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Spinal Cord Disorders Board Index


They want to go in w / a c4 c5- c5 c6 disc fusion both anterior - w/ the cages & then flip me & do posterior w/ the screws & titanium plates he said based upon my neuro exam when he flicks my fingers my thumb goes in& my reflexes r more abrupt then when examined immediately After mva in late feb. he also stated I have severe torn ligaments that did not show on the MRI - something about they show immediately / mine came later during pt .- something like that-- he said I have spinal cord impingement - & instability w- the disc the MRI in feb that I posted is the same as the one in June - a little more narrowing - I will give it to you so you can compare - yet he's basically going off of the flexion x Ray which shows severe spacing between my vertebre / which the other physician stated that could be something I wad born with - I asked him that he said no - I also asked him an
abou the muscle trap pain in my shoulder - he stated that the muscle is compensating for the instability in my neck that's why I have not been getting better - he scheduled the surgery - July 7 th it's 3.- 4 hours long & they have to flip me - he talked about going thru the front & not being able to talk for a while / raspy but it would subside - he stated he did have one patient that did not get her full voice back - what to do what to do - I have a call in for a 3 rd opinion but I'm not sure I will get it in time - it would be at u of Michigan - - should I go to Cleveland spine ? Should I hold off on surgery - can my neuro symptoms get worse ? Once I find my new MRI read I will post it - oh & I'm 40
here is my CT from feb.
Findings: No vertebral fracture or paraspinal soft tissue abnormality is seen alignment is straightened.The current exam does not assess for ligamentous injury. The spinal canal contents are suboptimally visualized. There is a posterior disc protrusion at c5-c6 with mild central canal narrowing. The visualized portions of the aerodigetive tract, thyroid and larynx are unremarkable. There is a pleural-parenchymal scarring at the lung apices.
Impression No cervical spine fracture or malaligment.
2. Posterior disc protrusion at c5-c6 with mild central canal narrowing.
Now MRI from Feb: Findings:

Alignment is anatomic.
The cervical spinal cord is normal in signal intensity.
There is no evid. of lig injury within the cervical spine
There is no prevertebral soft tissue swelling.
The cervical vertebra are normal in marrow signal intensity. There is mild loss of intervertebral disc height at c4-c5 and c5-c6
At c2-3 there is no posterior disc abnormality, cnetral canal stenosis, or neural foraminal narrowing.
At c3-4 there is no posterior disc abnormality, central canal stenosis, or neural foraminal narowing.
At c4-c5 there is a posterior disc protrusion with narrowing of the ventral thecal space, but no central canal stenosis or neuroforaminal narrowing.
At c5-c6 there is a posteiror disc protrusion eccentric to the right with mass effect on the right aspect of the cervical spinal cored with mild central canal stenosis. There is mild left and no right neural foraminal narrowing.
At c6-7 there is no posterior disc abnormality , central canal stenosis or nueral foraminal narrowing.
Impression:
1. No evidence of ligamentous injury
2. Posterior disc protrusions at c4-c5 and c5-c6. Protrusion at c5-c6 exerts mass effect on the right aspect of the cervical spinal cord with mild central canal stenosis.

Okay now June's MRI>
The cervical spinal cord is normal in signal intensity.
the cervical vertebrae are normal in marrow signal intensity. There is loss of intervertebral disc height and c4-c5 & c5-c6
There is no evidence of ligamentous injury.
At c2-3 there is no posterior disc abnormality, central canal stenosis or neural foramiinal narrowing.
At c3-4 there is no posterior disc abnormality, central canal stenosis or neural foraminal narrowing.
A5 C4-5 there is a posterior disc protrusion with effacement of ventral thecal space, but no central canal stenosis. There is a mild left and right neuroforaminal narrowing. Findings unchanged.
At c5 -c6 there is a posterior disc protrusion eccentric t the right with mass effect on the right aspect of the cervical spine cord and mild central canal stenosis. There is mild left and no right neural foraminal narrowing. Findings are unchanged.
At c6-c7 there is no posterior disc abnormaility, central canal stenosis or neural foraminal narrowing.


Impression: right paracentral disc protrustion at c5-c6 with mass effect on the right aspect of the cervical cord and mild central canal stenosis. finding are unchanged.
2. Posterior disc protrusion at c4-c5 with effacement of ventral thecal space.
3. Mild left neuroforaminal narrowing at c4-c5 and c5 -c6.

