasm or a chronic finding.

C2-C3: Normal posterior disc contour, and normal central canal caliber. Moderate right foraminal encroachment, predominantly secondary to right facet bony overgrowth. Patent left exit foramen.

C-3-C-4: Slight C3 on C4 spondylolisthesis, probably secondary to right facet hypertrophy predominantly. Associated posterior pseudodisc bulging, without a significant true disc bulge component, and with central canal caliber normal. Mild right uncovertebral joint degenerative change. Mild right foraminal encroachment. Patent left exit formen.

C4-C5: Mild posterior disc bulging, with osteophytic ridging about the vertebral bodies, and predominantly the right uncovertebral joint. Relatively normal central canal caliper. Minimal right lateral recess encroachment at the disc level. Moderate-severe right and minmal left foraminal encroachment.

C5-C6: Slight posterior disc bulge. Normal central canal caliber, and patent exit foramina.

C6-C7: Mild broad-based posterior disc bulging, with osteophytic ridging about the vertebral bodies, and bilateral uncovertebral joint degenerative changes. Mild central canal narrowing, and mild left lateral recess encroachment at the disc level. Moderate left and mild-moderate right foraminal encroachment.

C7-T1: Questionable slight posterior disc bulge on the T2 sagittal. Normal central canal caliber, and patent exit foramina.

I had a consult with an orthopedic surgeon a week ago. The appointment lasted no longer than 15 minutes. He said fusions should be considered at C4-5 and C6-7; however, due to a relatively good C5-6 level, it would require fusing all three levels, which he said he would not do. He recommended a diagnostic single facet block in C6-7, which he belives is causing "most" of my pain. The block provided minimal relief.

I had consult #2 yesterday with a neurosurgeon. The appointment lasted over an hour. He reviewed my MRI with me on the computer monitor to show and describe exactly what he believes is causing my pain. He gave me three options:

ACDF at C6-7, but said I needed to be realistic because the surgery may not improve my pain due to all of the other issues in my c-spine, and there was a possiblity of needing further surgery in three months or so.

Posterior fusion of C3-4, C4-5, C5-6, and C6-7. Even though this surgery is definitely a major undertaking, he feels it would take care of all the problems.

Posterior and Anterior fusion simultaneously in one procedure. This sounded like "belt and suspenders" to me, and I honestly don't remember everything he said about this!

I will be having a consult with another neurosurgeon next week.

In the meantime, I wondered if any of you would be so kind to give me any advice you may have. Thank you all in advance and sorry for the very lengthy post!

Kate

Hi and welcome. Quick question, are you having noticeable muscle weaknesses? can guess in the report that you must be in alot of pain...right sided?

if you're not having significant weakness, that may be why you're having the varied opinions? You see, I think the thoughts might be to give you the best chance for good pain outcome, your surgery would be extensive. So, unless there is a risk for permanent damage, it might not justify the risk if extensive surgery in the opinion of ortho. That said, it sounds like you've done alot of work to try non-surgical procedures.

Only you know what you can deal with and for how long. It may boil down to that single question for you.

My first MRI looked something like yours but not so involved. Because I had significant weaknesses, surgery wasn't much if an option. I needed additional levels but insurance would not approve. That was four years ago and I'm probably looking at additional surgeries right now though I don't yet know how extensive it might be. So there's something to be said about doing everything at once.

I know that didn't help much. Please just remember only you know what you can handle pain wise to look toward surgery. Read lots and ask lots of questions!

You have support here.

Thank you, Forevernana! Yes, lots of pain -- neck, shoulders and back (between my shoulder blades). It hovers around an 8 out of 10, worse on the right, but bad on the left as well. I do have weakess in both arms, although I wouldn't say it's severe...maybe mild to moderate. I also have tingling/numbness in fourth and fifth fingers on both hands.

Lots of advil helps take the edge off the pain. Unfortunately, before every procedure, I need to go off them for three days, which reminds me how bad it really is! It's become a depressing cycle of no pain meds, then a procedure, and no relief.

I'm 52 and have a very busy and demanding job, all of this has slowed me down to the point that all I want to do sometimes is lay still. Any head movement or arm extension makes me wince with pain. Ugh. I just want to feel better!

Thanks again!

You must be realistic. Surgery is ONLY for mechanical problems. It is NOT for pain issues. You have to accept that. Almost ALWAYS after surgery, you're left with the same pain or worse. That is just a given. If you can manage your pain right now, I'd leave it as is. BUT if you're in danger of permanent nerve damage, that's another story. I see nothing that indicates the cord is in danger so that's not a problem.

