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  #1  
Old 01-22-2017, 03:32 PM
locorebob locorebob is offline
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Default C5/6 herniated w/osteophytes...ADR or fusion

I've had a pancaked cord at C5/6 now for nearly 9 perhaps 10 years or more and now there is evidence ( Jan 2017 MRI ) of non-symptomatic myleomalacia. Numbness and pain down both arms and posterior neck pain. My intuition says get ADR, however two local surgeons - both qualified for Mobi-C implants - are reluctant and still recommend fusion. Why is that?
I can't imagine how fusion would be superior to ADR... perhaps it's the facets or foraminal Stenosis... or perhaps the aggressive osteophyte growth/activity and so maybe the implants will auto fuse.. Or will ADR implants cause facet preloading and result in issues later. I am waiting for Appt with one of the pro-fusion surgeons so he can explain why ADR is not ideal in my case. Meanwhile, I've heard from another surgeon in Texas who is pro-ADR and said yes by all means he would implant ADR..
And so, I need to decide what to do and then I need to do it..
I'm cautious and constantly thinking of the adage..."be careful what ask for"...
I need and want a discectomy at C5/6, however it's the instrumentation choice that I'm struggling with...

Thanks, Bob

Here is most recent MRI report.
.
DATE OF EXAM: 01/09/2017
EXAMINATION: MR C-Spine without contrast
CLINICAL INDICATION: Neck and right arm pain.
TECHNIQUE: Inversion-recovery, T1-, and T2-weighted images of the cervical spine were obtained in multiple
imaging planes without intravenous contrast.
COMPARISON: MRI cervical spine, 03/28/2011, Center for Neurosciences.
FINDINGS:
ANATOMY/ALIGNMENT: Slight reversal of the usual lordotic curvature of the cervical spine. Mild posterior
subluxation of C5 on C6, unchanged.
VERTEBRAE: Disc space narrowing and small anterior osteophytes at C5-6 and C6-7. Unremarkable marrow
signal. No evidence of recent or remote fracture.
SPINAL CORD: No change in small focus of hyperintense signal on the inversion-recovery and T2-weighted
images within the cord at C5-6, consistent with myelomalacia.
CRANIOCERVICAL JUNCTION/C1-2: Unremarkable.
C2-3: No cord deformity or foraminal stenosis.
C3-4: Disc/osteophyte complex, producing minimal cord deformity without cord compression. Mild to moderate
left foraminal narrowing.
C4-5: Disc/osteophyte complex, producing minimal cord deformity without cord compression. Moderate left
foraminal narrowing.
C5-6: Disc/osteophyte complex eccentric to the left and mild retrolisthesis, producing moderate to severe cord
compression. Mild facet joint degenerative changes bilaterally, with severe bilateral foraminal narrowing.
C6-7: Disc/osteophyte complex, producing minimal cord deformity without cord compression. Mild facet joint
degenerative changes bilaterally, with foraminal narrowing moderate to severe on the right and moderate on the
left.
C7-T1: Mild posterior osteophytic ridging, without cord deformity or foraminal stenosis. Mild facet joint
degenerative changes bilaterally.
OTHER: No significant findings.
IMPRESSION:
Degenerative changes in the mid and lower cervical spine, greatest at C5-6. There is moderate to severe cord
compression and a small focus of myelomalacia within the cord at C5-6, with multilevel foraminal narrowing
which is severe bilaterally at C5-6. There has been no significant change since 03/28/2011.
Electronically signed by
Bxxx X. Xxxxx M.D., Neuroradiologist
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  #2  
Old 01-22-2017, 08:02 PM
Gorrito Gorrito is offline
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Default

Report basically says the findings were there in 2011. Why is someone now recommending surgery, or has it been recommended since 2011 or even before that?

Some US surgeons don't recommend ADR beyond a certain age. Some US surgeons are not keen on multi level ADR and from reading your report, there are multiple levels involved. Those might be the reasons they have not recommended ADR.
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Right C6 facetectomy (foraminotomy) 09/24/2015
2 level ADR C5-C7 with Prestige LP 01/09/2017
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  #3  
Old 01-22-2017, 09:00 PM
aeromarkco aeromarkco is offline
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Default

Hi Bob,

I think that the answer goes back to what we as human beings are comfortable with and surgeons are no different - they've had succesful outcomes with a particular procedure and are comfortable with that.

ADR is newer technology - just the last ten years here and many in the medical field many would like impartial data over a longer period. The fact that several large insurers are now covering it is important to me however I would have gone to Europe if that made sense.
BTW, radiology (and medecine is an art and a science) I have noticed that MRI reports and interpretation can vary.

