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Neurology (Expert Forum)
Surgery VS paraplegia???
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Surgery VS paraplegia???
by Susan, Jan 30, 2001 12:00AM
Hello, and thank you in advance for your input. I've posted once before, and here are the basics:
40 yr old male, two head-on collisions (one at age 16, one at age 28) causing disability, post traumatic stress disorder, chronic pain syndrome, cervical instability, minimal brain stem dysfunction, and bilateral TMJ. Remarkably, not in a wheelchair
Chief complaint of 12/00:
Bilateral numbness in fingers and hands.
Recent MRI 12/17/00, San Diego California
First ortho specialist, when seeing the results of last month’s MRI, referred him to neck/spine surgical specialist. First ortho specialist felt that the problem might continue to the point of causing paraplegia.
MRI impressions:
1. Central disk protrusion at C 4-5 with moderate flattening of the ventral spinal cord
2. Disk osteophyte complex at C 5-6 with flattening of ventral spinal cord and spinal canal measuring approx 9 mm at this level. Moderate foraminal stenosis bilaterally at C 5-6 level.
3. Disk osteophyte complex at C 6-7 level without cord flattening with moderate neural foraminal stenosis bilaterally.
4. Probably myelomalacia, cervical spinal cord from C 4-5 thru C 6-7
5. Spondylosis, cervical spine, C 4-5 thru C 6-7 levels
6. Mild foraminal stenosis bilaterally at the C 3-4 level secondary to uncovertebral osteophytes
Current Symptoms:
Bilateral numbness in fingers and hands, seemingly to progress i.e worsening or more frequent bilateral numbness generally affecting fingers more than hands
Etiology: unknown, since the numbness began 2 years ago, which is 11 yrs AFTER his head-on collision--no other injuries or accidents since then
No comparative reports, since no MRI was taken after head-on collision in 1988.
Recent input from neck/spine specialist:
Was honest enough to say he didn't know whether or not anything (i.e. surgery, rehab, etc) would help.
IF surgery was to be explored, suggested anterior cervical disk excision C 4-5, 5-6, 7 with fusion and metal plating AND posterior cervical laminectomy. Said it was a **** shoot, and the honesty was appreciated.
If we do NOT do surgery, how long until this condition worsens to paraplegia?
Is it possible to avoid paraplegia without surgery?
What is the worst case scenario for this?
Where is the best neck/spine place in California??? USC?
Thank you very much!!!!
40 yr old male, two head-on collisions (one at age 16, one at age 28) causing disability, post traumatic stress disorder, chronic pain syndrome, cervical instability, minimal brain stem dysfunction, and bilateral TMJ. Remarkably, not in a wheelchair
Chief complaint of 12/00:
Bilateral numbness in fingers and hands.
Recent MRI 12/17/00, San Diego California
First ortho specialist, when seeing the results of last month’s MRI, referred him to neck/spine surgical specialist. First ortho specialist felt that the problem might continue to the point of causing paraplegia.
MRI impressions:
1. Central disk protrusion at C 4-5 with moderate flattening of the ventral spinal cord
2. Disk osteophyte complex at C 5-6 with flattening of ventral spinal cord and spinal canal measuring approx 9 mm at this level. Moderate foraminal stenosis bilaterally at C 5-6 level.
3. Disk osteophyte complex at C 6-7 level without cord flattening with moderate neural foraminal stenosis bilaterally.
4. Probably myelomalacia, cervical spinal cord from C 4-5 thru C 6-7
5. Spondylosis, cervical spine, C 4-5 thru C 6-7 levels
6. Mild foraminal stenosis bilaterally at the C 3-4 level secondary to uncovertebral osteophytes
Current Symptoms:
Bilateral numbness in fingers and hands, seemingly to progress i.e worsening or more frequent bilateral numbness generally affecting fingers more than hands
Etiology: unknown, since the numbness began 2 years ago, which is 11 yrs AFTER his head-on collision--no other injuries or accidents since then
No comparative reports, since no MRI was taken after head-on collision in 1988.
Recent input from neck/spine specialist:
Was honest enough to say he didn't know whether or not anything (i.e. surgery, rehab, etc) would help.
IF surgery was to be explored, suggested anterior cervical disk excision C 4-5, 5-6, 7 with fusion and metal plating AND posterior cervical laminectomy. Said it was a **** shoot, and the honesty was appreciated.
If we do NOT do surgery, how long until this condition worsens to paraplegia?
Is it possible to avoid paraplegia without surgery?
What is the worst case scenario for this?
Where is the best neck/spine place in California??? USC?
Thank you very much!!!!
Doctor's Answer
by CCF Neuro[P] MD, RPS, Feb 03, 2001 12:00AM
Dear Susan:
Again, I am sorry to hear about your friend. I am again unsure what to tell you. I really can't predict what will happen over time. Will it get worse or stay the same? From what I hear, it does sound progressive. But, without serial examinations it is difficult to tell. Whether or not surgery will halt the process depends on what the process is, and we talked about this alittle before. What surgery can do is relieve the compression of the cord. However, symptoms, outcome, further compression with the healing process, problems from the surgery itself, problems with the hardware, etc can be predicted very well. The neurosurgeon is probably correct in his/her assessment, but a second opinion would not hurt. There are plenty of good neurosurgeons around and likely some are at USC (since I graduated from UCLA I have a bias but they are excellent also). The best case is complete recovery, the worst case is quadraplegia. Do I think that either will happen, likely not and it will fall somewhere inbetween. Just a suggestion, I would get an opinion from a rehab specialist as I have had good luck with their opinions.
Sincerely,
CCF Neuro MD
Again, I am sorry to hear about your friend. I am again unsure what to tell you. I really can't predict what will happen over time. Will it get worse or stay the same? From what I hear, it does sound progressive. But, without serial examinations it is difficult to tell. Whether or not surgery will halt the process depends on what the process is, and we talked about this alittle before. What surgery can do is relieve the compression of the cord. However, symptoms, outcome, further compression with the healing process, problems from the surgery itself, problems with the hardware, etc can be predicted very well. The neurosurgeon is probably correct in his/her assessment, but a second opinion would not hurt. There are plenty of good neurosurgeons around and likely some are at USC (since I graduated from UCLA I have a bias but they are excellent also). The best case is complete recovery, the worst case is quadraplegia. Do I think that either will happen, likely not and it will fall somewhere inbetween. Just a suggestion, I would get an opinion from a rehab specialist as I have had good luck with their opinions.
Sincerely,
CCF Neuro MD
"Spinal Disorders 2" forum.
People there will openly tell you who to see. They can recommend the best in your area. It sounds like you have significant issues. There are others there with very similar things.
They can also provide or direct you to lots of information.
Also, search the forum and the one that closed due to too many posts (Spinal disorders).
Here is the link:
http://neuro-mancer.mgh.harvard.edu/cgi-bin/forumdisplay.cgi?action=topics&number=212&SUBMIT=Go
Best wishes.
Judy