I would ask if this could be "put off" and if physical therapy could be considered. I would try any and ALL conservative methods at my disposal before undergoing any more surgery. Surgery just begets more surgery, as you've already found.

I really hope you can avoid surgery, at least at this time. Physical therapy CAN be very successful in many cases, in relieving pain. In fact many times it's much more successful than surgery! Latest studies have shown that people who have surgery have the SAME results as people who have had physical therapy!

So ask your surgeon about therapy and see what he says. I wish you the very best. Please let us know. God bless and take care. Hugs, Lee ;)

I understand. Even without the weakness issue for me, the pain alone was having me almost beg for surgery (though they didn't give me that option...lol). Even with knowing the first surgery destabilized things, I think I would've have gone ahead.

I'm pretty strong, but I couldn't think of another day with that incredible pain, let alone never ending.

I will say that I got fabulous pain relief for a long time and even though issues are back, they've never come close to that level of pain. Nothing in my life to that point was as painful, even childbirth.

Stick around through this!

I will add...please remember that my surgery was only one level. Nothing compared to the larger option the neuro gave you.

I also need to add that my husband's pain was alot like yours and after some injections, but mostly decompression therapy, he was fine. He said the decompression was amazing and had alot of strength back after only two sessions with great pain relief. Have you tried decompression?

As you're seeing, outcomes are varied and very situation specific.

I very much appreciate everyone's thoughtful input. I didn't mention it in my original post, but I did physical therapy and decompression before all of the injections. I truly am trying to take it step by step, but none of the steps I've taken have helped. I will be very interested to hear what the third surgeon says. I'm fortunate to live in an area with excellent medical care options, plus I have the the benefit of knowing surgeons in other areas of expertise that are helping to guide me to who they feel are the best of the best to treat my condition!

Hi Kateinbluebell; I had the exact fusion as your one oppinion suggest-- and I also agree with both previous post. I will say were same age and I as also have a high demanding stressful job ....its came down I was spinal cord compressed all 4 levesl....the pain over period of 5 months became so bad I couldnt function anymore ....no way to live like this ---I have no regrets it gave me my life back. Some people it helps tremendous with pain relief-- some are not so lucky. Im somewhere in the middle. Let me say this I have no regrets-- it gave me my life back. Without this surgery I wouldnt or couldnt have lived in this pain and Im very stong ....I almost lost my leg to cancer so I know pain. I think Leesa saying put it off is good advice but also is Hanna ---pain is very sujective to each person. Im single own a new home and work 10to 12 hrs days....18 month post surgery im having some shoulder issues because of neural formeman but i can handle it so much better. Im so sorry I remember the pain prior to surgery and all the anxiety it caused. The recovery for me was not bad at all. In the end you can only decide how much you can take!! Wishing you the best and please feel free to ask as many ? as you need. Again wishing you the best of luck.

Hi Kate
 

I am so sorry you are going through all the cervical issues. It's great that you are going for a number of opinions. I am fused C3-7 after failed C6-7. They should have done the whole fussion first time around, as mine too were not in good enough shape to take the stress of the brackets etc. Please keep getting those opinions, until several are in agreement. Going anterior and posterior is a more difficult proceedure. Was it stated why both would be used? Don't hesitate to bring a friend along to your next appt. I did this so I wouldn't forget what the doc. said. In fact I had two people with me. Leesa is better than I am for sure at MRI interpretation. I do wish you all the best, and a good resolution. ginnie:hug:

Hi again Kate
 

I also want you to know, that surgery can help at times. In my case, I got good resolution with a reduction of pain, tingling, numbness and weakness. I had tried all the options before my second surgery. It was the pain specialist and the neurologist together that said I had to go for the second surgery. There are good outcomes. ginnie:hug:

Thank you, thank you all!

Personally, I don't feel that I can put off surgical intervention, and I'm willing to take the risk at some level that more than one doc agrees is the right road -- single level fusion or multi levels. I need to do something.

Mg neck prob, thank you for your post. We are extra similar in that I am also single and busy, busy. I'm heartened that surgery helped you. From your history, you do know pain. From time to time, I tell myself to "suck it up" and "it's not that bad" and "chin up". It doesn't work for very long. I'm fortunate that my employer has said take care of yourself first, and, if you need to be out for 6-8 weeks, that's what you'll do and we'll take care of business while you're gone...cross this worry off your list! Thank goodness...

