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Arachnoiditis Message Board


Spinal Cord Disorders Board Index


gmak, thank you for your time in reading and replying my post. Main dr is Orthopedic 1, because I visited him twice and went for PT according to his advice. He gave me Tramadol HCL for pain which I have not started to take. He also asked me if I want injection. He thinks I need surgery after 10 years. Other-2 is against injection, he is in favor of quick surgery, but not urging for it.

At present, I am only doing neck stretches at home, no other medical treatment. My neck pain reduced after PT, but recently I am getting more and more occasional numbness in my hands.

Here is my MRI report taken 5 months ago.

Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Just to recap my dilemma, the Ortho 1 said- do not let any one scare you to surgery. While the Ortho-2 said you need surgery, you can do it now as a precaution, otherwise after sometime when your symptoms will advance and you will give in. It sounded like 10 months max, not 10 years. I cannot go back to Ortho-1 before one year because that's when he will see me next. I have symptoms that are scary but not disabling yet.

Should I wait, should I do a surgery or see more doctors?
gmak, thank you for your time in reading and replying my post. Main dr is Orthopedic 1, because I visited him twice and went for PT according to his advice. He gave me Tramadol HCL for pain which I have not started to take. He also asked me if I want injection. He thinks I need surgery after 10 years. Other-2 is against injection, he is in favor of quick surgery, but not urging for it.

At present, I am only doing neck stretches at home, no other medical treatment. My neck pain reduced after PT, but recently I am getting more and more occasional numbness in my hands.

Here is my MRI report taken 5 months ago.

Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Just to recap my dilemma, the Ortho 1 said- do not let any one scare you to surgery. While the Ortho-2 said you need surgery, you can do it now as a precaution, otherwise after sometime when your symptoms will advance and you will give in. It sounded like 10 months max, not 10 years. I cannot go back to Ortho-1 before one year because that's when he will see me next. His office will not take appointment until it is one year from my last visit. I have symptoms that are scary but not disabling yet.

Should I do surgery so there is no permanent nerve damage, should I wait, or see more doctors?
Hello webdozer, thank you for your response. the first doctor indeed mentioned about replacing two vertebrae, I kind of ruled out his recommendations.

I told second one about the first doctor, he was upset and said don't let anyone scare you to surgery.

I told third doctor about second one and his strong words against surgery. Third surgeon kind of toned down after hearing it and started saying my report doesn't match with my symptoms.

Here is my MRI report-
Findings- Posterior fossa is intact and craniocervical junction is unremarkable. there is reversal of cervical spine lordosis centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

C2-C3: Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

C3-C4: There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

C4-C5: There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

C5-C6: There is loss of disc height with 2 mm grade 1 retrolisthesis C5 on C6 (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flatenning of the cord. Foramina mildly narrowed.

C6-C7: There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal with AP diameter 8 mm. There is moderate foraminal narrowing bilaterally.

C7-T1: Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

T1-T2 and T2-T3: Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.
IMPRESSION:
1. C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

2. Cord signal is normal

Any comments/suggestion will be much appreciated.
Jen, I like northern Virginia too. Thank you for your response and valuable advice. I didn't count the first doctor's opinion, and I probably heard it wrong. No one of these three advised laminoplasty. One reason could be that it is not their expertise. The second surgeon said no surgery because he told me my 8mm AP diameter and symptoms are acceptable. BTW, So far I did not feel weakness in hands or legs, I feel numbness several times a day and during sleep. He said I have 10 years and surgery is needed when it will show red on the MRI (being naive I didn't ask many follow up questions). The third surgeon is listed as one of the nation's top 50 spine surgeon according to a website and he is with NIH (Dr. Jay Khanna). He leaned towards immediate surgery. I made appointment with another surgeon who supposed to be very good too (Dr. Abraham Kader) but I agree with you, I probably haven't found the right surgeon yet. I am not settling until I am fully satisfied and until I can bear my symptoms. I have done XRAY besides MRI. What other kind of tests are there?

webdozer, thank you for your comments. Here is the full MRI report taken 6 months ago. I will appreciate your comment, and anyone else's who may have similar situation or know about this condition.
[B]
Open MRI[/B]
[B]Findings[/B]- Posterior fossa is intact and craniocervical junction is unremarkable. there is [B]reversal of cervical spine lordosis[/B] centered at C4-C5. Marrow signal is unremarkable. No prevertebral soft tissue swelling.