As far as myelomacia, I beleive that's important - at least on whether to have surgery sooner or later.
I don't yet have myelomacia but the neck pain and joint mobility are getting worse so that now seems to be the right time.
Good Luck,
Mark
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History of Degenerative Disk Disease:
1983 Laminectomy L3/4 & L4/5
2015 Diagnosed with Cervical Myelopathy C3-C7
C4/5 & C5/6 are worst
C4/5 & C5/6 Mobi-C Surgery 2/1/17 with Dr. Vikas Patel
Still active, working out and cycling - want to stay that way!
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  #4  
Old 01-22-2017, 10:26 PM
locorebob locorebob is offline
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Default

Gorrito, Prior to 2011 the initial MRI was in 2008 however, like 2011 there was no myelomalacia. I'm below the clip level for Mobi-C ADR by 8 years, so I'm good there. I'd be grateful for discectomy at C5/6 just to deal with the myelomalacia and that's what the Dr in TX recommended.
It's funny, or perhaps not, how people react, but I've been saying to myself... oh heck yeah, I'll go across the pond and pay cash for ADR, however now that ins covers here stateside and I've been given assurance that a reputable surgeon with lots of ADR experience in TX is willing to do it, it gives you ( or rather me ) pause.
Opinions are like herniated cervical discs... every ones got one ( or two... or three ).
Be grateful things aren't worse than they are...
Bob
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  #5  
Old 01-22-2017, 10:42 PM
locorebob locorebob is offline
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areomarkco, I've been watching the ADR picture show since 2008 and it;s not until now that I realized the FDA has made the 2 level approval happen etc etc and that ins is covers but you make an important point..."I would have gone to Europe if that made sense"... and I guess I have to ask... what is is it that makes sense? That's an open ended question or rather rhetorical comment because there are Dr's that rationalize with patients on just "what makes sense", And so we as patients are left to our faculties to decide "what makes sense". Or be influenced spiritually or otherwise to make a decision on "what makes sense".... right or wrong. I guess I'm of the mindset that I would rather have ADR and look at a revision in 10 years which is less likely if I choose fusion ( i.e revision is not an option when fused ) ... although maybe I don't even know what I'm talking about..
Stay active my friend. I am active and feel that post surgery ( regardless of ADR or fuse) will be much easier because I am in great physical condition..
When it comes to instrumentation, I prefer ADR...
Bob
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  #6  
Old 01-22-2017, 10:51 PM
Gorrito Gorrito is offline
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Default Not sure I agree

The report you copied says this: "SPINAL CORD: No change in small focus of hyperintense signal on the inversion-recovery and T2-weighted
images within the cord at C5-6, consistent with myelomalacia." This recent report was compared to the study done 2011. Therefore, even if they did not report the word "myelomalacia" in 2011, it was there because there has been no change in this finding from 2017 looking back to the comparison in 2011.

So, since there is no change in the signal abnormality representing myelomalacia in nearly 6 years, I was questioning what is different now to push for surgery? Are you feeling different? If the myelomalacia is the big deal, well it was there before.

Just asking.

Regardless of what happens, good luck in your search for the best thing for you.
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Right C6 facetectomy (foraminotomy) 09/24/2015
2 level ADR C5-C7 with Prestige LP 01/09/2017
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  #7  
Old 01-22-2017, 11:11 PM
locorebob locorebob is offline
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Gorrito You bring a very good point, In fact I wanted to question that specific statement in the report. They only reason I opted for a new MRI is because I started getting deep pain in and around right humorous and right fore finger and thumb was getting numb and so I new the right side was getting bad and so I got the MRI. Now I want to reach out to the Radiology Limited and question that reference.. Just the term myleomalacia scared the disc out of me. Actually went to a chiro oeior to 2017 MRI and increased my weight bearing exercise and the pain diminished... I'll take what pain is left, but the myleo has me running scared.. or should it? It's barely a visible white area in the cord axial view, even though the cord is so flattened, the white spot is visible even by me. It's asymptomatic and so yeah I guess I need to really learn just how long the myleo has or hasn't been there.
Bob
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  #8  
Old 01-22-2017, 11:27 PM
Gorrito Gorrito is offline
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Default my $0.02

Bob that deep pain is typical of nerve pain. That is likely from the right C5, but the hand/finger numbness is likely from right C6. So you probably need that C5-6 discectomy but also may need the level below done or maybe the right neural foramen opened up more to relieve the nerve root pressure. If the symptoms of pain and numbness are new, then surgery should be considered even if the MRIs don't look much worse.

Are you experiencing weakness as well? It could be arm, hand or even leg. I did not think I had any significant weakness myself but my surgeon tested my grip strength using a dynamometer and my dominant affected hand was only 70% of my otehr hand.

In any case, you are entited to put the surgeons on the spot and have them explain why they recommend one procedure over another. You can demand answers.
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Right C6 facetectomy (foraminotomy) 09/24/2015
2 level ADR C5-C7 with Prestige LP 01/09/2017
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  #9  
Old 01-22-2017, 11:32 PM
Gorrito Gorrito is offline
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Default one more thing

Sorry, but if the cord is flattened and weakened according to radiographic evidence, I think a chiropractic adjustment could be potentially dangerous. Has anyone told you to stop seeing a chiropractor?
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Right C6 facetectomy (foraminotomy) 09/24/2015
2 level ADR C5-C7 with Prestige LP 01/09/2017
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  #10  
Old 01-23-2017, 10:49 AM
locorebob locorebob is offline
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Gorrito, After the getting the 2017 MRI. I convinced myself to stop seeing the chiropractor.
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