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History of degenerative disc disease. Having sub scapular pain, neck pain, headaches. Surgery needed?

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Spine Surgeon
Practicing since : 2002
Answered : 322 Questions
I have a long history of severe DDD and had a C4-5 ACDF in Nov 2006. I now have adjacent segment degeneration both above and below the original fusion. We have been watchfully waiting and monitoring the progression of the degeneration. I am experiencing an increased sensation of heaviness in my upper arms, right greater than left, along with my typical subscapular pain, neck pain, and chronic headaches. I had a repeat cervical MRI last week with the results as follows:

CLINICAL INFORMATION: Chronic neck and shoulder pain as well as upper thoracic pain and chronic headaches. Status post C4 to C5 ACDF in 2006. Comparison to 12/03/2007.

TECHNICAL INFORMATION: T1, T2 MPGR T2 FSE and STIR sagittal thin sections through the cervical spine with T2 gradient refocused and T2 FSE axial sections at selected levels.

INTERPRETATION: Status post C4-5 interbody fusion with screw-plate instrumentation. There is no recurrent stenosis, and the fusion appears solid by MR criteria. STIR images are negative for acute fracture or active inflammatory lesions.

Craniovertebral junction structures are unremarkable.

At C2-3, the disc margin is normal and foramina appear patent. Facet joints appear within normal limits.

At C3-4, there is moderate to severe disc degeneration with moderate front-back central spinal stenosis and ventral cord impingement by 4 mm AP central herniation. Foramina appear patent and facet joints are normal.

At C5-6, mild to moderate disc degeneration with moderate to severe central stenosis and front-back compression of the cord due to 2.5 mm AP disc protrusion and degenerative infolding of ligamentum flavum. Mid sagittal canal diameter is reduced to 5 mm. Disc herniation extends asymmetrically to the right of midline with chronic uncovertebral hypertrophy causing mild right foraminal stenosis. Also there is moderate left foraminal stenosis.

The C6-7 and C7-T1 levels are unremarkable.

At T1-2, a 3.5 mm right central herniation contacts the cord.

CONCLUSION: Multilevel spondylosis with significant findings as follows:
1. Moderately severe C5-6 front-back central spinal stenosis with mid sagittal canal diameter measuring 5 mm. This is due to disc herniation and infolding of degenerated ligamentum flavum. Chronic foraminal stenosis also noted due mostly to uncovertebral hypertrophy.
2. Moderate front-back central stenosis and cord impingement at C3-4 with a 4.5 mm AP central herniation indenting and deforming the ventral cord. Foramina appear patent.
3. Right-sided T1-2 disc herniation contacts the cord.

Comparison note: Interval progression of disc degeneration and disc herniation at C3-4 and C5-6 since 12/03/2007 with progressive central stenosis at both levels. The C5-6 fusion remains solid. Also, T1-2 disc herniation has increased in size in the interval.

I see my spine surgeon next week to get his opinion on the results. My question though is in regards to the findings at C5-6. I have never seen the canal diameter measurement noted on any previous MRI, so I am assuming the mention of a 5mm diameter at this level is a key bit of information? What would be a normal diameter for a healthy adult? The infolding of the ligamentum flavum is also a newly noted finding and I read the report to say that is part of what is making the canal so narrow now, is that a correct understanding? All together, I believe that my period of watchful waiting is probably over and I assume my doctor will suggest we proceed with the C3-6 ACDF that I had hoped to avoid. Do you agree that is a likely recommendation? Finally, I am a 47 yo woman, 5'4" tall originally, but now have shrunk to 5'2". My weight is 170 lbs. I have Ehler Danlos Type 3 and Scheuermann's Kyphosis of the thoracic spine, both identified and diagnosed within the last year or so. I have a 75 degree kyphosis with the apex at t6-7. Per MRI every thoracic disc is degenerated and there is an area of severe central stenosis from T4-8 or so. My thoracic spine surgeon is waiting until my kyphosis is greater than 80 degrees before he wants to correct my Tspine. At the thoracic/lumbar junction i have healthy discs for several levels, then pick up again with severe degeneration from L4 to S1.
My questions are:
1) is it time for the cspine surgery?
2) Please, bluntly tell me what you think my prognosis is? You don't need to sugar coat anything, and you dont need to worry about me falling apart. I get the feeling that my doctors don't tell me everything, but I really do want to know. What sort of life am I looking at 5, 10, 20 years from now? I'm guessing I'll be in a wheelchair or worse at somepoint, do you think I am right?
I can provide additional MRI reports of the thoracic and lumbar regions if desired. My MRI's have been performed by a national imaging company called CDI and can be viewed on-line by the MD if desired. Please let me know so I can arrange for this if desired. Thank you!
Posted Wed, 27 Feb 2013 in Osteoporosis
Answered by Dr. Rahul D Chaudhari 19 hours later
Thanks for the detailed information. Decision about spine surgery need to consider clinical and MRI findings and correlation between those findings. If you have myelopathy symptoms and with this stenosis then I will go ahead with surgery however if you have stenosis on MRI but no myelopthy then I would wait. Myelopathy means persistent tingling numbness in hands and also there will be hyper reflexia on examination. Do you have feeling of imbalance very often?
Coming to cervical stenosis less than 10 mm canal diam is absolute stenosis and between 10-13 mm is relative stenosis and normal diameter is more than 15mm.
Thoracic spine issue need to carefully assessed. If you have significant stenosis and kyphosis then I would not wait till last end and I may consider doing the decompression and kyphosis correction earlier.
Please dont worry about getting wheel chair bound. I dont think thats going to happen. Timely intervention and decompression of the canal will allow you to live normal life.
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