Leesa, I do believe my issues are mechanical, and the neuro said that multi-level fusions together with disc/foraminal cleanup would help my pain. He also said that I'm not at risk for paralysis...yet...but the nerve issues caused by mechanical actions are the culprit. Do you believe differently?

Ginny, very interesting to hear that you did a C6-7 followed by a C3-7. May I ask how much time passed between these procedures? I am also heartened to hear of your positive outcome!

Thanks again!

Kate

May I add a few more personal things? My sweet son is a Marine and is in Afghanistan. More than once I've though that the guy upstairs gave me this neck distraction to prevent me from focusing on him, which it truly has. Reality says that I've got pain and stress from both issues! I also have a dear daughter that is helping me every step of the way! :)

Please thank him for his service, and you and your family yours...

From the daughter of a 22 year marine, retired master sergeant, viet nam vet, two people hearts from that period as well.

Forevernana,

Oh...gosh! Many thanks to your father for his service and you as well! My dad was career Army...more tours than I can remember! He's no longer with us, but those ribbons and medals are truly priceless. It gave me the chance to live all over this wonderful world, and I wouldn't change it for a second!
:hug:

Same here! Wow!

Sadly dad has passed as well. He was buried in what would have been his sixty fifth birthday. My father was a fine marine...retired "top" and loved his country like no other...served it well.

It was hard for our military personnel and families then, and it's hard now. You will ALL be in continued prayer. If you ever need an ear, I'm here and will likely understand. Don't hesitate to private message me if you choose.

The few, the proud...ain't it the truth. ;)

PS...God bless your daughter for not only being a good daughter but for enabling a marine to know his mother is in good hands so he can stay focused. Every family member pays a critical role.

Did you ever converse with your dad while on tour of duty via the old ham radio type system when you'd have to say "over" when you were finished with your part of the convo for the moment? Lol. I remember...

Hi Kate
 

Hi Kate, I trusted my first surgeon. He didn't tell me that I had more wrong with my neck at the time of my first fusion. I had trouble right out of surgery which he continued to tell me it was all in my head. There were 6 years of pain management, until my pain specialist did a floroscopy, with Katemine infusion. At that point he could see the other vertrebre failed and referred me to a different neurologist, who really did correct it right away.
I should have used my head, gotten my records from the first time, and addressed the issue right away with another neuro surgeon. The whole thing should have been done right to begin with. I had no money, no insurance, so he did only what he had to do to save me from being paralized. In my case I reversed the curve of my spine as well, so it was structural. Arm yourself with as much information as you can Kate. Really, I am OK now, and not in very much pain at all. I was not assertive enough, to demand some answers from that first surgeon, nor did I question why he thought it was in my head.
You know your body better than anyone, and don't allow a neurologist to avoid your questions and concerns. I will be thinking of you Kate. I hope all goes very well with you right from the beginning. take care. ginnie:hug:

Awwwww, Ginny, please don't be hard on yourself! I like to say that with any decision we make, we make the best decision we can with the information available. The internet and this site in particular have helped educate me in a way that just wasn't possible 5 or 10 years ago. Back in the day, we relied on a physician to guide us in a medical decision, for which the physician studied many, many years to be qualified to guide! Of course we trusted.

Thank you for your kind and thoughtful words!:hug:

Thank you Kate
 

Hi Kate, thank you. I guess we learn by our errors. I came to NT, right before my second surgery. Hysterical etc. This site did more for me than all the doctors I ever saw. People cared, and that is what got me through it. I will be here for you too Kate, and praying for your good outcome. ginnie:hug:

[Kate --I think your thinking is very clear and surgical intervention will need to be required --just my thoughts! I would go for the full fusion at one time esp knowing in the very near future 2nd surgery will be required esp with hardware used --the risk is much higher of adjacent disc disease.Knowing those disc already are problemtic. Who wants to have this kind of surgery twice...inquire with your next consult about getting a bone growth stimulator to where during you recovery---its just a device u where after surgery 4 hrs a day ---u dont feel anything it sends these currents to help aid in a solid fusion. I had one-- on a multi level u want to achieve a solid fusion so take any tool offered. The reason I say ask is-- the insurance company usually has to pre-approve it and usually a third party vendor come to your room the morning after surgery. Wishing u the best and Ginne is right the people on this forum will help u get thru it --and Im very glad to hear you have a good daughter helping you every step.Best always!!

Thank you, Mg neck prob! If the next doc offers the same options as #2 doc (single-level or multi-level), I will definitely focus on the multi-level discussion for exactly the reasons you laid out. Thank you for mentioning the bone growth stimulator. I'll check into it!

