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Cervical degeneration after nearly 2 years getting worse
Hi,
I have been getting worse since August 2022.
Throughout this experience I have seen neurosurgeons, pain managent specialists to no avail.
In August 2023 I made the stupid decision to get decompression laser surgery at C5-C6, C6-C7 and bilateral rhizothomies from C5-T1 at the Deukspine Institute in Melbourne Florida by neurosurgeon Ara Deukmedjian.
The surgery was a total failure because it gave me a dropped head and chronic muscle spasms that I did not have prior.
My condition has been getting worse, more symptomatic than before.
Not sure if the removal of the bulging disc material from already thin discs and facet joint ablations have contributed to the destabilization of my cervical spine.
2 neurosurgeons in Australia advised me not to seek anymore operations and ablations and to get off the drugs. Gentle Exercise was their recomendation. The surgeons did not think that an operation would improve my pain due to thae fact that it is multifactorial.
I have been trying to do more physical activity such as walking so that my muscles won't waste away.
Last week I had the latest cervical neck MRI that shows more deterioration than before.
Can anyone interpret the meaning of the following?
I asked my GP and Specialist but the don't really explain what is the meaning of this. Should I worry?
My symptoms are stinging, burning neck pain, shoulders, sholder blades, arms, hands, fingers nearly chronic pain. Pain a lot worse when sitting and lying down.
Pain, pins and needles shooting in legs and feet at times.
Thank you.
MRI - CERVICAL SPINE
History: A 67-year-old male with complex history of neck surgery presents with neck pain and deterioration in neck symptoms for investigation. ? Disc pathology.
? Radiculopathy.
Technique :
Standard protocol.
MRI Findings :
There is straightening of the cervical spine with loss of the normal
curvature and there is subtle anterior spondylolisthesis of C7 relative to Tl.
At this level, there are broad-based disc bulging, endplate ridging and facet arthropathy contributing to foraminal narrowing for the exiting C8 nerves bilaterally but worse on the right side. Vertebral body height is maintained. Small haemangiomata are visible. The Cl-2 articulation is preserved.
The cervicomedullary junction is intact and there is no cerebellar ectopia.
Cervical spinal cord has normal morphology and signal. Central canal is capacious .
C3-4: Disc degeneration is present with loss of disc height. There are broad-based disc bulging and endplate ridging preferentially towards the right side.
There is foraminal compromise for the exiting right C4 nerve and moderate grade foraminal narrowing for the exiting left C4 nerve.
C4-5: Disc degeneration is present with loss of height, endplate change and anterior corner bony ridging. There are disc bulging and endplate ridging preferentially towards the right side. There is foraminal compromise for the exiting C5 nerves bilaterally but worse on the right side.
C5-C6: Disc degeneration is present with loss of height. There are mild broad-based disc bulging and endplate ridging preferentially towards the left side. There is mild foraminal narrowing for the exiting left C6 nerve.
C6-7:
Disc degeneration is present with posterior disc bulging and endplate
ridging. There is moderate grade foraminal narrowing for the exiting C7
nerves more pronounced on the right side. Facet arthropathy is noted. There is mild fatty infiltration of the paraspinal musculature. No cervical rib and no fascial band is seen. Thoracic curvature is noted.
Conclusion :
Straightening of the cervical spine with mild degenerative spondylolisthesis of C7 relative to Tl. There are associated facet joint arthropathy and foraminal narrowing for the exiting C8 nerves.
There is degeneration of the cervical discs with disc bulging, endplate ridging and facet joint arthropathy resulting in multilevel foraminal compromise particularly on the right side as outlined above.
Alfred
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Hi, Alfred.
I feel for you and your suffering. I looked up your surgeon in Florida and he has some bad ratings.
Have you talked to an orthopedic spine specialist who specializes in cervical structure? I had ACDF surgery on my c5c6 level due to cervical spondylotic myelopathy. I needed my compression and flattening of spinal cord decompressed due to neurological decline. I can still move my neck pretty well after one level decompression.
It seems with all of your bike riding and leaning forward and looking up, your spine has straightened and c7 has slipped slightly forward over your t1 vertebrae. You also seem to have compression on c4-c8 exiting nerves through narrowed foraminal spaces which could be causing your pain/numbness/tingling/pins and needles/burning pain. The cervical levels could also impact your lower body. Have you had a lumbar MRI to check for any compression that would be causing your leg/foot pain symptoms?
Your MRI seems to show you may have bone growths at multiple levels that need to be removed if irritating or compressing nerves/nerve roots. Your MRI also shows you have multiple small benign tumors of blood vessels and not sure how this is treated if they press on nearby nerves. It may be good to ask a reputable orthopedic spine specialist if stabilizing your cervical spine with fusions and cleaning out bone spurs/benign tumors would help relieve nerve pain. Nerves may have grown back after your earlier nerve surgery which is causing increased/new pain.
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1 ReactionThere are several surgeons at Mayo Clinic-Rochester who specialize in cervical spine conditions as well as instability.
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3 ReactionsHi dlydailyhope,
how are you?
Thank you for your response.
I had those tumors before for a long time and have been told that they are benign and not putting pressure on my nerves.
In Australia I have consulted with 2 neurosurgeon and 1 orthopaedic surgeon.
They all told me that they never heard about cervical laser surgery in Australia and that I should not seek no more operations and ablations of the facet joint nerves which would only weaken my muscles. They all recomended pain managment.
Excerpt of neurosurgeon letter to me and my GP:
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I reviewed this 67-year-old man for a further opinion at my rooms on 3/19/2024.
Alfred's medical history is well known to you with motor vehicle accidents with TAC claims and chronic neck and lowback pain with multiple interventions including pain management under the Neuroxxxxx Team with Mr Nxxxxx,
Neurosurgeon and then Pxxxxxx Health with Professor Bxxxxxx.
Alfred then went to the United States and had laser cervical surgery in Florida which he reports made him worse in August 2023 and he said this was a "bad mistake". The laser surgery performed at SCV Surgery Center of Viera,
Melbourne, Florida was undertaken 8/29/2023 by Dr Ara Deukmedjian in the cervical, lumbar and sacroiliac joint regions.
Alfred's latest MRI cervical scan 11/2/2023 amended 11/14/2023 demonstrates paravertebral oedema in the cervical region. He has no cord compression nor intrinsic high cord signal.
Partial improvement with Tramadol, Endone and Endep.
Alfred had partial head drop following the laser surgery in Florida and hopefully this will improve. I did discuss the cervical and lumbar denervation procedures that he has had which inevitably do weaken the cervical and lumbar muscle.
Very appropriately Dr Axxxxxxx has discussed with Alfred his chronic multifactorial pain in the cervical and lumbar region and I concur with Dr Axxxxxxx that Alfred should not have any further surgical intervention.
I discussed with Alfred he should not have further ablation procedures which will not benefit his chronic pain and may worsen his muscle weakness.
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I have been trying to be active by doing a walk every second day, indoor bicycle and light workout at the gym using machines only. The weight is only 2.5kg.
Despite doing them slowly and taking breaks I still get pain. My physio recommended that I rather keep active than do nothing which would make things worse. I also do special neck isometric exercises and other cervical exercises.
Here is my latest MRI from September 2023:
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Procedure Date: 12 September 2023
Report Date: 13 September 2023
Examination: MRI - LUMBAR SPINE
Technique: Sagittal T1, T2, STIR and axial T2.
Clinical Data:? Radiculopathy
Findings:
There is scoliosis of lumbar spine convex to the left with the apex at L3.
Conus terminates at T12 and shows no focal lesion.
Vertebral bodies are normal in height.
There is lumbar spondylosis.
At L1-L2, there is disc desiccation and mild bulge. No canal stenosis.
There is moderate right foraminal stenosis.
At L2/L3, there is reduction in disc height with endplate Modic 1 signal change.
There is slight retrolisthesis of L2/L3. No canal stenosis.
There is mild right foraminal stenosis and right facet joint arthrosis.
At L3/L4, there is disc desiccation.
Disc bulge indents the anterior thecal sac.
No canal stenosis. No foraminal stenosis.
At L4/L5, there is disc bulge indenting the anterior thecal sac with mild canal stenosis.
There is mild bilateral foraminal stenosis. There is mild bilateral facet arthrosis.
At L5/S1, there is disc desiccation and mild bulge. No canal stenosis.
There is left foraminal stenosis. There is left facet joint arthrosis.
Facet joints and spinous processes are unremarkable.
Comment: Scoliosis of lumbar spine convex to the left.
Multilevel disc degeneration and bulge.
L5-S1 left foraminal stenosis. Mild bilateral L4-L5 and right L2-L3
foraminal stenosis. Right L1-L2 foraminal stenosis.
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I noticed that when my neck gets worse, IE compression of cervical nerves, I feel numbness and tighteness in the leg and foot. When the neck pain alleviates, the numbness and tightness decrease in the leg and foot. I have been told that I do not have cervical stenosis.
Another neurosurgeon here in Australia told me in November 2023 that I would require a cervical fusion from C3-C7. Dr Deukmedjian recommended a fusion from C3 to T2 in September 2023 after my failed laser surgery. I can't understand why he removed disc material after staing in my surgery video that my C5-C6 and C6-C7 discs were very thin. In my opinion this would cause more instability.
