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Spinal Cord Disorders Message Board


Spinal Cord Disorders Board Index


Hi all -
Many thanks for this message board as I've been perusing around quite a bit trying to educate myself on recent MRI results and subsequent Neurosurgeon consults. I have two opposite Neurosurgeon opinions on whether surgery is necessary or not; Neurologist is adamant that surgery is needed. So, now I am trying to get another opinion and am wondering if

1.Others have had these opposite opinions, and if so, what did you do?

2.Any advice on specific questions to ask the next doc (going to another neurologist and another neurosurgeon soon) – will ask about laminoplasty, thanks Jennybyc

3.It seems as if the Neurologist is the one who makes the ‘diagnosis’ of the severity symptoms, while the Neurosurgeon evaluates the MRI results for surgical intervention, so maybe the better second opinion is one of a neurologist and not a neurosurgeon? Anyone else think this?

4.I read in one post “the idea is do the surgery before the cord shows signs of damage.” Regarding stenosis v. compression (jennybyc). So how do you know when the cord shows signs of damage? how does one determine where on a scale of 1-10 we are?

I don’t want to be driven to surgery by fear, but I also don’t want to put my head in the sand and say I don’t need surgery, so any insights would be appreciated!! I’ve read that the earlier the intervention is in the deterioration process, the better the prognosis… BUT the risk of having damage to other discs and having to go through it again is scary too. BUT the idea of walking around knowing this is could get worse or I could trip and fall and be in a bigger mess is scary, BUTBUTBUT – all the same “damned if I do, damned if I don’t” feelings I’ve seen expressed in other posts here, so I guess no need to reiterate them : ) and I'm terrified of surgery.

Sorry in advance for the lengthy bit below, but for those interested, here’s the history w MRI @ bottom:

My first visit to a neurologist (4/2012) was prompted by numbness in my feet that I had had for about a year, which I had thought was related to ski boots that had been too tight - My dermatologist told me to get to a neurologist because I am on medicine (enbrel) that could have a side effect of MS.

-Lumbar MRI ruled out lower back issues causing numbness in my feet.

-MS was ruled out by brain/cervical/thoracic MRI ("there are no signal abnormalities identified to suggest a demyelinating process such as MS, myelitis, myelomalacia or a cervical cord syrinx at any level. There is slight prominence of the central canal of the spinal cord... The cervicomedullary junction is normal. The cerebellar tonsils are in normal position.").

-BUT I was told by the Neurologist that I have pressure on my spinal cord and that it was not a matter of if, but when I would have to have surgery - he said it was like "a ticking time bomb" and it was likely an incidental finding not related to my feet. Also, if I ever have loss of bladder/bowel, I am to get myself to the emergency room ASAP. He referred me for a Neurosurgeon consult…

I saw the head of neurosurgery & spinal trauma surgery at John C Lincoln hospital (Neurosurgeon) in Phoenix (and I really like him) to whom I was referred by the Neurologist.
- fellowship & residency: Barrow Neuro institute/St Joe's med center - orthopedic surgery of the spine and neurological Surgery
- he recommends ACDF on C5-C6 and told me to stop going to the gym and restrict my lifestyle (no eliptical, etc) activities, not lifting things, no running, be careful etc.
-on a scale of 1-10, I am a 7-8 in terms of severity
-sooner is better than later as something could happen or the issue could progress to a point where damage is not reversible with surgery (eg loss of bladder/bowel) which scares the heck out of me!

At the urging of my mother, I went for a second opinion – Saw the head of Neurosurgery at Mayo Clinic in Scottsdale, AZ. To my great surprise, he said he believed that I do not need surgery as I am “asymptomatic”. He said many people walk around all the time with Cervical Spinal stenosis, it’s very common, but since I am not in pain, there is no reason for surgery. He had the MRIs, EMG & bloodwork and the notes from my Neurologist visits. The numbness in my feet is not related to my neck but was likely a result of occluded blood flow to some of the nerves in my feet by tightened ski boots that caused some nerve damage. He would NOT put me on any activity restrictions and that I should be able to go to the gym etc. He would NOT characterize me as a ticking time bomb, nor do I have a ruptured disc. According to him, there are no exercises or anything else I can do to mitigate the progression and at some point if warranted, I might need surgery, just not at this point. When asked why such a different opinion from the other Neurosurgeon, he said it’s a different approach and he respectfully disagrees… Mayo is much more conservative when it comes to surgery (as in don’t operate if not necessary I guess) and doesn’t believe that the risk is great enough of something happening from daily activities that would warrant a ‘preventive’ approach.

SO, went back to my neurologist Firday… he had the notes from the Mayo dr. and he completely disagrees with the Mayo (2nd opinion) Neurosurgeon’s opinion and proceeded to explain that
-Since pressure is on the front of the spinal cord, I will have no pain, but that it doesn’t mean there’s not a problem
-The symptoms that I currently have are hyperreflexia (?) and weakness in my upper body muscles associated with c5-6 cord compression
-He said it was “not a matter of if but when” I would have to have surgery. When I asked about ‘when is ‘when’’, he responded “yesterday”
-I further inquired about knowing how much compression there is or what % loss in strength that I was looking for some quantitative data (such as the mm compression figures I’ve seen on some of the other MRI postings etc), he said there’s no way of knowing or measuring that and it doesn’t even matter because I have symptoms and an MRI with cord compression – basically it sounds like he views it as very black and white – any symptoms of cord compression require surgery regardless whether there is pain or not.
-Asked about getting a myelogram to get an understanding of the degree compression and again he said it won’t matter what the myelogram would say because the fact that I have these symptoms means that surgery is needed
-Surgery will allow me to resume normal activities and I might regain the arm strength I’ve lost, but all surgery carries risk blablahblah.

For those interested here are the Cervical MRI results:
c4-c5: there is degenerative spondylosis with posterior disc-osteophyte complex effacing the ventral thecal sac without cord compression or central canal spinal stenosis. There is moderate bilateral neural foraminal stenosis due to bilateral uncovertebral spurring and facet hypertrophy.

c5-c6: there is a small right paracentral disc protrusion superimposed on posterior disc-osteophyte complex effacing the ventral thecal sac and resulting in moderate right-sided cord impingement and moderate central canal spinal stenosis. There is moderate left and marked right-sided neural foraminal stenosis due to asymmetric right sided uncovertebral spurring and facet hypertrophy

c6-c7: there is posterior disc-osteophyte complex eccentric to the left side effacing the ventral thecal sac and combining with the posterior ligamentum flavum thickening to result in mild central canal spinal stenosis. There is mild right and moderate left sided neural foraminal stenosis due to asymmetric left-sided uncovertebral spurring and facet hypertrophy.

Many thanks in advance for your thoughts!
Tara





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