Cervical Spondylosis

[ayushjain]

My mother is facing problem in her lower back since around 2 yeasrs. She feels burning sensation in her thigh region in leg. We consulted many physicians but nothing helped, we even did home massage with oil, hot water with salt, but nothing helped. one week back we went to Neuro Surgeon and he recomended surgery as he diagnosed my mother with Cervical Spondylosis. Since 2-3 months my mother is feeling numbness in her both hand fingers. But she has no pain in neck region.We counsulted two neurosurgeons and both said to operater her from back and neuro spine surgeon said to operate her from front. I am presenting the MRI report of her.
MR imaging of the cervical spine was performed and high resolution T1- & T2-weighted serial sections obtained in the sagittal & axial planes usng a phased-Array surface coil on a 3.0Tesla scanner with high strength gradients.
The study reveals evidence of a lobulated band extending from lower border of C3 to D2 vertebral body causing commpression over underlying spinal cord. It demonstrate hypointense signal on both T1 & T2W Images. There is posterior displacement, effacement of anterior subarachnoid space & thining atrophy of cervical spinal cord.
Subtle Intramedullary hyperintensity is seen involving cervical spinal cord at C3 to C7 level suggests cord oedma/myelomalacia. The intervertebral disc spaces appear normal. No prevertebral and paravertebral soft tissue abnormality seen. Posterior fossa structures appear normal.Screening of lumber spine reveals posterior bulging of L4-L5 intervertebral disc.A few Schmorl's nodes are seen involving lower dorsal & upper lumbar vertebrae.Uterus appears bulky with presence of fibroids.

IMPRESSION:
1) MR findings are suggestive of ossified posterior longitudinal ligament extending from lower margin C3 to D2 level causing compression over underlying spinal cord.
2) Cord oedema/myelomalacia involving cervical spinal cord at C3 to C7 level.

The above are the MRI findings. I would appreciate any comment on these as what should be the treatment and if surgery has to be done then what should be the approach i.e. from front or from back. And if there is alternate treatment like accupressure, accupunture then is it helpful?

[AmyOK]

Oh, one more comment…..
So far my lower back hasn't showed any myelopathy, but I have burning pain in my thighs too. After seeing many doctors and having normal EMGs and MRIs, I was so frustrated and researched the problem I was experiencing. I self diagnosed myself, and the doctor confirmed, that it is lateral femoral cutaenous nerve damage. I've had several paravertebral sympathetic nerve blocks to relieve the pain. They work quite well. Also, some people get this condition from gaining weight and wearing tight clothes, which press on the nerves causing an entrapment.

The doctor should be able to tell where the pain is coming from and tell you what your mom needs to do to get better. She could ask about getting nerve blocks to help with the pain. It might just cover up the problem and not really fix what’s causing the damage, so be careful in your decision.

[AmyOK]

I'm sorry to hear about your mother. I too have been struggling with Cervical Myelopathy for 9 years now. I've had 4 surgeries to decompress my spinal cord, but got worse after the 4th surgery. Unfortunately for me, the damage was permanent, and the surgeon said perhaps he waited too long before recommending the surgeries.

I had seen 5 neurosurgeons and decided to go with the one who seemed the most knowledgeable. The others wanted to wait and see longer than the one I chose to operate.

In my opinion, she needs to have surgery right away, especially since both neurosurgeons have said so. She should choose the one with the most experience. Do Google searches to gain as much information about the surgeons as you can find. Then trust that they will do the best approach for the damage to her spine. Do not waste time with acupuncture for compression to the spinal cord. While it may relieve some burning pain in her thighs, it won’t move the bone to stop pressing on her spinal cord.

Best of luck!

[Kalvin]

I apologize for the delay in returning your message; I don’t spend much time on line during the weekends. And no, you did not disturb me; my Mother is not well either, so I completely understand your situation and concern.

The spinal cord compression noted in your Mother’s MRI sounds serious, how severe is her pain? She should be experiencing many more symptoms, than a burning sensation in her thigh and numbness in her hands and fingers. Would you characterize her pain as Intractable (severe, constant)? If her pain reached this level you really need to seriously consider surgery. With some injuries impacting the spinal cord, it is important they be treated quickly to avoid any permanent damage. And a surgical approach is usually based on the surgeon’s preference; however my understanding is that patients that are suffering from posterior compressions are generally operated on from the back. I’m sorry; I don’t have any first hand knowledge of acupuncture. If you decide to try it, check with her doctors first to make sure its safe for her to have it.

Did the surgeons that you have seen tell you that her surgery should be done as soon as possible? Did you mention to them about her lack of neck pain? In many cervical disorders, particularly radiculopathies, lack of neck pain is not uncommon. However I don’t know about spondylosis, I’m sure some people who have cervical spondylosis don’t have neck pain, but I can’t say for certain.

There are 2 forums here that I think will be very helpful to you. The first is the NEUROLOGY COMMUNITY; questions are answered by a Neurologist from India. He seems to answers questions fairly quickly, but if he doesn’t answer you right away, don’t be discouraged, he will answer you as soon as he can.

The other one is the NEUROSURGERY EXPERT FORUM, this Doctor can take several days to answer, but he is a Surgeon, and is very knowledgeable and interested in helping.You can post the same topic as you did in our forum, but you need to expand on your Mother’s symptoms. I hope everything works out for your Mother, and let us know her how she is doing.

Take Care

Here are the links:

http://www.medhelp.org/forums/Neurology/show/74

http://www.medhelp.org/forums/Neurosurgery/show/331

[ayushjain]

Thanks once again, for your valuable advice.

[squirtatious]

I don't know too much, I'm just someone who enjoys researching and reading up on different things. It really depends on how bad your mom's problem is and what exactlu the dr's are hoping to achieve for the way (back or front) surgery is performed.  It wouldn't hurt to give acupuncture a try, but in the end, I believe she will require surgery. I'm no dr, keep that in mind, its just my unprofessional opinion. Greatest blessings to you and your mom!!:)

[ayushjain]

Thanks a lot. So it means we should approach surgery from back. I know you are not doctor, but you seems to know very much about it. But one thing that i dont know is, how come she dont have any pain in neck region and still have this problem??? Is there can be any other opproach to the problem, I mean to say can we try for Acupressure or Acupuncture therapy???

Thank you very much for you reply, you too take care.

[squirtatious]

Whoops, totally read it wrong, it stated posterior, NOT anterior, my bad. Still very similiar procedures for OPLL as OALL. Expansive laminoplasty was performed as a posterior procedure for extensive OPLL while the anterior approach was done for the direct removal of OPLL. I wish your mother well on her journey, take care.  ~Deja~

[squirtatious]

Because symptommatic OALL ( ossification of anterior longitudinal ligament) maybe associated with spinal stenosis precise neurological examination is critical. What neurological tests have been performed on your mom? Its been said a simultaneous microsurgical operation for patients with OALL and spinal stenosis gives good results without serious complications. I'm no dr, but it sounds like she may be a good canidate for surgery. Is her doctor suggestiong a direct removal of the OALL?  If so, this can be done either anterior or posterior. If her OALL is extensive, then she may have an expansive laminoplasty done.   I wish your mom the best!! *hugs*