Over the past few days, everyone here has been so supportive! I'm starting to feel a good kind of anxious...like let's get the surgery party started and finished PDQ!

I'm tired of being a couch potato, but I am having fun watching Mad Men! I never watched it when it was on TV, so I bought the first three seasons on DVD. I think I only have one episode to go, so I'll need to get my hands on seasons four and five! Ahhh...the things we do when we can't move! Before all of the neck problems, I barely sat down...I would always be doing this or that! It's a whole new experience being so sendentary! I am already thinking ahead to my recovery and what I'll do to amuse myself! :eek:

I relate to that I watched more t.v that year then my whole life combined ---after surgery your right boredom because a problem (lol) my pain after surgery was so much more tolerable then before. Its bad when your family tells u ---you told us that story like 3 times--lol, whens your next apt??

Ha! I already tell my family things more than once! Or they say, Mom, I already told you! Gotta love aging!

I am waiting to hear when the next appointment is...a family friend who used to head up the top eye hospital in the country is talking to the chief of neurological surgery (he doesn't concentrate on cervical spine) at another hospital to determine which surgeon I should meet with and they're trying to "triage" me in. I am very, very fortunate to be able to call on friends such as this one to help me!

P.S. I've never done Netflix, but I'm thinking it might be just what I'll need during recovery!

My appointment with Doc #3 is this Friday, 1/25. Can't wait for his opinion!:)

Very good --Please post when its over I will be anxious to see that he has to say. Thanks!!

Update!
 

Hello friends!

I received a third opinion and have made a decision. I'm having a single level, C6-7 fusion using an iliac crest bone graft. It is scheduled for Wednesday, 2/27. I chose a neurosurgeon from University of Pennsylvania, who has been incredibly informative and caring. His PA and other staff members are wonderful too.

Since the purpose of this site is to share information, I plan to post updates as things progress. The good...and the bad.

All pre-op tests were done on Wednesday and included a chest x-ray. Ummm...here's the bad...I got a call from the very nice PA saying everything was normal except for the chest x-ray, which showed some lung "scarring". Not a lesion, not a mass...scarring. Possibly from a long-ago respiratory infection like bronchitis. I was told not to get worried or to make myself crazy, but I do need a CAT scan to confirm. It is scheduled for Monday morning.

I was already verklempt about the fusion decision, a little more when he told me about the graft, and now I'm really queasy about the results of the CAT scan! Yes, I smoke, but have finally seen the light...and it's not a cigarette lighter! I've been down to five per day since early January and will be down to none on Sunday according to my plan!

Now for good news! My sweet USMC son has returned from Afghanistan!!!

Kate

[Hi Kate,


Please ask dr try to get you bone growth stimulator --for your recovery period. You dont feel anything its like a horse collar you wear around your neck for 4 hrs a day for like 4 weeks ---it really help aid to achieve a sold fusion. Wishing you the best --let us know how your ct turns out .

Thankfully, all is a-okay with the CAT scan. The unremarkable results were sent to my primary physician, and we'll do a follow up scan in three months -- just to be on the safe side.

Surgery is set for next Wednesday, 2/27. I recall someone mentioning practical items to have on hand following surgery. Straws, front buttoned shirts/nighties, pillows of various sizes are some I remember. Anything else? I'm a subscriber in good standing at Netflix! Any other helpful hints?

I'm anticipating an overnight in the hospital and 6-8 weeks recovery. Walking is a must as soon as I can following surgery. I already have collars (one regular, one for shower) and have been told to wear them always, at least until my 6-week follow up.

Do any of you have any input on the iliac graft? I was told it may be more painful than my neck!

Many thanks in advance to the very kind folks on this site!

:hug:

Kate

Hi Kate
 

I wish you the best with your surgery. I used an incline pillow for about 6 months. Helped with pain, and to keep me comfortable. It will all turn out OK. We hope to hear from you soon, that all went well. ginnie:grouphug:

Hi again Kate
 

I didn't have the Iliac graft. I had donor bone grafts C3-7. I do know that the area can be sore for awhile. ginnie:grouphug:

[Hi Kate,

You will be in my prayers on 2-27-12 --only thing in case your throat is sore have pudding,yougart,soups,jello==soft foods just in case throat is sore for a few days. Always wishing you the best!!!:hug:

Hi Kate
 

For the most part I do agree with Leesa. Try all conservative treatments first.
There are several things in your report that give hope that PT may improve your pain. When the MRI says "mild" or "moderate" That is a clue to how severe your condition is. When the MRI says "SEVERE" and cord impingement, then sometimes surgery may be necessary.
The only other thing I can add is that I did C3-7 and it did resolve alot of my pain issues. I did have definate "structure problems" with reversing the curve of my spine, and nerve impingement. I am not pain free, but it is much better than what I was experiencing before.
Keep getting those opinions. I had a Katemine infusion in the cervical area several times which helped prior to my surgery. We will be here for you, and hoping this has a good resolution in what choices you make. ginnie:grouphug:

Update!
 

