[Kateinbluebell]

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

[forevernana4]

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.

[Kateinbluebell]

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!

[Leesa]

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

[forevernana4]

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!

[forevernana4]

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.

[Kateinbluebell]

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!

[mg neck prob]

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.

[ginnie]

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

[ginnie]

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