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I found this site and was amazed at the generosity of the people here. I was hoping I could share my symptoms and test results, the doctor's recommendation for surgery and the shear panic and depression that has set in since.

Almost two years ago I saw my gp for what I described as dizzyness which came in spells and then went away until the next wave. I also complained of "walking into walls" on occasion. He prescribed meclizine for vertigo but after some blood work and a cat scan of the brain knew of no cause. The vertigo still remains in on and off wave today.

In the following year I suffered 6 or 7 falls, one of which cracked three ribs.

Last June I started feeling my feet burning at night and my legs started hurting and getting weaker. By August the burning reached as high as my butt and the legs continued to weaken to where I complained that it felt like walking was starting to be a chore. Climbing my stairs or simply getting out of a chair was so much harder and I would need help getting up to my feet if I bent down to put something in a cabinet. These problems just get worse through the day and sleep has become no more than nap time.

I saw the gp in September, 2011. I explained the problem and the fact that I also had what I assumed was a piched nerve which shot electric sparks down my right armpit to my elbow, but only occasionally and mostly in bed. and sent me for a nerve conduction study thinking I had neuropathy. The study showed mild axonal sensory peripheral neuropathy. Thus started the ever increasing doses of Lyrica and elavil to treat the burning pain. The drugs prevented fire shooting out but never stopped the burning. The trouble walking and balance issues continued to worsen.

Around February I thought oh oh, the neuropathy was spreading into my arms as burning and pain began in them in earnest. I saw the gp in April and the gp wondered if that was the cause and ordered cervical xrays. When he received the report back his office called and they had already made the appointment with the orthopedic surgeon.

I saw the surgeon in May. He took a history, made an exam, especially neurological signs and ordered an MRI. He told me pre MRI I had myelopathy and that my cord was compressed but the MRI would confirm.

This is the MRI report:

No significant abnormalities at c2-3. At c3-4 there is left paracentral disc protrusion resulting in mild narrowing of the canal. There is also contact of the ventral aspect of the cord on the left without cord impingement.

C4-5: There is subtle flattening of the ventral aspect of the cord on the left due to a left sided disc protrusion and accompanying endplate spurring. There are degenerative facet changes on the right. There is mild to moderate foraminal narrowing, left greater than right due to these factors.

C5-6: There is left sided cord impingement due to a broad based left paracentral disc protrusion with accompanying spurring. Moderate left sided foraminal encroachment due to uncovertebral spurring. Moderate to severe right sided foraminal stenosis due to uncovertebral spurring.

C6-7: There is small right paracentral disc protrusion with mild resulting narrowing of the central canal. No significant foraminal stenosis or facet arthropathy. A small disc protrusion is also noted at C7-T1.

When I saw the surgeon he told me he actually disagreed with the radiologist going as far as to call his report lazy for leaving out measurements. He thought my condition was "much worse" than the report stated. He told me the spine was compressed to 3.72mm at c5-6 and in the other places the diameter was between 5.1 and 7.3mm.

His recommendation was ACDF for all discs between c3 and c7. He explained it will never get better on its own and the risk of doing nothing was probably not a good thing. He did not know if the symptoms would get better but without surgery would certainly get worse and with surgery probably will not worsen. The surgeon by the way is the team surgeon for the local football team.

I am now officially terrified. I expected one ACDF went I went back to the doctor not four. Of course, it is hard to wrap my head around such a serious neck problem when my neck does not now or has it ever hurt.

Thanks for reading this small novel and for any help or words of encouragement. I know the people on here understand all of this, pain, loneliness and fear.
Thanks Webdozer for the quick response.

I suppose I was hoping for alternatives or any reason to not have fours ACDF's.

I have the cervical MRI on disc but outside of the obvious bend and squeezing at c5-6 the other places just look like they are being pressed not bent. When my GP set up the orthopedic surgeon appointment they also set up an appointment with a new neurologist for a second opinion (since I refused to ever return to the doctor that diagnosed the original neuropathy). The orthopedic surgeon seems amazed that the original neurologist took a history including the history of falls, observed gait disturbance (which she thought PT would alleviate), locked in solely on the neuropathy shown on the NCV and which she insisted could not go above the knee and ordered a lumbar MRI only.

Sadly when I researched the new neurologist he had a reputation as a pill pusher and in fact was one of the registered pain clinics in Tennessee. Seemed like a terrible choice for help with the MRI or a second opinion.

I have faith in the orthopedic surgeon or at least his group since I have had four orthopedic surgeries performed by doctors in the group without difficulty (not counting the physical therapy of course).

The fusion surgery is in the process of being scheduled. My health insurance is fighting with our preferred hospital about reimbursements so there is no current contract and therefore they will not approve surgery there. The doctor's office is arranging surgery at another hospital. The doctor truly does not believe I should wait too long.

