I have cervical fusion at my c5-c6 and c6-c7 with metal plate. my last surgery was in 2001 on my c6-c7.

I had an MRI done April of 2006 which shows at my c4-c5 a large broad-based posterior disk osteophyte bulge with mild bilateral neural foraminal narrowing and severe canal stenosis. There is herniated nucleus pulposus,centrally. This causes moderate cord compression and moderate, to severe canal stenosis. There is a small bony osteophyte and disc bulge with flattening of the spinal canal.

My Question is: would I have the same type of surgery as before or, since I already have two fusion would this make any difference on what can be done as far as surgery is concerned?? Or should surgery been done?? I have also undergone facet injection and facet rhizotomy with limit improvement.

Is there any new type of surgery which will improve or help.

What would you do if you were to do the surgery??

Doctor Joshua’s Answer:

Generally speaking, there are two types of surgery that are used to treat cervical stenosis - anterior and posterior, meaning that it can be approached from the front or the back of the neck. In your case, apparently you have had an anterior operation for the c5-6-7 levels. Sometimes, when the compression is caused by thickening of the rear structures, the decompressive surgery can be done via the posterior approach, namely laminectomy especially when the stenosis is affecting multiple levels and is causing spinal cord compression rather than nerve root compression, or, if an anterior cervical discectomy and fusion has already been done and there is further narrowing of the foramina and nerve compression affecting the already-operated level, foraminotomy via a posterior approach may be considered.

The most important thing is to consider the MRI findings and compare them to the symptoms. You don’t describe your symptoms at all. If you have c5 nerve root compression, it should cause neck-shoulder area pain and possibly even weakness of the deltoid muscle (shoulder muscle). If there is significant spinal cord compression, it may cause symptoms of myelopathy, i.e. spinal cord damage, which would cause numbness and/or weakness of arms and legs, difficulty walking, clumsiness and so on. There are also certain signs that a doctor can notice upon a physical examination that will support the diagnosis. Physical examination is extremely important, and the information provided by physical examination is a significant factor in deciding whether to operate or not.

If the MRI findings, symptoms and signs match, operative treatment is considered. In your case, the operation of choice would probably be another anterior cervical discectomy and fusion, similar to what you’ve already gone through. I don’t normally use plates in a simple anterior decompression procedure - in most cases plates are not necessary - but some surgeons prefer to use plates, and there are some types of cases that require plates.

The rule of thumb is to operate only when there are symptoms that match the MRI findings. However, in some cases, if the MRI finding is significant, some surgeons consider operative treatment as a preventive measure, even when there are no symptoms that are clearly explained by the MRI. There is no clear consensus on whether this is a good approach, but it is a fact that if we did a cervical MRI in 1,000 healthy, symptom-free individuals, we would see a lot of cervical stenosis findings, but clearly shouldn’t operate an incidental finding, because surgery always carries risks.

In summary, if your neurosurgeon decides to operate the c4-5 level, he will probably do another anterior discectomy with fusion. Given the information that I have available regarding you case, this is probably what I would do also.

But having said that, you’ll need to talk to your own neurosurgeon and follow his advice, because only he will have all the information that a surgeon needs to make such decisions. If you are not satisfied with your surgeon’s decision, you can always get a second opinion.

Good luck, and keep me posted on the forum.

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