Hello dear friends! My apologies for not posting sooner, but here’s an update!

I had C6-7 ACDF on Weds, Feb 27, using a bone graft from my right iliac crest. All went well, and I was released from the hospital late the day after surgery with lots of pain, muscle spasm, and constipation meds. Recovery was going well at home with lots of help from my son and daughter, mother and sister. I also had a visiting nurse and quick visits from an OT and PT to ensure things were a-okay.

About a week into my recovery, I began to feel increased pain in the hip area below the bone graft incision. I called the doc’s office and told the visiting nurse. They said it was to be expected and graft pain is often more significant than the fusion site. I began using a cane, but I wasn’t moving too much except between my bed and the bathroom. Although the pain was pretty significant, it wasn’t getting worse, so I continued taking it easy.

On Weds, Mar 13, around 7PM, I was getting out of bed with the aid of my cane. As my right foot touched the ground, I heard/felt a “pop” in my hip and lowered myself to the ground, in horrible, horrible, horrible pain. My son came upstairs and tried to help me…the help was to call 911.

I was transported to my local hospital, which started me on dilaudid and took x-rays. X-ray indicated an avulsion fracture of my iliac wing. Basically, there was a vertical break from the graft all the way down to the bottom of the wing. I was transferred by ambulance to the hospital that did the original surgery for further treatment.

Long story short, I was readmitted to the hospital, suffered from excruciating pain for a couple of days until the docs reached a consensus for treatment. I was on self-administered morphine, and something else I can’t remember the name of, but it barely touched the pain. I had surgery late in the evening Mon, Mar 18, on my iliac wing using a plate and quite a few screws to reattach the chunk of bone that had fractured off. I was released from the hospital on Fri, Mar 22.

So here I am at home recovering again! I’m looking on the bright side and feeling a little better each day. Thank God for my family, visiting nurses, and everyone who has helped me through this!

A Picture Says a Thousand Words
 

The graft was the dark "triangle" towards the top left of the wing. The pointers show the beginning and end of the fracture...ouch!

Kate---WOW ---sick--- it snapped from your hip. What the heck is the chances of that??????? --Im sorry ---and i know the hip has a bad blood supply too. Im so very sorry to hear this news.

Oh Katen
 

So sorry this happened to you. I had never heard of the hip giving way like that after surgery. You have been through so much. Get well soon, I am glad you had help during all this too. Sending prayers for recovery your way. xxxginnie:hug:

Kate --i feel so bad for you !! Did your get the machine to wear around your neck ? By chance are you a smoker ? If you are you really want that machine to help achieve a solid fusion.

I did not get the device for my neck, but they took an xray of my neck when I was in the hospital. Fusion is looking very good and I'd say that 95% of the pain I had in the neck, shoulders, and along shoulder blades prior to the ACDF is GONE!!! YAY!!!

Thats great news!!! Im glad you posted to because it will help others who may be needing this surgery in the future ----that many of us so have a good outcomes ---not perfect but gives you a life back.

As soon as I'm feeling more up to it, I will definitely post a blow-by-blow of the ACDF...right up until "the troubles"! :)

Katie - what a crazy thing to happen! Glad to hear it sounds like your recovery is back on track now though.

I usually post in the post concussion syndrome section, but follow along in this forum because I suffered a neck injury back in 2011 when I also suffered a pretty bad concussion. I'm also in the Philly area and have an appt with a neurosurgeon at Jefferson in mid May (earliest avail appt!). I really want to see another surgeon before that though because the weakness in my arms and hands is getting worse. It's getting difficult to carry groceries, do chores around the house, etc. I'm wondering if you wouldn't mind posting the name of your surgeon at Penn or possibly pm'ing me. I've been living with mild cord compression at c5/c6 (along with more stuff going on at that level) as well as what I think is some minor stuff at the other cervical levels. I just want my life back! Thanks in advance.