I was hoping for some clarity on the MRI. While I consider my pain constant, I mostly tolerate it with Lyrica, NSAIDS and elavil, some days better than others. I was hoping to know other alternatives (surgical or otherwise) or if I limit the ACDF to the worst problem at c5-6 would I just be increasing the forces on the other vertebra and be postponing the inevitable. I do not know a single person who has had four fusions at once so no one to really ask what to expect. I have had many surgeries but none have even come close to the terror I feel now over this.

The surgeon cannot even hazard a guess if the neuropathy is caused by the neck, if it even really is neuropathy or if there will be improvement after the surgery. The original neurologist wanted to blame diabetes because of family history not my current blood testing. The surgeon does not know and I certainly do not know if myelopathy can cause mild sensory neuropathy.

I assume many of the posters here are in worse pain than I am and sometimes I wonder how you all do it. You all do it with amazing strength and grace.

I do appreciate the opportunity to vent and rant to people who have been through much themselves. Thanks
<< I assume many of the posters here are in worse pain than I am and I sometimes I wonder how you all do it. You all do it with amazing strength and grace. >>

Not me. I am the biggest whiner and complainer you can imagine, although I'd probably keep it offline.

<< if I limit the ACDF to the worst problem at c5-6 would I just be increasing the forces on the other vertebra and be postponing the inevitable >>

Probably and not necessarily. I believe that studies have shown that fusing one level does put greater "strain" on adjacent levels. Whether that translates to increased surgeries down the line on those adjacent levels is very much in question. You can do a search on Adjacent Disk Syndrome. Look for the study by Hillebrand, et al. I've seen that study cited as evidence in favor of ADS, but it looks like the opposite to me, and a neurosurgeon told me he sees it that way, too.

<< I was hoping for some clarity on the MRI. >>

I agree with the surgeon that the radiologist didn't do as well as he should have if he didn't provide measurements, but of the reports I've read here I'd say maybe only 1 in 5 includes measurements. I have to say, though, that the radiologist and the surgeon appear to have been reading two different sets of images. You're down to 3.7mm at C5-6, and all the radiologist says is "left sided cord impingement"? Note that he supplies adjectives like "subtle", "mild" and "moderate" all over, but has no adjective for the C5-6 impingement. How can 3.72mm be anything but "severe"?

As for surgical alternatives, you might want to read up on "laminoplasty". There's plenty of info online, and I wrote a thread here called Cervical Laminoplasty Chronicle that laid out my thinking before deciding on a laminoplasty last summer.

<< While I consider my pain constant, I mostly tolerate it with Lyrica, NSAIDS and elavil, most days better than others >>

I'm afraid that thinking too much about the pain - and how to manage it - may distract you from putting enough effort into finding more permanent alternatives, and quickly.

<< I do not know a single person who has had four fusions at once >>

There are several people here who've had surgeries at 3+ levels. I've had a 3-level laminoplasty, plus a single-level ACDF and a foraminotomy. At least a half dozen others have had extensive ACDF's. I suggest you change this thread's title (if that's possible) or start another thread that specifically asks for responses re 3-level+ ACDF's.

<< The surgeon cannot even hazard a guess if the neuropathy is caused by the neck, if it even really is neuropathy or if there will be improvement after the surgery. >>

I kinda had that thought, too, when I read your symptoms. They are somewhat different than anything I've seen here before. My guess - and it's the guess of an uneducated and unqualified amateur - is that you've got more than one thing going on. That's the worst situation to diagnose, because docs use a reductionist approach to diagnosis. e.g. C5-6 compression cannot cause dizziness, therefore C5-6 compression is not the problem.

<< The original neurologist wanted to blame diabetes because of family history not my current blood testing. The surgeon does not know and I certainly do not know if myelopathy can cause mild sensory neuropathy. >>

I don't see why not, but I'm not the person to ask.

Elite, while I'm unqualified to give you medical opinions - which doesn't stop me, but it's something you should keep in mind - I can quite confidently tell you this:

1) If your cord is compressed down to 3.7mm, you do not want to waste time deciding what to do. While some docs will scare you with warnings of paralysis in case of accident/trauma, probably a greater concern is that prolonged cord compression will result in nerve damage that cannot be fixed.

2) You need AT LEAST TWO MORE OPINIONS. One thing I'd try is finding another radiologist to read your MRI images. It is AMAZING to me that the radiologist and the surgeon see your situation so differently.You could take a look at the thread My Pre-Laminoplasty MRI (I think that's what I called it), which has my radiologist's report as an example of a well-done one. It's by Barry J Berkowitz (I think somewhere in Orange Cty, CA). I'll bet you could Fedex him a disk (which you should be able to pick up at the imaging place) and get him to read it, although you'd most likely have to pay out of pocket. Additionally, you need to see another surgeon. Maybe the first one is just wrong about the MRI. More than that, though, I think you need additional opinions on this 4-level ACDF.

Feel free to ask questions, put your question about 4-level ACDF's where people will see it, and report back on how you do.





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