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Dr. Mark
Dr. Mark, Doctor (MD)
Category: Health
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Experience:  U.S. Physician/Surgeon in Neurosurgery
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Anterior neck spinal fusion below C2 (05/2008). Before the

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Anterior neck spinal fusion below C2 (05/2008). Before the surgery I had neck pain with bilateral uper extremity numbness, weakness and tingling as well as lower extremity weakness. Before the surgery, MRI saidthatI had degenerative disc disease with moderate spondylitic ridging, uncovertebral spurring and small central disc protusion atC6-7 resulting in moderate compression of ventral spinal cord and bilateral foraminal narrowing.Less proeminent degenarative disc disease at C5-6 with moderate spondilytic and uncovertebral resulting in mild compression of ventral spinal cord and bilatera foraminal narrowing.I had the surgery (ACDF C4-C7) in05/2008, and in 08 a new MRI showed thata persistent abnormal cord signal having increased slightly inits cephalad extent since 04/2008. Felt better for 2 months aftersurgery, but after a lot pain started, the numbness increased and spread all my left side. Surgen says that nothing else can be done and just wait (the more pain the better)Is that true
Well, your MRI shows this "persistent abnormal cord signal".

This is a sign that the spinal cord itself has suffered some damage to it, likely due to the compression of the spinal cord you had before your surgery.

The cervical fusion that you had took the pressure off of the spinal cord, but the fact you have this persistent abnormal cord signal change in the spinal cord means that some damage has already been done to the spinal cord.

Unfortunately -- spinal cord damage cannot be undone, and the best one can hope for is improvement with time. There is nothing your surgeon (or any doctor) can do with this abnormal cord signal -- it is a sign that the nerves in the spinal cord have been damaged and could be causing your symptoms.
Customer: replied 8 years ago.
So, this means that another surgery cannot improve my cervical myelopathy and paresthesias, and all I can do is to live in pain (burning, left leg walking trouble) for the rest of my life?
Well, your cervical myelopathy seems to have been caused by your previous compression -- and the surgery helped to prevent further damage to the spinal cord.

In most cases -- the symptoms do improve after the spinal cord is decompressed -- but the symptoms almost never improve back to 100% normal, so it is reasonable to say that you will have some symptoms forever. But hopefully, the pains and paresthesias do improve with time, but unfortunately, no one can predict what will happen in the future.
Customer: replied 8 years ago.
My concern is that before surgery I had no pain and no lelft side of the body burning in the leg and on my left side of the body. The pain appeared after the surgery. The first month after the surgery I felt well ( no pain), but after 2 months I started getting worse and worse (pain on my left side of the body, burning, trouble walking, clonus still present). The surgeon said that all I can do is take Baclofen and Lyrica all my life, and that maybe I will get better in 16-18 months after the surgery. This is what troubles me. How I can get better with just pills, and why these symptoms appeared after the surgery. Do I need another surgery to resolve the clonus?
Clonus comes from actual spinal cord injury -- and no surgery can help to resolve this issue.

The only thing surgery can help is if the MRI shows continued compression on some region of the spinal cord.

If the MRI shows no further compression on the spinal cord -- then there isn't a neurosurgical procedure that will help.
Customer: replied 8 years ago.
The MRI after three months after the surgery says that: "Persistent abnormal cord signal HAVING INCREASED slightly in its cephalad extent since 4-08. Unchanged pattern of abnormal intramedullary enhancement at the C6-7 disc level. Cord edema and myelomalacia from previously exiting canal stenosis would certainly be most likely and most common etiology os such abnormal signal, however associated contrast enhacement would be quite unusual. This still seems to be most likely explanation, given geometry of previously existent canal stenosis with location of the abnormal signal and enhancement. Unfortunately, other processes that more commonly give abnormal enhancement and abnormal signal are not excluded. This would include demyelinating disease, transverse myelitis, and neoplastic process. Short-term monitoring is suggested. One would expect abnormal enhancement from the previously existent stenosis to resolve. "
I attached image 5 (before surgery) and image 1 (after the surgery).graphicgraphic
I am seeing a spine surgen on 06/08, and I don't know what to expect and if he can help me with anything. What's your advice?

Thank you for adding the MRI.

It appears you may need a second surgery for decompression -- a posterior decompression and laminectomy, as it appears you may still have compression of the spinal cord, despite the surgery you had from the front of the neck.

Of course, the spine surgeon you will see will also review these images, but considering you still have worsening symptoms -- and I think I see continued mild compression of the spinal cord -- it would be worthwhile at least considering a second surgery for decompression (this time from the back).
Customer: replied 8 years ago.
I am really considering the second surgery because it's impossible to live all my life with this pain. How much do you think the second surgery can help with the pain and the burning on my left side of the body and the leg. How dengerous is the surgery? Can I get worse from the second one? What's the best scenerio I can expect from the second surgery - less pain, less burning ....?
Well, the best case is improvement in the pain and burning -- and most importantly, giving your spinal cord a chance to heal itself.

