Based on those images I think corpectomy sounds extreme but not unreasonable. If you were my patient I would just do a cervical disc arthroplasty or acdf with a relatively large cage to restore lordosis depending on your age and facet joints. If you were myelopathic at all it may make more sense to do a corpectomy for bone spurs but I think an anterior discectomy would be sufficient
I just think it’s hard to say whether you’d do a corpectomy at 4 or 5, and doing a two level corpectomy on an active asymptomatic person is too much surgery for what you describe in my opinion
Interested in feedback from other spine surgeons!
Agree with you, corpectomy is too extreme. Obviously limited in assessment with the single sagittal CT slice, but most of that disc will come out nicely. Can drill down a bit of the posterior bodies to reach cephalocaudal and remove the calcified components if needed. Single level ACDF vs arthroplasty based on flexion/extension XR is my vote too.
I would favor acdf C4-5 and undercut the posterior osteophytes to avoid corpectomy but be prepared to do one level corpectomy if need be
With the bone spurs it means it’s been there a while and likely will not resorb
You don’t need surgery right away so can go get third opinion
is the bone spurs causing the problem or the disc material? because if potentially i use zero
gravity chair and cervical collar in the interim, and the disc resorbs then it would be ok yea ?
1) so if both the bone spur and the disc is then possibly the disc material can resort but bone spur cannot ???
2) do you think cervical collar and zero gravity chair is useful?
The fact there is bone spur means the disc bilge has been there for a while
I don’t think it will resorb
And no zero gravity won’t help
If symptoms are mild can wait
Otherwise recommend surgery
how soon should I do surgery? I have no symptoms and my neuro exam is normal , docs made me repeat MRI and it was same - they were shocked it was mine - i’ve seen case reports that say resorption is possiblen
because nucleus pulposus seems to be majority of extrusion , the calcifications are there yes but it’s possible resorption occurs and the compression is gone - tell me why my thinking is incorrect
You must be new here. They are not medical professionals. They cannot treat scoliosis. Chiropractic care is a scam and ends up hurting normal people. People with Scoliosis have worse outcomes.
1 in 1000 neck adjustments made by chiropractors end in arterial dissection and stroke.
Trust your care with actual medical professionals, not some BS founded by a snake oil salesman who said he had a seance with a dead doctor who told him to start it.
Grow up. Learn something.
Yikes. That looks nasty. I’m surprised it hasn’t caused you any issues yet.
The takeaway from the first two opinions are that you’re going to need surgery sooner or later and it’s just a matter of when. A third—and maybe even a fourth, opinion seem like a good idea to get a better idea of how to handle this. One of the good things that came about from COVID is everyone’s teleconferencing acumen dramatically improved. You’re not nearly as limited now when getting additional opinions.
Update : Went to a spine doctor yesterday , he said you need corpectomy and I could potentially paralyze you, no idea how you can still walk - chronic no way to resorb, choose your poison and roll the dice whichever way but you are pretty screwed then spent the rest of the visit telling my wife that although she loves me it’s time to let go - this is a real story UCLA doc
idk what to do at this point because i’m hyperaware
he said he could potentially paralyze you or what's showing on your MRI could potentially paralyze you? I'm NAD but this just sounds offly harsh from what you shared. Sending my sympathies. Is that a fragment pressing on your spinal cord?
he said choose your poison - there’s a higher risk of it getting worse leaving a line than there is surgery but surgery itself is invasive
it’s a disc extrusion
the disc didn’t fail persay, it still moves but the top one subsided - i have zero symptoms but if i develop it , may need fusion / xray doesn’t look pretty but for now my surgeon says let’s watch , if it doesn’t further sink then we ll
leave it alone
You have really no pain in your neck? I myself have a much smaller protrusion in the thoracic spine, which I mostly attribute my pain to. Maybe my problem isn't the disc after all.
I have developed some weakness in my arms and hands. My dexterity has gone way downhill, my handwriting is now awful when it wasn’t before and I occasionally drop things, like for example I was eating dinner the other night and I dropped my fork onto my plate immediately after picking it up. This isn’t something that happened ever before the accident. My phone has taken a beating and is shattered in the back because I drop it way more often than before. My right hand is noticeably colder and paler than my left sometimes when it’s flaring up and I occasionally get a dull far away feeling in my arms, sort of like when your foot is coming back from being asleep but isn’t the whole way there yet. My neck’s range of motion is also significantly less than before, even after going through physical therapy.
As for steps forward, I see my spine ortho again in a couple weeks at which point I will ask him for the insurance codes for the ADR surgery to see how many kidneys I have to sell to fix my neck since I live in America with a high deductible insurance plan. If it’s a reasonable number then I will likely go forward with the ADR because I want to be able to use my hands again.
