hello everyone
 

I recently had a cervical MRI that showed multilevel spondylosis within the cervical spine with spondylitic disc bulges and osteophytes from C3-4 through c6-7 most severe at the C5-6 level with marked cord compression. There is focal increased T2 signal also seen within the cervical cord at this level consistent with myelomalacia at C5-6. There is mild retrolisthesis of C5 in relation to C4 and C6

I met with a neurosurgeon last week who told me that because I am not complaining of severe neck pain, that I would have to convince him to do surgery. Then my best friend who is a neuro ICU nurse showed my film to one of her neurosurgeons on her floor and he said I needed immediate surgery with fusion of C3- C7 with a C4 corpectomy. I don't get it, how can 2 separate neurosurgeons have such differing opinions.

Having 2 so different opinions I think I would try another Dr and get there opinion

Medical imaging is a wonderful diagnostic tool, but it doesn't tell the whole story. I'm not sure how a surgeon (the 2nd one) could—or would—make a snap judgment/statement like that without also doing a complete workup on the patient. IMO it's not medically responsible. He's the one I would avoid.

The first surgeon sounds (to me) like he's taking a more conservative approach. Cervical surgery is a risky proposition that should not be taken lightly. Studies have shown that long term, surgery results are no better than physical therapy.

Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up.

I read the other (long version) post. Not being a medical doctor, I don't know if those symptoms are possibly related or completely unrelated (the first surgeon may, and may have based his opinion on that assessment).

Is there some overwhelming reason you're eager to risk surgery at this time?

I have no problem with getting multiple opinions (I would discount/give significantly less weight to the one who saw imaging only).

Doc

That's why they call it Medical Practice
 

Hi brwnney
 

Welcome to Neuro Talk. Sometimes this difference between physicians is very difficult to the patient. I would seek a third opinion, no question about it.
If the words in your MRI say SEVERE compression, that is an indicator that you do need surgery. Please do all other therapies before you go into surgery. A Neuro Surgeon would be my choice of that next opinion. I do think you have some issues that need to be dealt with. I am not a professional in any way, but I am fused C3-7. I know a bit about the language. Leesa is the best on the site for reading the results. I think I would have to go for another opinion and bring all the records and questions you have. I hope there can be a resolution that will work. ginnie:grouphug:

Doc,
Thanks for reading my post and replying. The first neurologist I saw didn't do a medical exam, he brought me into his office pulled up my MRI film and asked me if I was having severe neck pain. When I answered no, his response was that I would have to convince him to do surgery (whatever that means) because he likes his patients to feel better after their surgeries and in my case, since I wasn't having neck pain to begin with, that I wouldn't notice a difference with surgery. The second surgeon, who I mentioned works with my best friend, did inquire about symptoms I was having such as weakness in my upper extremities and hands, numbness in my right hand and being off balance. True, he did not examine me but neither did the first surgeon. My concern is with the myelomalacia and the severe spinal cord compression at C5-6. I'm not eager to risk surgery, however I was told by the first neurosurgeon that a slip and fall or minor traffic accident could further damage the cord and cause paralysis. I am in the process of scheduling an appointment with a third neurosurgeon to get his input. Is physical therapy an option for spinal cord compression?
Thanks again for your reply

Thanks ginnie,
I am in the process of setting up an appointment with another doctor to get his opinion. The report does indeed say severe compression at C5-6 with myelomalacia. That is the part that scares me.

Hi brwnneyedgrl,

Thanks for elucidating; some of that wasn't clear.

AFAIK, physical therapy is almost always first line treatment for spinal issues.

It's not uncommon for surgeons to disagree on course of action (see following quote); there are many variables involved, including (but not not limited to) differences in doctor experience/knowledge, difference in interpretation, expertise in/with different procedures/therapies, etc. As is often noted here on NT, that's why they're called medical "opinions"; sometimes there's an easy consensus (a burst appendix has to come out) and sometimes 2 or more opinions are advisable to help a patient make an informed choice.

(emphasis mine)

You might post something to the Spinal Disorders & Back Pain forum for other opinions. I would either link to your previous threads, or consolidate them, including all information from both.

Doc

Hi Brwnney
 

Sorry you have to go through this. Well after what you told me, You most likely will get another opinion that says you need some help. Pick the neuro surgeon you are most comfortable with. I got lucky and had a fantastic doctor. I will be here for you, to listen and comfort if and when you have to get this medical issue resolved. There can be good outcomes with this, and a real fix, that will give better quality of life. Let me know what happens with your next appointment. ginnie:grouphug:

Get a 3rd, 4th, maybe 5th opinion...
 

You have seen two surgeons with vastly different opinions.

In 1999, I underwent a C4-C5 posterior laminectomy without fusion, I was 27. At the time, I had been experiencing severe headaches in the base of my skull for months (I fell on my ***** rollerblading). After the surgery, no more headaches. My neck felt great. The long-term side-effects: the surgery caused the vertebrae in my neck to straighten out (military neck) and the disks located above/below the surgical site are bulging due to the added compression (confirmed by X-rays in 2006).

My neck hurts. Right now, as a matter of fact. But, does that mean I'm going to run out and get surgery again -- Heck NO!

The smartest thing my Orthopedic surgeon ever told me was this -- unless you can no longer move (re: lower back, pars defects L2/L5), avoid surgery for as long as possible (he sent me to the Neurosurgeon that performed the cervical laminectomy). The other thing he told... Just break a bone already, all you do is destroy soft tissue... Still makes me laugh.

Seriously though, there are a lot of options available that do not include surgery. After all, you don't have any severe pain right now. You will experience pain once you have the surgery. The question is this: will the pain be surgical/recovery related (cutting into bone hurts!), or will the pain be a long-term side-effect of the surgery itself? You don't know.

When you are in agony, as I was – the option of relief is a good reason to proceed. If I had not been in pain, or had severe headaches, I would NEVER have undergone the surgery.

Hope this helps!

Hi all, I agree
 

Yes, the more opinions the better. Surgery is a last resort. Ginnie:grouphug: