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Is Laparoscopy, Cervical Disc Replacement Or Fusion Suitable To Treat A Nerve Root Compression And Bilateral Radiculopathy?
Question: Diagnosed with herniated discs (DDD) in neck at 3 levels with nerve root compression & bilateral radiculopathy. what are pros & cons of laproscopy vs. cervical disc replacement vs. fusion? would appreciate an objective 3rd party analysis. thanks
additional info to previous question - affected cervical discs are c4-c5; c5-c6; c6-c7. See tests results below:
Discogram performed wednesday XXXXXXX 5, 2018; results were;
c3-c4 pain intensity 6/10, non-concordant, fissure with tears
c4-c5, c5-c6, c6-c7; pain intensity 8/10, concordant, fissures with epidural leak.
CT scan performed immediately after discgram also on XXXXXXX 5, 2018:
conclusions:
c2-c3 diffuse disc bulging.
360 degree radius annular tear c5-6 with contrast extending tear periphery of disc bulge. disc bulging eccentric to right.
contast is seen centrally within the nucleus pulposis at c3-4, c4-5, c6-7.
staightening of cervical lordosis.
Nerve conduction/EMG conclusions done march 30, 2018:
Evidence suggestive of acute left c5, c6, and c7 radiculopathy with denervation confined to the paraspinal muscles, however cannot further localize as no findings were found distally in peripheral studies.
Mild bilateral sensory demyelinating median nerve neuropathy at the wrists consistent with clinical diagnosis of carpal tunnel syndrome.
No evidence of peripheral neuropathy, motor nueron disease, or brachial plexopathy at this time.
These are test results to supporting diagnoses in commmnication. I hope the test result info will help in your response to my previous question about the pros & cons of laser discectomy vs. cervical disc replacement vs. fusion as i consider my surgical options.
additional info to previous question - affected cervical discs are c4-c5; c5-c6; c6-c7. See tests results below:
Discogram performed wednesday XXXXXXX 5, 2018; results were;
c3-c4 pain intensity 6/10, non-concordant, fissure with tears
c4-c5, c5-c6, c6-c7; pain intensity 8/10, concordant, fissures with epidural leak.
CT scan performed immediately after discgram also on XXXXXXX 5, 2018:
conclusions:
c2-c3 diffuse disc bulging.
360 degree radius annular tear c5-6 with contrast extending tear periphery of disc bulge. disc bulging eccentric to right.
contast is seen centrally within the nucleus pulposis at c3-4, c4-5, c6-7.
staightening of cervical lordosis.
Nerve conduction/EMG conclusions done march 30, 2018:
Evidence suggestive of acute left c5, c6, and c7 radiculopathy with denervation confined to the paraspinal muscles, however cannot further localize as no findings were found distally in peripheral studies.
Mild bilateral sensory demyelinating median nerve neuropathy at the wrists consistent with clinical diagnosis of carpal tunnel syndrome.
No evidence of peripheral neuropathy, motor nueron disease, or brachial plexopathy at this time.
These are test results to supporting diagnoses in commmnication. I hope the test result info will help in your response to my previous question about the pros & cons of laser discectomy vs. cervical disc replacement vs. fusion as i consider my surgical options.
Brief Answer:
I think decompression and fusion are necessary.
Detailed Answer:
Hello,
I have read your question and understand your concerns.
Three levels is a long segment of the cervical column affected, so, techniques such as endoscopic discectomy, simple disc replacement, could result in postoperative instability of the cervical spine.
Furthermore, if there is actually instability (dynamic x-rays are necessary to evaluate it) decompression with fusion is the best treatment way.
I need to see the MRI and CT scan in order to give you a correct opinion, anyway, if there is an indication for three levels decompression, I would choose stabilization (fusion) too, be it anterior with discectomy or posterior with laminectomy.
Hope you found the answer helpful.
Let me know if I can assist you further.
Take care.
I think decompression and fusion are necessary.
Detailed Answer:
Hello,
I have read your question and understand your concerns.
Three levels is a long segment of the cervical column affected, so, techniques such as endoscopic discectomy, simple disc replacement, could result in postoperative instability of the cervical spine.
Furthermore, if there is actually instability (dynamic x-rays are necessary to evaluate it) decompression with fusion is the best treatment way.
I need to see the MRI and CT scan in order to give you a correct opinion, anyway, if there is an indication for three levels decompression, I would choose stabilization (fusion) too, be it anterior with discectomy or posterior with laminectomy.
Hope you found the answer helpful.
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dr. Spaho: I was trying to upload copies of the CT scan post-discogram & also MRI but the files were to big. Any suggestions on how to get this info to u? I can send info via dropbox if I get ur e-mail.
In the meantime I am uploading the MRI report (2 pages) along with 3 MRI images. 1 image is saggital view & the other 2 are referenced in the MRI report.
I also uploaded the post discogram CT scan.
Question: I see ur suggestions for either ACDF or posterior laminectomy with fusion. What are ur thoughts about hybrid fusion as far as the pro and cons.
In the meantime I am uploading the MRI report (2 pages) along with 3 MRI images. 1 image is saggital view & the other 2 are referenced in the MRI report.
I also uploaded the post discogram CT scan.
Question: I see ur suggestions for either ACDF or posterior laminectomy with fusion. What are ur thoughts about hybrid fusion as far as the pro and cons.
Brief Answer:
Read below.
Detailed Answer:
Hi,
You can use google drive to upload your files and post the link here. You can send the files at YYYY@YYYY and address it to my name: Dr Erion Spaho.
My email is YYYY@YYYY if you will use dropbox.
Let me see the images and after that, we can discuss the hybrid fusion too.
Waiting...
Read below.
Detailed Answer:
Hi,
You can use google drive to upload your files and post the link here. You can send the files at YYYY@YYYY and address it to my name: Dr Erion Spaho.
My email is YYYY@YYYY if you will use dropbox.
Let me see the images and after that, we can discuss the hybrid fusion too.
Waiting...
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Ok. I’ll work on uploading the images and let u know.
Brief Answer:
Follow up.
Detailed Answer:
Okay, let me know when you upload the images.
Greetings.
Follow up.
Detailed Answer:
Okay, let me know when you upload the images.
Greetings.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dr. Spaho: I’ve uploaded the MRI & post discogram CT in my husbands dropbox. You should receive a notifying e-mail from Dropbox.com. If you don’t then go to Dropbox.com & search for XXXXXXX Mazzola, and the file is called “Pauline Mazzola Medical Information”.
If you can’t find the info, then when u r in Dropbox u can search using my husbands e-mail which is YYYY@YYYY .
I await your response.
If you can’t find the info, then when u r in Dropbox u can search using my husbands e-mail which is YYYY@YYYY .
I await your response.
Brief Answer:
Mainly degenerative changes.
Detailed Answer:
Hello again.
Thanks for uploading, I examined the post discogram and MRI images that you provided.
I don't identify any true spinal cord or nerve roots compression, besides small herniation especially at the C4-5 and C5-6 levels.
Post discogram CT scan, however, shows that only at the C5-C6 level the contrast is located abnormally, other discs seem to have only degenerated.
Three levels of decompression seem a little bit exaggerated for me at this time, I would say that anterior discectomy at the C4-5 and C5-6 is sufficient, if all the conservative treatment possibilities were exhausted.
Before to decide for surgery, a correct match between symptoms and imaging findings is necessary.
Hope I helped you.
Greetings.
Mainly degenerative changes.
Detailed Answer:
Hello again.
Thanks for uploading, I examined the post discogram and MRI images that you provided.
I don't identify any true spinal cord or nerve roots compression, besides small herniation especially at the C4-5 and C5-6 levels.
Post discogram CT scan, however, shows that only at the C5-C6 level the contrast is located abnormally, other discs seem to have only degenerated.
Three levels of decompression seem a little bit exaggerated for me at this time, I would say that anterior discectomy at the C4-5 and C5-6 is sufficient, if all the conservative treatment possibilities were exhausted.
Before to decide for surgery, a correct match between symptoms and imaging findings is necessary.
Hope I helped you.
Greetings.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks for looking at the images Dr. Spaho. I see ur recommendation of anterior discectomy. So, this mean that u think fusion or disc replacement is not necessary at this time?
Also, I’m not too sure what u mean in the last paragraph that “before surgery a correct match between symptoms and image findings is necessary” can u please explain a what u mean by that? Thank you,
Also, if anterior discectomy is done what is the probability of further deterioration of the discs after surgery.
Also, I’m not too sure what u mean in the last paragraph that “before surgery a correct match between symptoms and image findings is necessary” can u please explain a what u mean by that? Thank you,
Also, if anterior discectomy is done what is the probability of further deterioration of the discs after surgery.
Brief Answer:
as explained below.
Detailed Answer:
Welcome back and thanks for being on follow up.
By correct match, in other words, a correlation between your symptoms ( pain, numbness, weakness ) in your certain parts of the arm(s), and affected levels/nerve roots in your cervical spine, is necessary.
For example, if the left C6 nerve root is found to be compressed/pinched in MRI, symptoms distribution ( dermatome, myotome) should correlate with left C6 nerve root in order for the surgery to have success.
Anterior discectomy includes several possibilities from simple removal of the disc, to replacement with autologous bone graft or heterologus grafts, hybrids, with or without fusion.
I think this is a choice that we should leave to the operative Surgeon.
The discs at the affected levels are removed completely during the anterior discectomy, so, there is no risk of deterioration.
The risks are transferred at the adjacent levels.
Hope this helps.
In good health.
as explained below.
Detailed Answer:
Welcome back and thanks for being on follow up.
By correct match, in other words, a correlation between your symptoms ( pain, numbness, weakness ) in your certain parts of the arm(s), and affected levels/nerve roots in your cervical spine, is necessary.
For example, if the left C6 nerve root is found to be compressed/pinched in MRI, symptoms distribution ( dermatome, myotome) should correlate with left C6 nerve root in order for the surgery to have success.
Anterior discectomy includes several possibilities from simple removal of the disc, to replacement with autologous bone graft or heterologus grafts, hybrids, with or without fusion.
I think this is a choice that we should leave to the operative Surgeon.
The discs at the affected levels are removed completely during the anterior discectomy, so, there is no risk of deterioration.
The risks are transferred at the adjacent levels.
Hope this helps.
In good health.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dr. Spaho thanks for replying, ur answer was helpful. Did u see any slippage of the discs or vertebrae when u looked at the MRI/CT scans?
I’m doing a Cervical spine w/flextest X-ray tomorrow & would like to upload it to the Dropbox tomorrow for u to take a look at it. Please let me know ur thoughts...
I’m doing a Cervical spine w/flextest X-ray tomorrow & would like to upload it to the Dropbox tomorrow for u to take a look at it. Please let me know ur thoughts...
Brief Answer:
Okay.
Detailed Answer:
Hello again.
There is no evidence for slippage in the CT/MRI.
Dynamic x-rays are the preferred examination when it comes to slippage.
Let me know after you upload the x-rays.
I remain at your disposition.
Okay.
Detailed Answer:
Hello again.
There is no evidence for slippage in the CT/MRI.
Dynamic x-rays are the preferred examination when it comes to slippage.
Let me know after you upload the x-rays.
I remain at your disposition.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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