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Spinal Cord Disorders Message Board

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hi everyone,

I've been having some neck/spinal problems that are affecting my arms and hands, and have found this site incredibly helpful to understand these a little better and to learn about others' experience with similar issues. I'm posting my first message after "lurking" and reading the message boards for the last few weeks, and would really appreciate any thoughts or insight you might have on my situation.

To be honest, the idea of surgery is scary as hell to me, but the risk of permanent pain and problems and possible paralysis is certainly not better (I'm an active 42 yr old)! I saw a neurosurgeon last week, and incorrectly thought that was the first of at least a couple consultations I'd have with him to determine if surgery is the right course. I was a bit stunned when the appointment was over to be handed a brochure about cervical surgery and told to "give them a call when I've decided." I'm seeing at least one other doctor for an additional evaluation, but here's what I have so far:

MRI results:
There is reversal of normal cervical lordosis. The apex is at C3-4 level. Effacement of the anterior thecal sac is seen at C3-4, C4-5, C5-6 and C6-7 levels. At each of these levels, there is flattening of the cord. At C5-6 level, there appears to be effacement of the CSF space around the cord in addition to large disc osteophyte complex which projects into the left subarticular recess. There appears to be increased central cord signal an loss of discrimination of gray-white matter between C2 and C7 level suggesting myelomalacia. No syrinx is seen. No acute marrow signal abnormality is seen. Decreased T2 disc signal and disc space is seen at C3 through C6-7 levels. Posterior fossa structures appear normal. Precervical soft tissues are normal-appearing. The nasopharynx and oropharynx normal.

And this is part of the assessment I rec'd from a neurosurgeon last week:

MRI of the cervical spine obtained recently shows reversal of the normal cervical lordosis at C3-4 with some disc space collapse at this level as well as at other levels. There is fairly significant stenosis with disc/osteophyte complexes thickly at C5-6 and C6-7, but to a lesser degree at C4-5 and C3-4. Cord signal changes are noted from C3-C6 consistent with possible myelomalacia. Canal diameter is down to a proximally 7 mm at C5-6 and C6-7 which is quite tight stenosis.

Thanks so much for passing on any thoughts you have!
<< Can any of you explain if and why myelomalacia may make surgery more of a probability for me >>

Myelomalacia is permanent cord damage. If you CAN correct whatever is causing that damage, then you need to do so before it causes even more. I don't know if the disks that are flattening your cord are causing that myelomalcia, but if they are, they need to be fixed. At any rate, this is my amateur understanding of it.

<< Jenny mentioned someone on this board had or has stenosis down to 4 mm w/o opting for surgery. Does the fact that I quite possibly have myelomalacia increase the argument for having surgery, even though my stenosis is "only" down to 7 mm? >>

Jenny believes that the speed with which the stenosis occurs has some importance. That is, a cord that is compressed down to 5mm over many years may not be in as bad shape as one that's compressed to 7mm more quickly. Besides, this is not just a matter of measuring millimeters. It's a very complex and dynamic situation, and even MRI's are just blunt tools for diagnosing it.

<< I'm terrified of having surgery and super squeamish about anything that involves needles, scaples or blood. >>

No reason to fear surgery itself. They sneak the anesthetic into your IV without even telling you. One moment you've been wheeled into the operating room and the next moment you wake up in post-op with little idea what happened. A moment later you wake up in the recovery room. If there's something to fear, it's not the surgery, but the recovery.

<< Am I being delusional to think that NOT having surgery may still be a viable option for me? >>

I don't know, and neither do you, until you see those two other docs. You may as well chill out until then.

BTW, your MRI report refers to "loss of normal lordosis", which could be anything from minor to very serious. The NS, however, mentions "correcting the kyphotic deformity", which is somewhat stronger language, as kyphosis is the opposite of lordosis, and can be quite serious. Does your neck have a forward (kyphotic) bend? Spend a lot of time looking at your feet, and find it difficult to look up? If so, and if this can be addressed surgically, you'll want to consider it.

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