I am getting neck muscle spasms all the time. Not sure if it is also nerve compression. Lots of creaks and snapping sounds when I turn my head.
Thank you
Best regards
Alfred
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1 Reaction...continuing from previous, I asked my GP for cortisone injections to ease my pain but he told me that it wouldn't help me even though my neurologist recommended it.
I think I am not getting much support from the medical professiionals.
I even asked them if if PRP/STEM CELLS injections could help me. They told me that it is experimental and they don't know much about it.
@alfredb
I see in your MRIs of cervical and lumbar spine narrowing of spaces at various levels that may be compressing nerve roots/nerves exiting the spinal cord. I am not familiar with what the nerve ablations do to nerves and which nerves were actually ablated but you may have had some nerve regeneration and these nerves are being affected and irritated by disc bulges, etc. I noticed your lumbar spine has one level that has your vertebrae slipping slightly backwards (L2-L3 retrolisthesis). I also noted you have foraminal stenosis at several levels which is affecting exiting nerves/nerve roots (L2-L3, L4-L5 and L5-S1). Your spinal cord is dented/compressed by disc bulges at L3-L4 and L4-L5 anterior thecal sac which would cause neurological problems in legs/feet and back pain.
https://www.spineinfo.com/conditions/is-thecal-sac-indentation-serious-everything-you-need-to-know/
I agree that you would not want to get anymore ablations but if your spine at the cervical and lumbar levels is compressing nerves, nerve roots or putting pressure on your spinal cord/thecal sac, you need to get the discs/bone spurs off them.
@ab6540183 (Alfred)
I think the lidocaine/cortisone shots would help you relieve any inflammation surrounding your nerves/nerve roots and soft tissues. Can you get the pain management doctor (neurologist/orthopedic) to do the injections and avoid the GP? I get my spinal injections through my Orthopedic Spine doctor’s office (doctor that specializes in spine pain management injections). You should get more support from the medical community to help improve your quality of life and reduce pain.
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1 ReactionHi dlydailyhope,
Last December (2023) I was ditched by my new pain management group called Metro Pain.
Dr. Verrills from Metropain decided not to proceed with cortisone injections due to my mult-factorial pain and complex situation.
I couldn't believe my ears.
I have been trying to get some sort of pain management, but it is difficult to find someone here.
My neurologist made a recommendation to my GP to arrange these injections.
I was surprised that he didn't arrange them himself. Obviously he is not a pain management specialist.
I feel very abandoned by the medical profession. My traffic accident insurance is still liable to pay for medical expenses but I can't get my GP to recommend a good pain management specialist.
The Australian health system here is pretty troubled here.
This is what Dr Deukmejian did to me last August:
Surgical Recommendation (8/29/2023 and 8/30/2023)
Deuk Laser Disc Repair ® Right Approach C5-C6, C6-C7
Deuk Plasma Rhizotomy ® Bi-Lateral Approach C5-C6, C6-C7, C7-T1,
Right Approach L4-L5, L5-S1, Bi-Lateral Approach SI Joints; Coccydynia Injection.
Best regards
Alfred
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1 Reaction@ab6540183
Did your doctor in Florida do a nerve block and fluoroscopy to find the right nerves for rhizotomy procedures? Did he review all risk and complications with you before the surgeries? Was anything mentioned about nerve regeneration or other orthopedic options if the rhizotomy did not work? Have you looked into any legal action against the doctor?
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1 Reaction@ab6540183
Wanted to share these links, too.
1.
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/rhizotomy
2. https://my.clevelandclinic.org/health/treatments/24903-rhizotomy
3. https://www.painscience.com.au/for-patients/your-pain-management-procedure/facet-joint-neurotomies-rhizotomies/
4. https://www.medindia.net/surgicalprocedures/rhizotomy.htm
Dr Deuk never reviewed the risks with me, never did nerve blocks.
He assumed it from the MRI.
He just made a recommendation and I trusted him.
What a big mistake.
After coming back last year I found all of his bad reviews.
I should have been more alert . I was in a lot of pain and desperate.
He promised me that I would be pain free after surgery.
I tried to find law firms in Florida to act on my behalf on a "no win, no fee" agreement but no one was interested.
I am currently on a basic old age pension and all my money was wasted on this operation.
I have no more money.
In Australia people without private health insurance rely on the Australian Medicare system. If you are not rich, you can go to a public hospital and you will be looked after for free. The problem with the public hospitals is that there is a very long waiting queue.
The public hospitals are overloaded.
You could be waiting for months or longer.
Before I had a private health insurance that was covering my for spine but recently I had to cancel it, it was costing me $240 AUD per month that I couldn't afford anymore.
The old age pension pays me $1144 american dollars which is not a lot with the cost of living going up every week.
Alfred
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