[B]C2-C3:[/B] Mild broad-based disc bulge and uncovertebral hypertrophy without mass effect

[B]C3-C4: [/B]There is a posterior broad-based disc ostephyte complex and bilateral uncovertebral hypertrophy minimally narrowing the foramina and anterior canal

[B]C4-C5: [/B]There is loss of disc height with broad-based disc protrusion and bony ridging with right greater than left uncovertebral hypertrophy. Disc ridge abut the cord on the right side moderately narrowing the canal and mildly flattening the cord. Right foramen mildly narrowed.

[B]C5-C6:[/B] There is loss of disc height with 2 mm [B]grade 1 retrolisthesis C5 on C6[/B] (spndylolisthesis) with broad based disc protrusion and bony ridging and left greater than right uncovertebral hypertrophy. There is cord abutment with moderate canal narrowing with mild flattening of the cord. Foramina mildly narrowed.

[B]C6-C7: [/B]There is broad-based disc protrusion and bony ridging and bilateral uncovertebral hypertrophy mild to moderately narrowing the canal [B]with AP diameter 8 mm[/B]. There is moderate foraminal narrowing bilaterally.

[B]C7-T1: [/B]Central disc protrusion abutting the cord mildly narrowing the central canal. There is mild bilateral facet degeneration.

[B]T1-T2 and T2-T3: [/B]Small central disc protrusion without mass effect.

The cervical spinal cord demonstrates normal signal without syrinx.

[B]IMPRESSION: [/B]

[B]1. [/B]C4-C5 and C5-C6 spondylosis ( with super imposed degenerative spondylolisthesis C5 on C6) with disc protrusion and bonny ridging moderately narrowing the canal and mildly flattening the cord.

[B][B]2.[/B][/B] Cord signal is normal
The fourth surgeon I saw last week gave me MRI again and EMG test. First MRI I had was an open one, this one is closed. Just got the MRI report. Looks like it there is a newer finding, the stenosis is congenital. Also, there is no mention of the word "moderate", all compression is qualified as "mild". Did my neck get better, or is it due to the open MRI which exaggerated the problem? Or this MRI is not accurate? During the EMG process the doctor said my numbness in hand is not due to the neck problem. There is no such indication. two out of first three surgeons recommended surgery. Fourth surgeon asked for second MRI and has not recommended one way or other. I am going to see him sometime next week.

Here is my new MRI report. I am confused. Any comment is welcome.


Examination performed on a 1.5 T closed MRI scanner.

Findings:
There are reversal of normal cervical lordosis with the apex at C4. The vertebral body heights are maintained without acute fracture or subluxation. The disc spaces are maintained. Bone marrow signal intensity is unremarkable. The cervical spinal cord is of normal signal intensity. The visualized posterior fossa and brainstem are unremarkable. The prevertebral soft tissues are unremarkable. No paraspinal masses are noted. There are congenital narrow cervical spinal canal.

Evaluation of the individual levels demonstrated

C2-C3: There is mild disc bulge resulting in mild central canal stenosis without cord compression, stable. There is no foraminal stenosis.
C3-C4: There is mild disc bulge resulting in mild central canal stenosis without cord compression, stable. There are degenerative changes of the left uncovertebral joint mildly narrowing the left neuroforamen.
C4-C5: There is disc bulge resulting in mild central canal stenosis with indentation of the ventral cord, stable. There is mild bilateral foraminal stenosis.
C5-C6: There is a central disc protrusion resulting in mild central canal stenosis with mild cord compression, stable. There is mild bilateral foraminal stenosis.
C6-C7: There is disc bulge resulting in mild central canal stenosis with indentation of the ventral cord, stable. There is mild bilateral foraminal stenosis.
C7-T1: There is a central disc protrusion resulting in mild central canal stenosis without cord compression. No foraminal stenosis.

Impression:
1. Stable MRI with demonstration of degenerative disc disease and a congenitally narrow cervical spinal canal resulting mild central canal stenosis with mild cord compression at C5-C6, mild central canal cord compression at C2-C3, C3-C4 and C7-T1.
2. Multilevel foraminal stenosis secondary to congenitally short pedicles as above
3. Reversal of the normal cervical lordosis, degenerative





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