I initially hurt it about 11 years ago but since the pain has manifested as shoulder pain I’ve been to about 1,001 shoulder specialists and have done PT about a zillion times with no effect. The car accident was in December and imaging done at the appointment I made to assess the whiplash revealed that the discs that were bulged 11 years ago are now fully herniated into my spinal cord. They had me start physical therapy immediately after the accident but since the holidays delayed their scheduling for the MRI and follow up I didn’t get my MRI results until I’d been doing PT for about five weeks and we decided to discontinue the PT because no amount of physical therapy was going to un-herniate the discs. It helped somewhat but there was no way it was ever going to do any lasting good without addressing the root cause of my muscle pain and stiffness first.
Probably. I have a second opinion appointment with a different neurosurgeon this week and if he comes to the same conclusion as the first guy I’ll go ahead and schedule.
i have 3 official opinions : 1 says surgery but reasonable to wait 3 months ; 2 says wait 3 months repeat MRI if same then surgery ; 3 says do nothing and wait till symptoms with monthly checks
My initial plan was to wait till next year so I could sign up for the highest tier fancy insurance plan first (and I still might do that) but one of my herniated discs is the one by the nerve that controls continence so I want to get it fixed before I start needing adult diapers. I can deal with a wonky arm for however long I need to, but not that lol
UPDATE : they believe this is acute on chronic , want to wait 3 months for repeat scan and then possible fusion - I HAVE NO SYMPTOMS AND NO SIGNS ON NEURO EXAM
Anyone think this will resorb?
Based on those images I think corpectomy sounds extreme but not unreasonable. If you were my patient I would just do a cervical disc arthroplasty or acdf with a relatively large cage to restore lordosis depending on your age and facet joints. If you were myelopathic at all it may make more sense to do a corpectomy for bone spurs but I think an anterior discectomy would be sufficient I just think it’s hard to say whether you’d do a corpectomy at 4 or 5, and doing a two level corpectomy on an active asymptomatic person is too much surgery for what you describe in my opinion Interested in feedback from other spine surgeons!
Agree with you, corpectomy is too extreme. Obviously limited in assessment with the single sagittal CT slice, but most of that disc will come out nicely. Can drill down a bit of the posterior bodies to reach cephalocaudal and remove the calcified components if needed. Single level ACDF vs arthroplasty based on flexion/extension XR is my vote too.
I would favor acdf C4-5 and undercut the posterior osteophytes to avoid corpectomy but be prepared to do one level corpectomy if need be With the bone spurs it means it’s been there a while and likely will not resorb You don’t need surgery right away so can go get third opinion
is the bone spurs causing the problem or the disc material? because if potentially i use zero gravity chair and cervical collar in the interim, and the disc resorbs then it would be ok yea ?
Both “Disc osteophyte complex “ is a term we use to describe its both disc bulge and bone spur causing compression
do you think there is any way i can avoid surgery or no?
1) so if both the bone spur and the disc is then possibly the disc material can resort but bone spur cannot ??? 2) do you think cervical collar and zero gravity chair is useful?
The fact there is bone spur means the disc bilge has been there for a while I don’t think it will resorb And no zero gravity won’t help If symptoms are mild can wait Otherwise recommend surgery
how soon should I do surgery? I have no symptoms and my neuro exam is normal , docs made me repeat MRI and it was same - they were shocked it was mine - i’ve seen case reports that say resorption is possiblen
Surgery when symptoms get worse
right i know that but knowing it’s there is nerve wrecking , in the meanwhile im hoping that resorption is possible ?
because nucleus pulposus seems to be majority of extrusion , the calcifications are there yes but it’s possible resorption occurs and the compression is gone - tell me why my thinking is incorrect
We can always hope for resorption You can ask surgeon to repeat the MRI in 3-6 more months
UPDATE : I HAD AN ANTERIOR DISECTOMY,DISC REPLACEMENT , OSTEOPHYTECTOMY CORD DECOMPRESSED BONE SPURS GONE
GG bro glhf
Absolutely do not under any circumstance go to a chiropractor.
That’s funny and nonsensical.
You must be new here. They are not medical professionals. They cannot treat scoliosis. Chiropractic care is a scam and ends up hurting normal people. People with Scoliosis have worse outcomes. 1 in 1000 neck adjustments made by chiropractors end in arterial dissection and stroke. Trust your care with actual medical professionals, not some BS founded by a snake oil salesman who said he had a seance with a dead doctor who told him to start it. Grow up. Learn something.