I think your MRI still shows some spinal cord compression -- so it is important to get the pressure off of the spinal cord to give you the best chance possible.

Unfortunately, because of the changes seen in the spinal cord, you'll have to understand that it really is impossible to predict how much you can improve -- but this really is probably the only thing that can be done to give you a good chance to improve your symptoms.
Customer: replied 8 years ago.
Thank you very very much!! You are great and God bless you! Wish good luck and if I have more questions I will definetily contact you again.

Best of luck to you.
Dr. Mark and 2 other Health Specialists are ready to help you
Customer: replied 8 years ago.
I have a new MRI for my spinal cord. Can I have your opinion about what's going now. Am I better or worse, or...graphic

This new MRI is much better concerning the possible compression of the spinal cord.

The ligaments that were pressing on the spinal cord on your post-op MRI appear to have shrunken, leaving some more room for your spinal cord.

However, it does appear that there is a pronounced "cord signal change" in the spinal cord itself, right at the level of C6, which is brighter than it was on your post-operative MRI. Of course, I can't tell if that is significant, because the actual MRI picture here appears to have excessive "brightness" to it (like the contrast/brightness levels on a TV have been turned up).

Also, if you could post the T2 signal MRI (the one you posted is a T1) so I can compare apples to apples, it would help. (In the upper left corner, third line down it says: SC:T1 SAG)
Customer: replied 8 years ago.
Here is the SC:T1 SAG.graphic
Actually, I was hoping you would post the T2 sagittal (and scroll to the picture with the spinal cord in the middle).
Customer: replied 8 years ago.

With the image on the right side, I need to see the spinal cord itself, so you have to scroll through the images until it appears that the spinal cord runs down the spinal canal, similar to the way the post-op MRI picture you put up looks.

Sorry this is such a hassle.
Customer: replied 8 years ago.
these onesgraphicgraphic?

Those are good shots of the midline, but they are the T1 "LOC" (localizing shots) for the spine.

I'm looking for the T2 image that is similar in position to those above, like this one you posted:

That has the spinal cord in dark grey color, the spinal fluid around it (to the left and right of it bright white). That's the T2 image. (It should also say T2 in the upper left corner).
Customer: replied 8 years ago.
I found SAG FSE T2graphic
Customer: replied 8 years ago.
another one graphic
Customer: replied 8 years ago.
more T2- finally got it where they are :-)graphic
OK. Good.

The spinal cord itself now looks like there is less pressure on it, as mentioned above, as the ligaments have regressed somewhat. So there is no longer severe compression on the spinal cord itself. But the T2 images make the "cord signal change" a bit more obvious, with signal change seen in the spinal cord at the C6 level, and at the C6-7 level.

So, in summary, I think this MRI looks a lot better than your immediate post op study, in terms of the cord compression. It is debatable now whether or not you would need a second surgery for decompression in the back (of course -- an actual opinion is made by your own neurosurgeon, who has to look at all of the images to ensure that the spinal cord is fully decompressed).

However, the signal change in the spinal cord is larger than it was post-op, and this could represent the damage that has been done to the spinal cord itself, and could be the reason for your new numbness and pain.

So I would have the neurosurgeon take a very close look at the images, especially at the C6-7 levels to ensure that there isn't anything compressing the cord at this level -- and if there is, a posterior decompression is probably best. If there isn't, then there may be nothing else to do.
Customer: replied 8 years ago.
Sorry, but I am confused. It was not supposed the first surgery to resolve all these, inclusive the C6-7 levels compression.
Well, yes, it does appear that the first surgery did do it's job to decompress your spinal canal, as the MRI now appears to be a lot better than your post-op MRI.

However, remember I am just looking at one image here, and that your neurosurgeon has to go through all the images to ensure that the entire circumference is decompressed.

In particularly severe cases, the spinal cord is "squeezed" from the front and the back of the spine (which was your case, on the pre-op MRI). In such cases, usually surgery is performed from the front of the spine to relieve the compression coming from the front of the spine (the stuff in the back is not touched). In most cases, this is enough to reopen the spinal canal.

Then, at a later date, if needed, a second surgery is done from the back. If today's MRI had looked like your post-op MRI, I would have said you definitely need a second surgery. However, today's looks much better, so now I probably would think that you wouldn't need one, though I am basing this opinion on one picture only.
Dr. Mark and 2 other Health Specialists are ready to help you
Customer: replied 8 years ago.
OK. I will see what the surgeon has to say. Thank you very much.