All the textbooks, journal articles, and web sites say congenital stenosis is an A-P diameter of less than 10-12 mm. They say it is a clinical diagnoses and not a radiologic diagnoses. Myelopathy in these patients is not a given ,but if you have the myelopathy and the condition of a small canal, why do all the dr.s look solely at the axial images of the MRI and say "as long as there is spinal fluid seen around the cord , the A-P diameter does't matter"? That isn't what is proven in the literature through trials but yet no one reads and believes the written definition. I'm confused. Our MRI's never included A-P diameters but found out my wife was 8-9 mm at three levels with cord contact but no compression. How can this not be a source of myelopathy???
Thank you for the suggestion.
I'm a PA in Dayton and already tried to get that series done. Dr.s here say that it wouldn't change their minds even if positive. Wife is post laminoplasty 5/2010 ( C-4,5,6). Open door laminoplasty with Medtronic plates. Was not a good plating choice. opened from 8-9 mm to 9-10 mm and then Ligamentum flavum buckeled at C-6-7. Her spasticity went away for 6 wks post-op and slowly retuned as the buckeling developed. Dr.s say she's decompressed(even though the numbers show differently). Literature says 10% of laminoplasties/laminectomies need reoperation. What to do? Come to Ohio State? She's also post Chiari surgery ( NY- 2005).That was a very successful surgery with the exception of helping her spasticity. Makes sense-fixed the upper spine--lower cervical spine still compressed. Thanks for your opinions. It helps to talk. Steve
Dear Dr. Prevedello,
Thank you. A recommendation would be most appreciated. My wife seems to be a complex case. Myelopathy caused by stenosis is not a very well accepted theory here in Dayton. However, Her surgical improvement was miraculous-just short lived. It's hard to convey everything about whats happened in a one hour appointment so it would be nice if you could "shadow" her even if not the primary doctor since you list chiari as an interest. Our last appointment with a neuro was disappointing because he said he didn't disagree with our "stenosis still the cause" theory, but he didn't have enough peer backing to justify the repeat surgical risk. We need a surgeon experienced and confident in these redo operations. Your active participation on this forum may just be the "miracle" she needed to find the care she deserves. I look forward to making the appointment with your recommendation.
I would recommend for her to see my partner Dr. Farhadi:
Phone: (614) 366-4961
Fax: (614) 366-5763
At this point I don't think the chiari is the problem since it was a successful surgery and she improved most of her symptoms. If Dr. Farhadi believes it is still a chiari problem after seeing her, I will be glad to see her afterwards.
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