C5-C6 Fusion with new findings, Help Plz?!?

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Will900

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All Concerned,

I had a 5-6 fusion in october of '08. Since then I have been in Pain Management and recently complained of symptoms that reminded me of my initial injury before the surgery. That doc put me in for another MRI and everyone freaked out when they read the dictation. By everyone, I am refering to the doctors at Primary Care and Pain Management. I dont know exactly what the dictation says and was hoping someone could help interpret them to me? So here is the dictation:

FINDINGS: There has been prior fusion at C5-C6 with some artifact. There is normal appearance to the disc interspaces at C2-C3, C3-C4, and C4-C5. Normal signal and marrow and cord is suggested.

C5-C6 demonstrates fusion and has no posterior disc bulge or canal stenosis that is significant.

C6-C7 demonstrates a new finding with considerable protrusion mass effect on the thecal sac and displacement of the cord posteriorly that has changed in the interval. An extruded disc cannot be ruled out at this level. There is no free fragment noted. No significant asymmetry of the neural foramina are noted at this level.

C7-T1 demonstrated minimal residual focal disc protrusion right parasagittal without marked impression on the thecal sac. This has actually diminished since the prior study.

IMPRESSION:
1. New finding of significant disc protrusion/extrusion at C6-C7 below the fusion. There is marked impression on the thecal sac and displacement of the cord posteriorly.
2. Only a minimal residual focal disc protrusion at C7-T1 parasagittal right that has improved.

I am in the military currently going through the discharge process and the doctors aren't very good at explaining things to me. As a resuly, all sorts of things are going through my head; surgery, longer time before discharge (I am slated to be a civillian 29MAR10.) I am supposed to be in my surgeon's office on 12FEB10 to discuss my "options." In the mean time I would really like to know what the radiologist is talking about and what the consequences might be. BTW I did nothing that stanRAB out in my mind that might have caused this.

Can anyone help? I would GREATLY appreciate it. Thank you very much.
Sincerely SPC Sanderson
 
sometimes you just really don't have to 'do' alot and this crap just happens. also when you just have a fusion at all it can very much impact the areas above and below the fused one,which may be part of this here. at any rate, what they were kind of freaked out about i am assuming is that finding right under where your fusion actually is? the c 6-7 had really herniated in some fashion so it would appear that you not only have compression going on at the dura/thecal sac(this is the covering that surrounRAB the actual cord itself. it is filled with CSF fluid that bathes the cord) it also appears that whatever is actually compressing this is also distorting your actual spinal cord too. it states 'posteriorly so it is being seen at the back side of the cord vs the front tho that would be where the actual compression would have to be in order for the back to actually show distortion of any kind? this DOES need some surgical intervention, probably much sooner vs later? your surgeon will more than likely want this done as soon as possible just to relieve that heavier compression off the cord. its just the longer ANY true compression actually is on that cord,the more likely certain types of more permanent damage can occur. the one thing i did NOT actually see noted as occuring YET is what is called myelomalacia? this is areas of deadening in the heavier areas where compression just sits upon cord tissue? that has NOT happened yet so that IS a very good thing and a very solid reason to get this done before that can even start in there.

hopefully the surgeon can get this done for you soon. sorry to have to tell you that but i would imagine the not knowing and seeing the reaction of your pain docs was already kind of freaking you out? they really should have actually explained this to you, not react like that and not tell you why? kind of a stupid thing to do to any patient actually. i do hope all goes well for you. please let me know how things are going. marcia
 
If you need surgery prior to your release from the military, you would probably be smart to get it...even if it extenRAB your duty time. Think about this...once you are released....do you have insurance which will cover the surgery?? Will this be a preexisting event?? It is unfortunate this has happened to you...but, I really feel that you have to take the time and evaluate your situation. Take care of you...do what is necessary for you to be healthy so you can live your life as a civilian...and not be in pain..with possibly no health insurance... I wish you the best...
Sage
 
Solidified several uncertainties that were LOOSE in my mind. I cannot thank you enough. Realities that I would have most certainly grasped on my own, however the nudge was not only friendly, but timely, sincere, knowledgeable, appreciated, morose, , ,

I can move on.

P.S. One thing that worries me is the 10 years later part?!?! Am I destined for a surgical steel/titanium c-spine? I can handle the truth!!
 
sorry to have to tell you all that, but personally, i have had soo many real 'medical professionals' actually withold very crucial info from me that actually showed up on my MRIs i could freakin scream. it is just crucial that we as patients just have as much of our own medical info as needed so WE can make 'informed' decisions.

honestly, it is kind of up to the actual surgeon who would decide just what is or is not truely needed with any surgery. i would say that there IS probably a good liklyhood here of an added plate and screws only becasue you just do have another fusion above this one? do you already have hardware up there? i noticed it mentioned in your MRI the worRAB 'some artifact' and sometimes that does mean metal added somewhere? i have a titanium plate and screws in my front c spine in place at the c 6-7 level that was added after i did not fuse? i have really not felt a whloe lot of ROM loss really from it. i just cannot like 'tuck' the phone under my chin like i used to? but not alot of problems from it, i really do not 'feel" like anything is actually even 'there'.

what the other poster mentioned about getting this surgery and any follow up done while you are STILL 'in' the services vs what can you do, or how long would you have to wait for this do be done with only your VA hosps to do this at available to you? there is usually a long list of people and longer wait times after discharge. my sister works as a post op care nurse at our local VA hospital here in MN, so i have heard about some stories of really long waits for some to even GET a badly needed surgery. it more than likely would be much better for YOU in the long run to get this done while you are still 'in pre discharge" mode.

what you have going on right now in your c spine with that cord distortion just being there at all? the much sooner you can just get that compression relieved, the better your chances are for either no lasting damage or very minimal. your cord just IS very vulnerable right now(it just takes quite a bit of real solid compression to even distort ones cord) and any particular things that can happen to you at this point just could make that area much worse with more impactful symptoms too? believe me, the very last thing you want to end up with is ANY level of a lasting type of cord injury. they just suck in what they can do to a persons body and functions too. i have had mine now since 2003 and i STILL am having new and strange insane things pop in to attack me from time to time. you just DO NOT want this to occur in your cord at all. any surgery that can get done, the sooner the better for you overall, trust me. good luck will and do keep us posted, Marcia
 
Well to answer your questions, marcia, (and btw thank you for your concern. It means a lot to me) as far as what is going on: I do have a plate and four screws at c5-6. I dont really know why, though if you only got yours after your fusion failed. The surgeon installed the plate the first time. Maybe the practice has changed. I still can't hold a phone on my shoulder either. For the longest time I couldn't check my blind spot while driving, but I dont notice that pain anymore. Well i should say that it had subsided until around christmas. That was when these new symptoms starting showing. They remind me a lot of what was happening in my neck before the first surgery. That's why I knew to tell the doctor and personally knew that I was hurt again. My arm pain is weird. Best I can describe it: if your brachial nerve were a no.2 pencil, grab it with your hand and squeeze it as hard as you can. This is located directly under my bicep into my armpit. My little finger and ring finger went nurab while driving one time. Reading or typing for more than about 10 minutes will do it every time. I guess just having my chin down to any extent. And worst of all I can't pick up my 2 year old daughter when she asks me to. Nobody should have to feel that. I talk to the neurosurgeon friday (2 days!!) and I'll share her thoughts w/u. Thanks again. Will_900
 
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