Any cervical laminoplasty, laminotomy, or foraminotomy folks out there??

[MDE]

What's funny is I was going to ask regarding positioning during the MRI as that really does change the view dramatically.


I took a look at the two pictures and there are 3 things of note. 1) You have very little water content in any of your cervical discs. I'm not sure if you're a smoker, but I would really recommend you try very hard to quit if you are. You're far to young to have discs that degenerated without outside factors playing into it, and smoking is the number one thing that does that.
2) I can see both doctors viewpoints. The discs are already bulging at the above levels and they will continue to degenerate unless you change something, and may cause a problem eventually, but the current problem is entirely located at C5/C6. (mostly just C6) Just solving that should eliminate the pain for now.

3) the above levels don't have a lot of room. It won't take MUCH degeneration to cause impingement again, which is again, why they're looking towards the future. If you are able to, through PT or other ways, regain disc health at the above levels, the c2-c5 surgery wouldn't be necessary.

[scotto74]

Hey Greg, thanks for taking the time to respond again. Yeah, I definitely recall a small stack of sheets under my head in that recent MRI for support! Would be interesting to see it again without the props...

You know, I've never smoked a day in my life. Well, that's not entirely true... I smoked a few over the course of a couple of days in the seventh grade, but that's pretty much been it! I have heard from other docs over the years though that my cervical discs seem completely dried out. Just bad luck I guess. Other than my cervical problems, which I've had most of my life, I've always tried to live a fairly healthy and active lifestyle.

In terms of the levels above, I'm trying to figure out what the exact dimensions of my canal are at each level in my c-spine. That is something they should be able to get from the MRI or CT Myelo, right? Should I be chasing down the radiology department for that info or asking the surgeon? So far two docs say that my congenital stenosis calls for more aggressive decompression now, while two others are basically saying just decompress those levels where the problem is the worst (c5-7) and worry about the rest later. The other complicating factor for me is my 2/3 facet joint (left side) which is incredibly painful and I'm told is "auto-fusing". Not sure how the c2-7 laminoplasty would affect that painful facet joint...

Two other questions that are bouncing around my mind right now... This idea that the cord will "drift back" into the area that is decompressed. Two surgeons (including mine) say if you only decompress c5-7 that drift back will lead to additional cord compression; the other two basically say not to worry about it. Again, very confusing!

Last question, I know you're a fan of laminoplasty in general... but does either procedure (laminectomy vs. laminoplasty) allow for greater access to decompress the nerve roots during the foraminotomy? Intuitively, I would think that laminectomy allows for greater nerve decompression, but my surgeon told me that is not the case. My left arm weakness/nerve compression is definitely something I am concerned about.

So I'm gonna try to get a couple of additional opinions (hopefully quickly) and hope things start to move toward a consensus. Right now it feels like too much of a coin flip!

Thanks again, and hope everyone is doing well!

Scott

[MDE]

Hey Greg, thanks for taking the time to respond again. Yeah, I definitely recall a small stack of sheets under my head in that recent MRI for support! Would be interesting to see it again without the props...

You know, I've never smoked a day in my life. Well, that's not entirely true... I smoked a few over the course of a couple of days in the seventh grade, but that's pretty much been it! I have heard from other docs over the years though that my cervical discs seem completely dried out. Just bad luck I guess. Other than my cervical problems, which I've had most of my life, I've always tried to live a fairly healthy and active lifestyle.

Glad to hear you're not a smoker, but I'm sorry to hear that this is something you have to deal with.

In terms of the levels above, I'm trying to figure out what the exact dimensions of my canal are at each level in my c-spine. That is something they should be able to get from the MRI or CT Myelo, right? Should I be chasing down the radiology department for that info or asking the surgeon? So far two docs say that my congenital stenosis calls for more aggressive decompression now, while two others are basically saying just decompress those levels where the problem is the worst (c5-7) and worry about the rest later. The other complicating factor for me is my 2/3 facet joint (left side) which is incredibly painful and I'm told is "auto-fusing". Not sure how the c2-7 laminoplasty would affect that painful facet joint...

