> 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??
>Tori

Doctor Sinuhe Answers:

Dear Tori,

Thanks for your question, which, unfortunately, is impossible to answer. To give you a fair answer, I’d need to know your symptoms and actually see the MRI as well as to know the indication for the previous operations you’ve had. The MRI report as such means very little. Being a neurosurgeon, I have never in my life seen a ”normal” spine MRI. It is always the clinical symptoms and results of physical examination together with radiology (MRI) that count. MRI findings as such do not justify surgery, especially not a symptomless foraminal narrowing. Some neurosurgeons, on the other hand, would operate on symptomless (severe) canal stenosis (a situation in which the spinal canal is so narrow the spinal cord does not have enough space and may be/is compressed). The logic behind this would be to prevent the possible myelopathy (actual damage in the spinal cord causing also symptoms). In that type of case, the operation could be anterior (from the front, as your previous ones probably have been) or posterior (from the back), depending on the symptoms and on the direction of the compression.

So, would you please give some more background information about the reason for the recent MRI and for the previous opetations.

Dr Sinuhe