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Conflicting advice/C7-T1 herniation
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Conflicting advice/C7-T1 herniation


  My husband, Norm, was lifting weights on April 22 and herniated his C7-T1
  disc.  The first neurosurgeon said that he would go in and "pluck" the
  disc out posteriorly; therapy would not help and if Norm wanted the
  operation in 2 weeks, he would do it.  The second neurosurgeon said that
  because he had no neck pain at all, that an osteophyte was involved and
  that he preferred to do the anterior fusion procedure.  The MRI showed
  narrowing at C5-6 which is not symptomatic, probably from an osteophyte,
  by the way.  The second neuro said he would do either procedure, but he
  preferred the anterior.  (So Norm would get to choose!!!) He prescribed
  therapy including traction and said to wait and see if it got better.
   The first orthopedic doctor we saw said that he could remove the
  osteophyte from the back and would do the posterior procedure (oh yes, he
  wouldn't use bone from the bank unlike the 2nd neuro if he did the
  anterior procedure.)  He also said that therapy would not help.  He prescribed a
  CAT scan because he said that would show the osteophyte (the radiologist
  had told us previously that the scan would not show an osteophyte well
   enough.) The third neuro we saw said at first that he would do the
   anterior fusion but after we told him about all the conflicting advice,
   he prescribed a myelogram so he would know for sure.  He disagreed with
  the radiologist about the osteophyte (both having read the MRI and CAT
  scan, giving us the impression that the osteophyte was causing more of
  the problem instead of the disc.  He said to go ahead with the therapy
  until the myelogram could be scheduled.
       Meanwhile, "back" at the ranch, Norm was getting better.  His pain
  and numbness decreased considerably.   Why have we seen all these people?
  Norm is a jazz guitarist and the ring and little fingers on his left
  hand were too weak to play the guitar well.  After six weeks now, he can
  play better, but his little finger still has only 30% strength of normal.
  The ring finger has about 60% of strength.  His livelihood, especially
  after retiring eventually from the ownership of his music store, depends on his
  hands.  Norm is 49.
       Now for the questions:  is C7-T1 unique enough that we insist on a
  surgeon who has had a lot of experience with it?  Is that disc much
  easier from the back?  How do we get a surgeon to tell us his experience?
    (one refused to say when we asked)  Do we ask about Adcon-L?
   Scarring might be a crucial consideration.  With all the risks of
  surgery and the "domino" effect of fusion destabilizing other vertebra,
  would Norm be better to go with maybe 50% strength in his little finger
  and accept that his playing will never be normal again?  By the way, at
  his store Norm has to lift heavy instruments over his head to store them.
  He also lifts heavy amplifiers, etc.  Norm is 6'1" and 170 lbs.  (sexy,
  too!!)  Of course he would have chronic pain that would come and go, as
  it has done recently, which can be depressing in itself if he doesn't try
  the surgery.  Any advice will be greatly appreciated!  Thanks!
  crucial consideration.
=
I personally am very conservative about management of degenerative spine disease. If I can keep a patient from having an operation, I'll do whatever it takes. There is a real benefit from conservative therapy (physical therapy, ibuprofen, etc).
You need to know: Is this a real herniation or just a disc bulge? (Often, doctors are not careful about making the distinction). Is there a lot of debris in the spinal canal at C7/T1 or is it just some? How much room does the spinal cord have? What does the nerve root look like, and how much room is there at the neural foramen (the hole through which the nerve exits the spine)?
Next, you need to know: are symptoms getting better or worse? I personally have had some experience with this (L4-5 herniation with damage to L5 root). My symptoms got better and a neurosurgeon who I trust (and to whom I refer a lot of patients) asked me one question: am I getting better? Yes? Then no operation is needed right now.
It is very important to know prior to contemplating any surgery that surgical procedures are done to ** prevent you from getting worse **. That is, there is no guarantee than weakness in your finger or hand would get better. Sometimes it happens (recovery from weakness), sometimes not. Sometimes recovery from weakness occurs without any surgical intervention.
It is not quite that simple, but I want you to know that there is a non-surgical option. You probably need a third opinion before you let anyone cut on you. You are welcome to make an appointment with the Spine Center here (800 223 2273 ext 4-5559) and have them check you out. If a third opinion says you should have surgery, then you can proceed with some confidence.
I hope this helps. As you know, this information is provided for your medical education only. Any specific comments regarding diagnosis, prognosis, and treatment options must come from your doctor after appropriate evaluation. CCF MD mdf.





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