Now the # 3 under (impressions: )is new on this recent MRI. We asked our 2nd of opinion NS. she said she see's no change. Nothing dramatic that would need surgery. Yet my 1st opinion is showing instability based on the flexion xray along w/increased narrowing at levels and spinal cord impingement. along w/ several neurological changes.
when my 2nd referral NS looked at the flexion xray she stated I could be born like that she see's no issue just need strengthening exercises. I heard that stand up mri's show instabiltiy ? could this be true?
In pt they wanted to start strength training. They stated my muscles are still lig. sore torn ..I'm just wondering will not having the muscles around that area working up to 100% effect the growth or fusion...I noticed that in another thread that her disc did not fuse because of the loss of muscle and therefore blood flow to the area. ? Please help.
I have surgery scheduled in 1 week..should I cancel should I go ..? should I get a 3rd opinon again....Once the 2nd neuro see's the bone scan she was going to consult w/colleagues regarding my case that she worked with when she was chief resident of nuerosurgery at UofMichigan...I'm thinking I should take that bone scan w/her & see what else she has to say.? This is a big step once surgery is done it's a long recovery....Is my body up to it...?
Thanks Marcia, yes I'm unclear - I wake up sometimes w/ no pain - yet from wearing my neckbrace my muscles in my neck & arms are a little week .... Other than that I think the tingling in my feet is coming from my lower MRI scan - this could be - ? Or no? Do neurological changes only come from spinal cord Impingement ? When they say mass effect - is that major ? It's definetly not mild. - but what if the tingling in my feet is from the MRI lower level & because of the weight of the collar it has been bothering me ? Yet my feet do still tingle sometimes when I lay on my back - so then what ? & what if stregthening does help ? What if it paralizes me ? I can't deal w/ that decision - can I get a 3 rd does insurance cover that? Here is my MRI from the lumbar - alignment is straightened- the conus has a normal appearance and ends at the level of l1 - l2
the lumbar vertebre are normal in marrow signal intensity. There is loss of intervertebral disc height at L 4- L5 and l 5 - s 1
at t12-l1 therevis no posterior disc abnormality, ccstenosis or neural foraminal narrowing
at l1- l2 there is a small difusevdisc bulge w/ out cental canal stenosis, or neural foraminal narrowing
at l2-3 same as l1 l2
at l3-4 there is a small difuse disc bulge and bilateral facet athropathy without central canal stenosis and neuralforaminal narrowing
at l4-5 there is a difuse disc bulge bilateral facet artropsyhy w/ superimposed central disc protrusion and annular tear. Findings result in mild central canal stenosis. There is mild bilateral neuroforaminal narrowing.
At l5-s1 there is moderate posterior disc protrusion which mildly narrows the central canal and mild to moderately narrows the keft lateral recess in close proximity to the traversing left s1 nerve root, correlate for left s 1 radiculopathy. There is no neuroforaminal narrowing.
Impression; 1- central disc protrusion at l 4- l -5 with mild central canal stenosis.
2- moderate posterior disc protrusion at l 5. - s 1 with mild narrowing of the central canal and mild moderate narrowing of the left lateral recess in close proximity to the traversing left - s 1 nerve root, correlate for left - s1 radiculopathy.

Yet - why is everything on the left when I have tinfling in both my left and right foot , but no leg pains - would this be the spinal cord neurological changes or no ???
Marcia, I hope you can take a look at the lumbar MRI as well - should I be worried about the radiculopathy ? Is that nerve root impingement ? I heard thruither threads once you have that they cannot fix that if it's a post op symptom is this true ? - or do you think the tingling in my feet is more neuro due to spinal cord impingement - so maybe the linger I wait the worse my symptoms could get ? & therfote cannot improve w/ this spinal cord impingement issue - I guess I don't get it if it's impingement on a certain level I get how the nerves at that level r affected - yet if it's the spinal cord then what nerve is affected ? Help need some more info when you have time - still contemplating surgery ? No surgery ? Wait? 3 rd opinion ??? What to do someone anyone in a similar situation please respond
good info there jen. mj, the word 'myelomalacia did NOT yet show up in your MRI report, and that IS a GOOD thing since having it at all simply means what jen mentioned with the cord tissue REALLY being impacted beyond maybe the outter layer? what takes place when TOO MUCH real solid compression is simply ON that cord IS called mylomalacia or granualuizing of the cord tissue itself? this is kind of natures way of removing what would turn into like "scar tissue" only becasue it would be necrosed, or dying from too much cord compression, so that there is good for your cord. BUT while it is NO^T there right now, over time, it can pop in like mine did post op.but mine was from the dead tissue created by having a scalpel cut into my cord to resect whats called a cavernoma that was bleeding. this was a seriously icky lessor of two evils type of decision that if i did not decide to have the surgery at all, i WOULD have it later(to mostly stop bleeding and also THEN remove the cav), but only AFTER i became paralyzed from the chest on down from having only two mms left that was not yet taken up by my cavernoma.

