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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

It never ceases to amaze me how many docs will dismiss you if you're able to get into their office under your own power. Whatever happened to preventive medicine?

OK, let me, for starters, quote the report re your various levels and comment on each one...

"""C2-C3: The anterolisthesis of C2 on C3, with unroofing of the intervertebral disc, partially effaces the ventral aspect of the thecal sac, causing mild spinal canal narrowing. Otherwise negative."""

Interesting.... your C2 vertebrae is displaced FORWARD (anterolisthesis). I'll bet that was from trauma during your youth. It's so rare (on this board, at any rate) to see problems that high in the spine that I don't really know what to say. While the displacement doesn't seem to be severe, ANY problem that high up could cause a host of neck problems and maybe even pain in the head. The C2-3 is your highest disk (there is no C1-2), and it is critical for neck range-of-motion. I don't know if this is what caught the doc's eye, but it's something to ask about.

""C3-C4: The retrolisthesis of C3 on C4 with congenital cervical stenosis causes moderate spinal canal narrowing, with complete effacement of the ventral and dorsal aspect of the the thecal sac and mild flattening the ventral cord without underlying cord signal abnormality. Asymmetric left greater than right uncovertebral arthopathy and facet joint hypertrophy cause moderate left and mild right neuroforaminal encroachment on the exiting C4 nerve roots.""

So C2 was displaced forward on C3, but C3 is displaced BACKWARD on C4. I wonder if that isn't ONE problem instead of two, that is, C3 is just too darn far backward? Anyway, even though it may not be displaced very far, it is causing some cord flattening, DUE TO CONGENITAL STENOSIS. That is, you were born with an insufficiently wide spinal canal, so anything that intrudes on it (displaced vertebrae and herniated disks from in front, swollen ligaments from behind, and bone spurs from all over) may also impinge upon the spinal cord. You may have an unrelated problem with abnormal bone growth into your foraminal openings, possibly impinging on the peripheral nerves as they exit the spinal cord. The problem is only at "moderate", for now, but that's a judgment call by the radiologist, so I would not assume that it isn't causing symptoms in left shoulder and arm.

""C4-C5: Degenerative spondylotic change with symmetrical bulging disc and concomitant congenital cervical stenosis causes moderate spinal canal narrowing. Asymmetric right greater than left uncovertebral arthopathy of facet joint hypertrophy cause severe right and mild left neural foraminal encroachement on the exiting C5 nerve roots.""

At this level, instead of a displaced vertebra, you have a displaced disk, which is a little more common. Doesn't seem to be causing a problem (yet) in spite of the congenital stenosis. However, the abnormal bone growth at this level is significantly worse. That "severe" problem on the right side is really something to pay attention to. The C5 controls the deltoid and biceps, as well as the hand to some extent. Is your right biceps weak? Can you lift things using only your right shoulder, as well as you can with the left? When I had a C5 problem, I suddenly couldn't lift with my shoulder, and couldn't "make a muscle" with my biceps.

""C5-C6: Degenerative spondylotic change with symmetrical bulging disc and concomitant congenital cervical stenosis causes moderate spinal canal narrowing. Left greater than right uncovertebral arthopathy and facet joint hypertrophy cause severe left and moderate right neuroforaminal encroachment on the exiting C6 nerve roots.""

Same thing as higher level, except this time the "severe" problem is on the left.

""C6-C7: Mild disc space narrowing is symmetrical bulging disc causes mild spinal canal narrowing. Asymmetric right-sided uncovertebral arthopathy causes mild right-sided neural foraminal encroachment.""

Starting to return to normal at this level.

OK, you have several kinds of problems: (1) displaced vertebrae up high (although maybe just the C3), (2) some bulging-disk problems, and (3) moderate to severe foraminal narrowing at several levels.

I just don't know what to say about the antero/retrolisthesis. One neck problem I have never had. As for the rest, I strongly urge you to educate yourself about the three basic kinds of surgery... ACDF, foraminotomy, and laminoplasty.

The ACDF is the one that every spine surgeon knows, and many will - unfortunately - try to push you into that because that's what they do.

Since your non-listhesis problems seem to be pretty much limited to foraminal narrowing by bone growths, it would seem that foraminotomies could take care of the problems. The foraminotomy is a mininally-invasive surgery that comes in diagonally from behind and grinds off the abnormal bone growths. I don't know how they'd deal with the fact that you have multi-level and multi-lateral problems. Maybe do multiple foraminotomies in a single session?

I must say, though, that other than myself I've never seen someone who looks more like a candidate for a laminoplasty, which is a surgery that opens the spinal canal (from behind) and gives the patient more room in the canal. It's specifically for people with congenital canal stenosis. While it's true that your stenosis may not yet be directly causing trouble, I'd guess that it will, soon enough.

Maybe, though, foraminotomies will be all you need. If a surgeon tries to shoehorn you into an ACDF, though, ask him how that will help your multi-level foraminal-narrowing problems.

I'm very interested to hear what the surgeon has to say, and hope you will post again. If you have any questions about what I've written, or want elaboration, I'm always happy to supply my amateur opinion.

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