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Surgery options for cervical spondylotic myelopathy and multivessel CAD - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2584 Questions
User: We have a situation over here for my dad who is 72 yrs old and is suffering Cervical Spondylotic Myelopathy on C3-C4 disc compression in spine. Due to this he is on wheel chair & cant walk. During the initial analysis it was found that he has a MULTIVESSEL CORONARY ARTERY DISEASE & need to under go a CABG. Now the issue is if he under goes Cervical Spondylotic Myelopathy, there is a moderate risk of MI/Heart failure during neurosurgery. If he undergoes CABG, there is a risk of Spine stress & neuro. Please provide us your opinion, which will help us in making decision.           
User :   Hello
Doctor :   Hi
Doctor :   I am Dr.
Doctor :   Let me read your query
User :   Hello Doc. Sure
Doctor :   Very experienced surgeons can do such surgeries
Doctor :   Which surgery are you preferring first
User :   that's the issue. we are not able to make the decide on which one. as there is a risk factor on both the surgeries
Doctor :   Yes
Doctor :   There is a high risk but some surgeons who are experienced in doing these surgeries who have enough confidence can do them
Doctor :   The risk would be the same
User :   if we go for neuro surgery there is a risk factor of the BP dropping off & heart beat going down depending on anesticia
User :   what is your suggestion Doc? which one to go first?
Doctor :   A specialist in Neuroanesthesia is to be preferred
Doctor :   like wise a specialist in Cardioanesthesia is preferred
Doctor :   Believe in your doctor
Doctor :   Give him full powers
Doctor :   Prepare yourself mentally all the risks
Doctor :   and put your father in safe hands
User :   understood. a specialist in Cardioanesthesia for neuro surgery is a good one, if we go for neuro surgery first?
Doctor :   Yes
User :   that way he can monitor the Heart function.
Doctor :   You may ask the surgeon to prefer an experienced in Anesthesist one who is trained in Neuroanesthesia
Doctor :   You may take that extra burden to put Cardioanesthesist to be in the Operating room
Doctor :   The risk is the same, but having trained people on board, the salvaging is easy
User :   the doc told me for a neuro surgery a general anestheisan is good
User :   Also for a Cardioanesthesian, is it a mandate for him to know the neuroanesthesia?
Doctor :   In, there is only a single branch called General Anesthesia
Doctor :   Based on their work in the Neuro Operating rooms
User :   before he specialises in cardioanesthesian
Doctor :   they are called Neuro etc
Doctor :   Similarly for Cardiac
Doctor :   If anesthetist works in Heart specialty hospitals is more a cardioanesthetist
Doctor :   I am sure your Doctor shall tackle these cases in previous time
Doctor :   He has to inform you about the risk
User :   the place where I am showing is a multi speciality hospital
Doctor :   Ok
User :   so, they have both. but I was not very convinced by the neuro surgeon talks, which I had today.
Doctor :   Just ask your surgeon, if you can hire a trained anesthetist who had done similar cases
User :   so wanted to know how best we can take this up
User :   ok.
Doctor :   Ok, take another neurosurgeon's opinion
Doctor :   If he says the same, you may go ahead with the surgery
Doctor :   with the first one
User :   anything else we need to take care doc before we make the decision?
User :   i know its a wrong department. but as you are a doc, you can tell your views
Doctor :   Did you take the cardiologist's opinion
Doctor :   Did they give a go ahead for the surgery
Doctor :   after seeing your father
User :   yes, but wanted another check from the neuro surgeon. before they go ahead with CABG. now the ball is going from one court to other.
User :   is this link for a neuro surgeon?
Doctor :   YEs
Doctor :   Please give the entire details to him
Doctor :   and if you have reports
Doctor :   The current status of your father
Doctor :   You can post the scanned copies
Doctor :   that you hve
User :   ok.
User :   thanks a lot doc.
Doctor :   I hope your father gets better
User :   have a pleasant day ahead.
Doctor :   Thanks for consulting me
Doctor :   Bye for nwo
User :   bye
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