in my paricular case, unlike jens,and this CAN be different in every person, my cord amp was only about 10 mms,and my cavernoma actually was already 4x6x8 mms in size. it WAS taking up ALOT of space there and would even more if this lil sucker bled and i did not choose BEFORE that to just have my amazing and very experienced in what I had neurosurgeon who had been head teaching prof at the U of MN for well over twenty years(35 years as an NS total) and removed hundreds of what i had there, remove it. and that just really IS the key here mj, the more experienced your NS just IS in doing what you need done is always the best way to go in almost every case.

i am sooo glad they actually did that lumabar too mj,seriously. anyone who goes thru the forces involved in any solid MVA simply NEEDS that whole cord and column totally cleared for ANY issues. the thing here tho is the fact that you actually have the bilateral(both feet) involved in whats going on,and depending upn whther or not that area in the lumbar is impacting BOTH sensory nerves or this is from your cord alone, really would impact your decision here. any GOOD NS would be able to tell you whther or not the lumbar IS mostly a sensory and would have to be dead on central in order to even crate the bilateral symptoms or if this just IS the way your cord is showing itself with its injury.

if you simply DO show the hyper reflexia in both legs with that brisk bounce pop out vs the more subtle slight subtle one, then chances are it just IS that cord that creating this and not the lumbar. i WOULD double check exactly what IS stemming from what with NS number one mand not two? she just does NOT seem as "clued into" what can occur here with direct cord compression since she actually WANTS you to remove that one thing that right now just IS giving YOUR cord and spinal column true stability at all? like i mentioned before mj, all NSs are just NOT at all created equal, in approach or knowledge and experience either.

you just DO have some findings that DO require some level of real surgical intervention well BEFORE they will usually create tissue death or permanent pain and numbness too. i just personally do NOT 'get' what the heck NS two is actually 'waiting for" here at all? honestly? for what you just have there at all mj, i seriously do think that by getting a third opinion, you may really end up more confused than you already are and not what YOU really need to actually want to know? you simply DO have some very obvious types of injuries here that are showing their very own types of symtpms that do need intervention the sooner the better.

honestly mj, i qwould simply have another consult with NS two and find out what he feels IS creating the bilareral foot sesory loss in you, that c spine/cvord contact, OR the lumbar area? like i said. it would HAVE to, in order to even BE the lumbar findings, a nvery central issuer impacting the sensory nerve and not the motor? up in that c spine, wo only have one nerve on each side at every level that actually do carry BOTH mpotor and sensory components, unlike from the T1 on down that has 'paris' of nerves on each side with one sensory and one motor nerve. so there IS a bif difference there in just how that very basic innervation simply is between the c spine and the reast of the spinal. one other thing here? your actual '
conus' they mentioned is merely where your individual spinal cord ends and nothing more? the cord ends well before the end of what IS the spinal column itself. tho yours would appear to actually go down just a bot beyond the average where most peoples will end right about T 12? but nothing really crazy there, just highly individual.

i would just see NS number one here for the very best real consult eval on what he feels IS the generator of the feet issue,that cord or the lumbar. HE would be able to tell based upon that hands on exam,and esp with hyper relexia present in the lpower legsa among other testing, and whether or not your actual sendory nerves are a central issue? but you DO appear to have canal narrowing in that lumbar too so his imp[ressions really ARE needed for you to actually even know for certain with all that was found just at that lumbar level. my personal feeling here just given the hell you have been experiencing thru out,then the idoit who did traction on ypou too, that this does involve your cord level upt there in your c spine. and you also have compression upon i think it was c or ? that is creating your radicu symptoms theu the arms/hands as well? i cannot recall offhand the exact location,butthat TOO has to be relieved as well before that pain imprints upon the nerve there. it does happen with too much time passing with having any direct impingement/compression upon it. my hubby had to wait to have surgery(decomp fusion) for his c 5-6 and nerver did get his sensory back in his forefinger even after like 13? years? its just the way nerves are.

