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Neurology (Expert Forum)
Re: Cervical cord compression
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Re: Cervical cord compression
by CCF NSG MD / gsh, Jan 01, 1995 12:00AM
Posted By CCF NSG MD /gsh on February 07, 1999 at 15:41:37:
In Reply to: Cervical cord compression posted by Joyce on February 01, 1999 at 12:35:27:
In 1974, I had ACDF C2-4; in 1993, (2) ACDF C4-5; in 1995, corpectomy with fibula strut graft C4-C7. MRI's in 1992 confirmed multiple levels of cord compression and stenosis. Had positive Babinski, Romberg, loss of position sense, upper/lower extremity weakness & sensory changes, ataxia, spasticity, chronic bladder/intermittent bowel incontinence, L'hermitte sign, hyperrefleix. Prior to each surgery, was told I was at high risk for quadaplegia from falls or whiplash injuries. Area of worst compression was at C4-5; surgeon diagnosed segmental OPll, and told me that he would not want to operate on Cspine again, but that spinal problems could possibly "travel" below cervical level, requiring more surgery. (MRI's also showed 3 levels of disc rupturing in lumbar spine - have always had back pains/problems, but never had surgery.
All symptoms remain; severity depends on my level of activity and positioning of neck during activities. After trying to work for 2 months in 98 symptoms markedly worsened, L'hermitte returned. Had another MRI.
It showed: cervical kyphosis; abnormally increased signal intensity C2-4 vetebrae; C2-3, mild posterior midline osteophyte slightly reducting AP diameter of spinal canal. No significant stenosis. C4-5, hemispherical lesion measuring approx 8mm in transverse diameter, lying immediately adjacent to posterior margin of C4 vetebral body, which protrudes into the spinal canal slightly to left of midline, appearing to directly compress the spinal cord. Osteophyte encroaches slightly on the left neural foramen.C5-6, osteophyte rsults in mild encroachment on the left neural foramen.
Have relocated from Hawaii to Oregon, so consulted new surgeon, who said that normally, he would want to operate immediately to relieve compression, but risk of quadaplegia from another cspine surgery was too great, and that without surgery, risk of quadaplegia was high from fall or whiplash injury.
QUESTION: am 49 years old. How should I be followed? What kind of progression/increase in severity can I expect? What are the odds of quadaplegia? Should I just give up and file for social security and try to protect myself from further cervical trauma?
I am scared and am uncertain of my future. Would like to sit down and talk with someone who will explain all this to me - where I am and where I will be in the future.
I don't want to make more of this than it might really be, but do want to know exactly where I stand.
Any thoughts of insight will be really appreciated.
Dear Joyce,
Your situation is difficult. You have had numerous fusion procedures in the cervical spine and still are having problems. Two issues arise with regard to your present status with regard to the cervical spine.
The first issue is whether the cervical spine is 'stable'. This can be determined by plain x-rays to evaluate the status of the fusions and see whether any areas are failing to fuse correctly.
The second issue refers to whether there is any compression on the neural structure in the spine. There can be central compression on the cord or lateral compression on the cord and/or nerve roots. These two issues should drive the decision-making process as to what should be done for you at this point.
Second referrals in this type of situation are common, but know that some surgeons will not want to operate given your already complicated history. If you find it necessary, find a spine surgeon who has extensive experience in spine surgery and the odds are he will have seen cases similar to yours before. It is difficult to render a solid opinion in these cases without seeing the studies that were done.
Speak to your surgeon about the two issues of stability and neural compression for his thoughts on your situation.
Good luck.
In Reply to: Cervical cord compression posted by Joyce on February 01, 1999 at 12:35:27:
In 1974, I had ACDF C2-4; in 1993, (2) ACDF C4-5; in 1995, corpectomy with fibula strut graft C4-C7. MRI's in 1992 confirmed multiple levels of cord compression and stenosis. Had positive Babinski, Romberg, loss of position sense, upper/lower extremity weakness & sensory changes, ataxia, spasticity, chronic bladder/intermittent bowel incontinence, L'hermitte sign, hyperrefleix. Prior to each surgery, was told I was at high risk for quadaplegia from falls or whiplash injuries. Area of worst compression was at C4-5; surgeon diagnosed segmental OPll, and told me that he would not want to operate on Cspine again, but that spinal problems could possibly "travel" below cervical level, requiring more surgery. (MRI's also showed 3 levels of disc rupturing in lumbar spine - have always had back pains/problems, but never had surgery.
All symptoms remain; severity depends on my level of activity and positioning of neck during activities. After trying to work for 2 months in 98 symptoms markedly worsened, L'hermitte returned. Had another MRI.
It showed: cervical kyphosis; abnormally increased signal intensity C2-4 vetebrae; C2-3, mild posterior midline osteophyte slightly reducting AP diameter of spinal canal. No significant stenosis. C4-5, hemispherical lesion measuring approx 8mm in transverse diameter, lying immediately adjacent to posterior margin of C4 vetebral body, which protrudes into the spinal canal slightly to left of midline, appearing to directly compress the spinal cord. Osteophyte encroaches slightly on the left neural foramen.C5-6, osteophyte rsults in mild encroachment on the left neural foramen.
Have relocated from Hawaii to Oregon, so consulted new surgeon, who said that normally, he would want to operate immediately to relieve compression, but risk of quadaplegia from another cspine surgery was too great, and that without surgery, risk of quadaplegia was high from fall or whiplash injury.
QUESTION: am 49 years old. How should I be followed? What kind of progression/increase in severity can I expect? What are the odds of quadaplegia? Should I just give up and file for social security and try to protect myself from further cervical trauma?
I am scared and am uncertain of my future. Would like to sit down and talk with someone who will explain all this to me - where I am and where I will be in the future.
I don't want to make more of this than it might really be, but do want to know exactly where I stand.
Any thoughts of insight will be really appreciated.
Dear Joyce,
Your situation is difficult. You have had numerous fusion procedures in the cervical spine and still are having problems. Two issues arise with regard to your present status with regard to the cervical spine.
The first issue is whether the cervical spine is 'stable'. This can be determined by plain x-rays to evaluate the status of the fusions and see whether any areas are failing to fuse correctly.
The second issue refers to whether there is any compression on the neural structure in the spine. There can be central compression on the cord or lateral compression on the cord and/or nerve roots. These two issues should drive the decision-making process as to what should be done for you at this point.
Second referrals in this type of situation are common, but know that some surgeons will not want to operate given your already complicated history. If you find it necessary, find a spine surgeon who has extensive experience in spine surgery and the odds are he will have seen cases similar to yours before. It is difficult to render a solid opinion in these cases without seeing the studies that were done.
Speak to your surgeon about the two issues of stability and neural compression for his thoughts on your situation.
Good luck.
