I am a 62 year old male, employed with a desk job. I first noticed a slight, infrequent tingle in my left arm about 11/94. The intensity and frequency increased rapidly with periodic "shocks" in the left arm when certain activities were performed. After visiting a few doctors, having x-rays, MRIs, myleograms, etc., I opted for surgery.
This was done on 8/31/95 and comments from the doctor's report are as follows:
-.Painful spondylosis with spinal stenosis, cervical 5-6 and cervical 6-7. .
-Lesser spondylosis and suspected mild spinal stenosis, cervical 4-5.
- Painful spondylosis with spinal stenosis, cervical 5-6 and cervical 6-7.
- Anterior cervical discectomy with removal of osteophytes and bilateral foraminotomies (microscopic), cervical 5-6 and cervical 6-7.
Since that time, after a brief 2-3 month period, neck pain and tingling in the left arm continued. About 8/98, I began to experience numbness in both hands. As time progressed, the severity of the numbness increased in my right hand until I have very little feeling in the hand. At times, this discomfort goes up the arm above the elbow. This has led to another MRI and visits to two doctors. There is close agreement regarding the cause of my problem which is:
RADIOGRAPHS: The MRI scan from 12/98 shows a patient who has severe cervical stenosis at the C3-4 level. He has evidence of kyphotic deformity above the previous discectomy level at C5-6 with acquired kyphosis. The myleogram shows significant stenosis at C3-4. It does show some foraminal narrowing at C6-7 on the left side. Only minimal resultant narrowing at C5-6. The most significant finding is severe stenosis at C3-4.
I. Cervical spondylosis, cervical stenosis with myelopathy.
2. Acquired kyphosis status post-previous anterior cervical discectomy. This patient has evidence of myelopathy, as well as, significant stenosis of both MRI scan and CT myelogram at C3, C4 level. He has had a previous discectomy without fusion that shows some collapse at C5, C6. As a result of this he has a significant kyphotic deformity as well.
INVESTIGATIONS: Outside cervical spine MRI shows severe cervical canal stenosis at C3-C4. There is no significant stenosis at C4-C5. He has post-surgical change of a fusion between C5 and C6. There is loss of normal cervical lordosis in the mid- and lower cervical region. The most prominent finding is the severe stenosis at C3-C4.
#1 Progressive, severe cervical spinal canal stenosis, C3-C4 level.
#2 New onset cervical myelopathy.
#3 Chronic, old, multiple left lower cervical radiculopathies.
#4 Congenitally-narrowed cervical canal.
One doctor recommends decompression of the C3-C4 level. His "inclination would be to do this posteriorly utilizing a laminectomy approach. Nature of procedure explained using a spine model. Surgical risks, including small risk to life, small risk of quadriplegia and small risk of infection were reviewed. It was explained that there is a one-in-three chance of significant improvement, a one-in-three chance of remaining out the same and a one-in-three chance of slow deterioration despite seemingly successful surgery. An anterior cervical approach to this problem is not unreasonable, but it appears to me that most of the compression he currently has is dorsal to the cord. I would therefore do an initial posterior approach, but I did tell the patient that he may ultimately require additional anterior surgery at the C3-C4 level and possibly from C3 down to C5. I don't believe that any conservative treatment by itself would be of much benefit in this situation."
The other doctor states: "The issue is that he would definitely need a decompression at the C3, C4 level, however, due to the kyphotic deformity my recommendation would be an anterior cervical discectomy or corpectomy at C4 with strut grafting down to C5 to correct the kyphotic deformity with instrumentation. I would recommend this with an anterior cervical approach."
Both doctors have stressed the importance of having surgery within the next few weeks. I believe it is necessary but I am very concerned about which avenue to take. One procedure seems to be more conservative than the other but I wonder if it will address my problem without having additional surgery 2-3 months later. The other procedure scares me as it seems more complex and, truthfully, the thought of paralysis from the surgery is causing much anxiety at this time; however, my gut feel is that the more complex surgery is the route to go.
Can you provide some information regarding success rates for the two different plans? What may I expect as far as recovery time, physical limitations, length of time off work, etc. after each of these procedures? Will I wear a rigid brace in the more complex surgery? For how long? Would you recommend any other alternatives to these plans?
(My apologies for the length of this but any comments/guidance you can provide will be most appreciated.)
What you are describing are some of the problems that may arise after an anterior cervical discectomy. The bony fusion has collapsed a bit and the spine is kinked forward more than normal, according to the accounts you cited. There is also stenosis at the level above the site of the previous discectomy and fusion. Clearly you are having symptoms from this and it will likely need to be repaired. All this is stated without having seen the films, so this reservation should be noted.
There is an ongoing controversy in the spine literature about the better approach in certain situations, anterior or posterior. This is, to say the least, an incompletely resolved conflict with adamant believers on either side of the issue.
Many surgeons would argue that your pathology is located in front of the spinal cord and therefore warrants an anterior approach to stabilize the spine and decompress the cord. It would probably involve some sort of corpectomy (removal of the vertebral body) or another multi-level discectomy with fusion. Much of this would depend on the appearance on the recent films. Many spine surgeons would state that a posterior approach would predispose you to further problems with anterior instability in the future.
You should consult with an experienced spine surgeon in this matter. Reoperative spine surgery can be difficult and should be thought through completely prior to undergoing a big procedure. Consult with another surgeon that comes highly recommended to be sure you are doing the right thing.
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