i would just play out here what NS wants to do(except in removing that collar) and see what she comes up with, and also get re evaled and have a good consult with the NS number one using a list of really good questions you will put together before you see him again? he owes you THAT muich if he is going to be doing ANY surgery on your spinal(even if he can give you a simple fifteen minutes or so)? and also ask him if he uses "intraoperative monitoring" for findings that are close to or compressing the cord too? this IS a really great way of doing any surgery close to the cord to assure NO actual motor or sensory functions are actually being damaged within that cord itself along with spinal tracts too? i had to also have this type of monitoring for my cord surgery and it is something that acts like a bit of a safety net for that surgeon as he progresses closely to that cord area? all that surgeon really has to do here is lightly 'touch' a particular area and see if anything shows up on that monitor that IS watched constantly by what is called a neurophysiatrist(an expert in how the nerve interacts with muscle with motor and sensory) this just would tell the surgeon whether or not that particular 'approach" WOULD disrupt/impact signal so they could either go ahead that way, or to try another area approach if it does react? just read up on 'intra operative monitoring' and see what it is and does for the surgeon and how it really protects the patient much better from damage that could have very possibly been avoided had it been used at all? once you know about the ins and outs of it, ask him if he uses it or if he 'could' if you go ahead with this surgery?

i personally just do NOT really understand just exactly what if anything NS two really hopes to gain by basically doing nothing and waiting for 'something" to heavily prompt a more emergent type surgery AFTER something has occured(esp with NO collar which just IS your main source of stability right now) vs the first one who IS simply taking care of the more critical areas and relieving compression? one is wait and see and the other is doing something to prevent further injury by relieving all real compressed areas and simply 'being" very proactive? that cage he will place combined with when you simply fuse all that bone WILL BE your new stability. with some good muscle rebuilding types of excercises, it will be soo much better for you and the major risks TO you will be gone.

thats just kind of how i see things having had my own two c spine surgeries and one on my cord too. once you find out from NS one exactly what if anything is really even playing ANY part in the feet symptoms and know exactly what you have down there. it can possibly be treated in a much more conservative way than with surgery too. i too have an annular tear with heavy stenosis to the L side among other things way down in my L 4-5 that has only become really symptomatic like three times in the past ten years when it was found "incidentally" while scanning my entire spinal cord for anynore cavernomas? did NOT have the slightesest clue i even had it since it never bothered me? strange how this crap can be and what will or will not actually show itself with any real symptoms? the fact that your c spine crap IS highly symptomatic means something NEEDS some real solid intervention there hon. esp if that hyper reflexia is even IN your legs or even one leg. this just IS one of the earlier signs of possible cord impingment or compression going on, usually up in the much more vulnerable/susceptable to injury c spine levels, most espescially during an MVA. marcia
i really am glad you have made the decision mj, its honestly really needed or your NS would not have even bothered to stabilize you c spine as soon as he saw the MRI and that flex and ext x ray. i am also glad you went back and read thru what were your original symptoms and what went on from there too, it really IS more enlightening when you look at things from the beginning? i went back and reread it too just to refresh my lil brain as well, thats why i asked YOU to read thru it. once that NS placed on that collar, honestly mj, your symptom just DID finally start to stop progressing, and that tells ALOT.

while you did have some things show up there that DO sound like they were already present to a certain degree,once you experience the in some cases, just really impactful types of forces involved in ANY real trauma, but esp MVA, anuything can become worse thatw as alrteasy there along with some brand new symptoms too. its the nature of MVA on our bodies that does this,mwhich could be responsible for some of the lumbar sindinds as well?

i am NOT as well versed on the lumabar as i am the c spine, tho i DO have a pretty good level of annular tear at L 4-5 with heavy L sided stenosis and bone spurring too among other findings down there as well, its only thankfully been symptomatic a handful of times. i did NOT even have a clue it was actually there til they simply scanned the rest of my cord(in 02?) for ANY signs of another cavernoma floating around at lower levels? another lovely 'incidental finding" god i do HATE those. but anything as far as what you will actually feel at any level of spinal damage is highly individual, not knowing just what WAS already there pre MVA would make it kind of hard to tell what IS creating what, tho you DO have some 'centrally" located symptoms there. but as your NS stated, that will be checked out AFTER you get that more impactful c spine taken care of?