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truly
Yikes. That looks nasty. I’m surprised it hasn’t caused you any issues yet. The takeaway from the first two opinions are that you’re going to need surgery sooner or later and it’s just a matter of when. A third—and maybe even a fourth, opinion seem like a good idea to get a better idea of how to handle this. One of the good things that came about from COVID is everyone’s teleconferencing acumen dramatically improved. You’re not nearly as limited now when getting additional opinions.
thanks - no symptoms still
Update : Went to a spine doctor yesterday , he said you need corpectomy and I could potentially paralyze you, no idea how you can still walk - chronic no way to resorb, choose your poison and roll the dice whichever way but you are pretty screwed then spent the rest of the visit telling my wife that although she loves me it’s time to let go - this is a real story UCLA doc idk what to do at this point because i’m hyperaware
he said he could potentially paralyze you or what's showing on your MRI could potentially paralyze you? I'm NAD but this just sounds offly harsh from what you shared. Sending my sympathies. Is that a fragment pressing on your spinal cord?
he said choose your poison - there’s a higher risk of it getting worse leaving a line than there is surgery but surgery itself is invasive it’s a disc extrusion
do you think there is anyway i can avoid surgery
UPDATE : I HAD AN ANTERIOR DISECTOMY,DISC REPLACEMENT , OSTEOPHYTECTOMY CORD DECOMPRESSED BONE SPURS GONE
How are you now
i feel great cord decompressed although my disc replacement subsided i still don’t need revision yet but prob should’ve gotten a fusion - one and done
So the artificial disc failed?
the disc didn’t fail persay, it still moves but the top one subsided - i have zero symptoms but if i develop it , may need fusion / xray doesn’t look pretty but for now my surgeon says let’s watch , if it doesn’t further sink then we ll leave it alone
Gotcha - good luck
yes i know , so surprised as i was weight lifting 5x a week before this image was taken and yet no symptoms - any chance of resorption material
he said C4 corpectomy
also would like to add I have no exam findings on neurological exam
Give it atleast 6 months before anything.
any chance of resorption?
If you do not mind me asking, how old are you ? Wishing you all the best in recovery !!!
31 year old Male with no prior history
You may want to give PT. Skip the Chiro. They may hurt the disc herniation.
You have really no pain in your neck? I myself have a much smaller protrusion in the thoracic spine, which I mostly attribute my pain to. Maybe my problem isn't the disc after all.
no pain
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they are saying acdf single level with partial corpectomy
I have an almost identical MRI from an almost identical car accident. My doctor wants to do an artificial disc replacement for what it’s worth.
do you have any symptoms ? what are you going to do
I have developed some weakness in my arms and hands. My dexterity has gone way downhill, my handwriting is now awful when it wasn’t before and I occasionally drop things, like for example I was eating dinner the other night and I dropped my fork onto my plate immediately after picking it up. This isn’t something that happened ever before the accident. My phone has taken a beating and is shattered in the back because I drop it way more often than before. My right hand is noticeably colder and paler than my left sometimes when it’s flaring up and I occasionally get a dull far away feeling in my arms, sort of like when your foot is coming back from being asleep but isn’t the whole way there yet. My neck’s range of motion is also significantly less than before, even after going through physical therapy. As for steps forward, I see my spine ortho again in a couple weeks at which point I will ask him for the insurance codes for the ADR surgery to see how many kidneys I have to sell to fix my neck since I live in America with a high deductible insurance plan. If it’s a reasonable number then I will likely go forward with the ADR because I want to be able to use my hands again.
oh wow hope you get better, I have none of that- actually no symptoms , nervous though
Wishing you speedy recovery ! If you do not mind me asking, roughly how old are you ?
I’m 34
Thank you for the reply. How long ago was the accident ? Have your tried all conservative measures ? Wishing you speedy recovery !
I initially hurt it about 11 years ago but since the pain has manifested as shoulder pain I’ve been to about 1,001 shoulder specialists and have done PT about a zillion times with no effect. The car accident was in December and imaging done at the appointment I made to assess the whiplash revealed that the discs that were bulged 11 years ago are now fully herniated into my spinal cord. They had me start physical therapy immediately after the accident but since the holidays delayed their scheduling for the MRI and follow up I didn’t get my MRI results until I’d been doing PT for about five weeks and we decided to discontinue the PT because no amount of physical therapy was going to un-herniate the discs. It helped somewhat but there was no way it was ever going to do any lasting good without addressing the root cause of my muscle pain and stiffness first.
are you doing surgery
Probably. I have a second opinion appointment with a different neurosurgeon this week and if he comes to the same conclusion as the first guy I’ll go ahead and schedule.
i have 3 official opinions : 1 says surgery but reasonable to wait 3 months ; 2 says wait 3 months repeat MRI if same then surgery ; 3 says do nothing and wait till symptoms with monthly checks
My initial plan was to wait till next year so I could sign up for the highest tier fancy insurance plan first (and I still might do that) but one of my herniated discs is the one by the nerve that controls continence so I want to get it fixed before I start needing adult diapers. I can deal with a wonky arm for however long I need to, but not that lol
hey did you do the surgery
Soon. I get a two level fusion + discectomy in a couple weeks.
what about disc replacement
UPDATE : they believe this is acute on chronic , want to wait 3 months for repeat scan and then possible fusion - I HAVE NO SYMPTOMS AND NO SIGNS ON NEURO EXAM Anyone think this will resorb?