Both MRI pictures provided were from a software called Osirix (free mac only DICOM viewer). I was assuming you had the full DICOM files and were viewing them with the software (There are free DICOM viewers for windows, they're just not as good) If you can get a CD with your MRI or CT data, you should be able to download one of these to allow you to see the scan in 3d. It will also allow you to manipulate the image in order to make it easy to measure the canal both A-P and laterally.

Dr. Bitan was planning on addressing the facet joint separately (rhizotomy) but the laminoplasty in general would not have any effect on a facet joint.

Two other questions that are bouncing around my mind right now... This idea that the cord will "drift back" into the area that is decompressed. Two surgeons (including mine) say if you only decompress c5-7 that drift back will lead to additional cord compression; the other two basically say not to worry about it. Again, very confusing!

Last question, I know you're a fan of laminoplasty in general... but does either procedure (laminectomy vs. laminoplasty) allow for greater access to decompress the nerve roots during the foraminotomy? Intuitively, I would think that laminectomy allows for greater nerve decompression, but my surgeon told me that is not the case. My left arm weakness/nerve compression is definitely something I am concerned about.

So I'm gonna try to get a couple of additional opinions (hopefully quickly) and hope things start to move toward a consensus. Right now it feels like too much of a coin flip!

Thanks again, and hope everyone is doing well!

Scott

As far as it "Drifting back" causing more compression, I'm not sure I can comment. I believe I understand his concern, but I have no knowledge of the likelihood or severity of the issue.

With respect to peripheral nerve decompression with laminoplasty, they will pick the side they "open" based on access to the more symptomatic side. So you have neurological symptoms in your left arm, they'll hinge open your right side and completely open your left side to allow the maximum access. (let me know if this needs more explanation)

Good luck! I wish you a speedy but full recovery.

[scotto74]

Hey everyone, just checking in and hoping to get any input that might help in my incredibly painful decision-making process. So I'm set to have the C5-C7 laminectomy and fusion (plus some foraminotomy work) next week, and I'm unfortunately still agonizing about whether or not it is the right decision. I've already postponed this surgery once (with this surgeon), and I'm sure he would be livid (not to mention I would basically sever the relationship I'm sure) if I were to back out at this point. So here's what's keeping me up at night...

On one hand, I think this surgery directly addresses my most prominent problems most directly -- failed fusion and slight cord compression around the C6-7 level mostly, as well as minor nerve issues along the left side, also primarily around C5 - C8. In addition, a surgeon at Hopkins who I really liked alot seemed to endorse this approach over either the C2-7 laminoplasty (plus c5-7 fusion) or the C2-C7 laminectomy and fusion.

However, what keeps me up at night is the fact that three other surgeons (including the one who did my original ACDF) have said that you can't only decompress the C5-7 level -- that there's stenosis (although not cord compression) at pretty much every level in my neck, and if you only decompress the c5-7 level, the cord will drift back and essentially become kinked at the junction just above the decompression. Both the surgeon I am scheduled with and the Hopkins guy said I didn't really need to worry about the "drift back" issue as my worst compression is at the c5-7 levels.

So my question is, has anyone ever heard of anyone having a partial laminectomy and fusion (as opposed to a C2-7 or c3-7) and then subsequently having to go back in for more surgery either b/c of incomplete compression or b/c the cord drift caused a subsequent problem??

Also, I do really trust my original surgeon -- the one who is proposing the C2-C7 laminoplasty with a C5-7 fusion -- however, this surgery just seems really complex to me. Has anyone ever heard of a combination of laminoplasty and fusion?? A couple of the docs I consulted with called that proposal "insane" (or some variation of that), which basically scared me away from going with the original guy... as much as I really like and trust him.

Well, that's the update for now.. and if anyone has any quick thoughts or suggestions they would like to share, I would be incredibly grateful!

Thanks!
Scott

[Genn]

Hi Scott

While I had no quick thoughts or suggestions to add to you decision making process, it has been just over a week since your last post. Just checkin' in to see how the Op went. You are in my thoughts. .

Godspeed and !

Hope to hear from you when you feel up to it