all that "close proximity actually means is that "something is close by" it did NOT state it had impingement tho, so it IS only 'close by", and not actuall fully impacting it? the thing here too, if i remember right is your actual "conus(the very end of your actual spinal cord, stopped wayy above that level tho if i recall it was "into" that L spine just a bit, but not overly much? so we are ONLY dealing with spinal nerve issues there really and not what you just 'could have' if that cord was all the way down to that s level here? so DO keep that in mind too. for the lumbar only here, you would probably obtain much clearer info from the back boards since like this board here deals with mostly c spine stuff, that back board kind of deals with most other levels more then c spine up there? there is just alot of differences between what is kinda "squeezed' into the very narrow c spine levels/neck and what the T down thru S spine levels actually impact in different ways too? but for your OWN sake mj, please do NOT get yoursaelf too overly involved witht he lumbar and s level findings right now, just try as much as possible to really keep your head in what IS going on now, right now in that c spine and planning ahead for that needed surgery.

the thing here is, certain types of findings may or may not actually show themselves with symptoms. this is the main reason they do NOT even want to go there til they find out just what really was stemming from the c spine or the L spine too kinda thing? it can be somewhat hard to tell, like i already mentioned? alot really depends upon how truely impacted things are even tho you may have a few of different levels of crap down there, it does not automatically mean that YOU actually are feeling them right now in your legs? also from what i read of the lumbar stuff so far is any and every finding is stating 'mild" or moderate" and NO severe in there or moderate to severe either, so that IS a really good thing for you right now too? and some findings are just truely really hard to tell from only MRI as well? getting that EMG post op done on the legs(when you are simply really ready to have that lumbar actually addresed) may help after to better define any flow velocity? but that c spine being THAT unstable really NEEDS attention first since it has the bigger potential for permenant types of damage if it is not simply relieved and fixed appropriately. and when they simply even place the trodes for the intra op monitoring, they will also be running that baseline of flow velocitys too(all motor and sensory below and at your level of injury will be troded and checked and monitored too), so we will just have to see with the lumbar hon. but right now in all honesty, the best thing YOU can do for you is to simply put the lumbar kind of in the back of your mind for now and just concentrate on that c spine surgery and healing from that first.

if you just read thru only the first few pages of your original thread mj, you would see how really profound the intial post MVA onset of your symptoms actually were(including what you posted as your entire R side and also L hand too and the feet?), and then just continueed to really progress from there til that collar was placed too? and personally i DO feel that those had alot to do with your cord suddenly being compressed by mostly that finding up there and how the cord actually 'absorbed" that initial hit along with inflammation and swelling that would also have come along for the ride too? but there are quite a few posts from you kind of freaked out over the newer and exascerbating symptoms as to what you were also feeling and experiencing too, and THAT really IS what you need to kind of really look at as far as what 'could/would" actually be there now if your NS had not simply placed that collar which stabilized things for you and most critically, kept all those symptoms from simply becomming much worse and what would be more impact upon that cord right now since there is suspected ligament laxity or outright damage there too? right now, whether you actually even had this pre MVA or post really does not matter from the 'gettting it fixed/stabilized aspect as much as that it was 'put into hold" and IS getting addressed right now.

if i were you mj, just put everything else BUT that surgery and the c spine stuff in your own 'holding pattern' inside your head til you even know post surgery just what IS or is not a real indicator of the possible lumbar and s stuff here? you just need to have and get thru this surgery right now and totally put all your energies into THAT? it will require your full attention for a bit here. once you have gotten thru all that, THEN that is also when your NS will start to look at that part too? but just deal with what you have going on right now, and not what may or may not be down the road right now hon. it really will be sooo much less stressful for you overall if you simply concentrate on the tasks at hand and not simply start adding to what you already have going on in your life and on your plate here now? i just DO feel that you have put yourself thru soo much unneeded and stressful stuff already?

sooo, is that surgery still on for the original 7th, tomorrow or was that date ever changed to something else? i just really DO think you ARE doing the best possible thing for yourself right now in simply getting this fixed so you CAN get on with your life. just keep us all posted on things,K? good luck hon, marcia





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