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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Hi All,

I'm a 45 year old woman who had a C4/5 ACDF in November 2006. While I had some initial relief in my neck pain after that surgery, it was short lived. Scarcely 12 weeks later my symptoms began to return. My neurosurgeon was a jerk and refused to listen to me when I told him I was having problems again. I finally turned to another spine surgeon in Nov/Dec of 2007 for a second opinion. For comparison purposes, here is a copy of the MRI I had during that evaluation:
[QUOTE]CLINICAL INFORMATION: Status post C4-5 ACDF with chronic neck and upper back/shoulder pain, now with swallowing symptoms and increased symptoms. There are no prior studies available for comparison.

TECHNICAL INFORMATION: Multiple 3 mm sagittal T1-weighted images were obtained in addition to 3 mm T2 MPGR and T2 FSE sagittal and 3 mm axial gradient-echo T2 FSE images.

INTERPRETATION: Sagittal images show a normal cord and craniocervical junction.

At C7-T1, the dorsal disc margin is normal and foramina appear patent. Facet joints are normal. There is a disc bulge at T1-2 without central stenosis.

At C6-7, there is no central or lateral neural compression and facet joints are normal.

At C5-6, a disc bulge contacts the thecal sac and ventral cord. There is mild chronic left foraminal narrowing and the right nerve root canal is patent. Normal flow signals are present in the vertebral arteries with a right dominant vessel.

The C4-5 interbody fusion appears solid by MR criteria with no central and lateral stenosis.

At the supra-adjacent C3-4 level, a small midline disc herniation contacts the ventral surface of the cord. Foramina contact and flatten the ventral surface of the cord. Foramina appear patent and facet joints are unremarkable.

The C2-3 annular margin is normal and foramina appear patent.

Facet joints are intact bilaterally.

1. A central C3-4 disc herniation contacts and flattens the ventral cord.
2. A small C5-6 disc herniation abuts the ventral surface of the cord with mild left foraminal narrowing.
3. Solid-appearing C4-5 interbody fusion by MR criteria with no residual stenosis.
4. The cord is intrinsically normal without mass or syrinx.


That neurosurgeon was of the opinion that I would need my fusion extended someday to possibly 3 levels. But he felt that I should put off resorting to a second surgery for as long as possible. He sent me off to pain management and told me to come back when the pm practice couldn't keep me comfortable any longer.

Flash forward to now:
I continue to have significant pain and have noticed some other changes that concern me. In particular, I have a lot of trouble doing anything with my hands. They feel clumsy and they cramp up quickly when I try to write or type. I've also noticed that I have a hard time urinating sometimes. Its like I can't initiate and maintain the flow very readily. So I felt it was time to go back to the neurosurgeon for an update. Unfortunately, the NS I saw in Dec 2007 has moved out of the state, so I had to start over with someone new. Here are the MRI results from the exam he ordered:

CLINICAL INFORMATION: Neck pain with degenerative disc disease and prior cervical fusion. Comparison is made to 12/03/2007.

TECHNICAL INFORMATION: T1, T2 MPGR T2 FSE and STIR sagittal thin sections through the cervical spine with T2 gradient refocused and T2 FSE axial sections at selected levels.

INTERPRETATION: Craniovertebral junction structures are unremarkable and no fractures or active inflammatory lesions are identified on STIR images.

The cord is intrinsically normal without high signal alteration or mass lesion. Flow signals are noted in the vertebral arteries with no paraspinous mass lesions.

The C2-3 disc margin is normal and foramina appear patent. Facet joints appear within normal limits.

At C3-4, there is a 3 mm AP diameter central disc herniation indenting the ventral cord. Mild to moderate central stenosis. Foramina appear patent and facet joints are unremarkable.

At C4-5, the interbody fusion appears solid by MR criteria with no recurrent disc herniation or spinal stenosis.

At C5-6, disc degeneration is present with degenerative annular bulging and asymmetric right posterolateral 1.5 mm disc protrusion with overall mild central stenosis and mild ventral cord flattening. Foramina appear patent and facet joints are unremarkable.

C6-7 and C7-T1 levels are negative for disc herniation or stenosis.

At T1-2, the dorsal disc herniation indents the thecal sac centrally and to the right of midline.

1. A 3 mm AP diameter central C3-4 disc herniation indents and deforms the cord with mild to moderate central stenosis. Foramina appear patent.
2. Mild C5-6 spondylosis with dorsal annular bulging and concurrent 1.5 mm right disc protrusion with cord contact and mild central stenosis.
3. No recurrent C4-5 disc herniation or stenosis.
4. Intrinsically normal cervical spinal cord and craniovertebral junction.
5. Disc protrusion centrally into the right at T1-2.

Note: The C3-4 disc herniation has enlarged since 12/03/2007. Findings at C5-6 are unchanged.
Unfortunately, the new neurosurgeon I saw most recently was an even bigger jerk than my first neurosurgeon! I kinda feel right now like I don't know where to turn or what to think.

I am wondering if some of you who have been down this road more than once in your own lives might have an opinion for me? The newest MRI is now showing stenosis at C3-4. Does stenosis always mean surgery is indicated? Is there a certain degree of stenosis that can be safely lived with? What should my concerns be at this time?

Any and all opinions are appreciated!
Thank you!

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