Need Some Input re: My Situation/Decision:
62 Year Old Woman assessing inability to undergo 2 complex surgeries last 2 levels in c-spine and 2 levels into t-spine; fusing all c-spine levels; exception atlas,C-2/3 deformed severe scoliosis; only partial movement.
Symptoms: Advanced neuropathy left arm/hand/fingers chronic nerve spasms with dysfunction and loss of strength, movement, hand/fingers.
Diagnositics: MRI,CT,Flexion X-Rays
EMG severe compression ulnar and median nerve at wrist; moderate compression ulnar nerve elbow.
2005 MRI C-6/7 advanced DDD Surgery assessment: posterior decompression C-6/7 and T-1/2
Two surgeon assessments; confirmed same; exception Surgeon #2 advised to "wait until symptoms are constant of intolerable pain or radiculopathy...because of complex anatomy change of bridge, only done absolutely necessary, do interventional treatments and hope to never have to get to that phase.
2005 Decision: No surgery; non-interventional treatments; to by-pass having surgery.
2010 MRI C-6/7 severe advanced DDD now collapsed onto T-1/2; bi-lateral nerve compression nerve roots in front c-spine, deformed thecal sac. Surgery assessment: anterior decompression of C-6/7 plates/screws fixation to T-1/2 possibly T-2/3. Set-up for pre-surgery eval on larygeal status; high risk for damage to voice box and swallowing ligaments = always much higher with second anterior surgery. 60/40 chance posterior surgery required to successfully fuse (anterior fusion at those levels have difficulty with fusion)
Surgeon re-assessed and advises week later: No Surgery - "re-assessed scans and my case determined the prognosis for successful surgery to reverse progressive symptoms in arms and hands is not good..." (wrist drop/ thumb failure/ finger spread failure)"and taking into account high risk for compromising laryngeal damage..determined you would not be a good candidate for surgery" adding "get a second assessment if you like..good idea, but as far as I am concerned I believe doing the surgery at this time is not a good idea"
Current status: In-hold pattern for out-of-state neurology and neurosurgeon assessment 2nd opinion; long wait Nov. 11 (major univ. best of the best in US)
Current symptoms: Chronic nerve spasms two separate episodes; ulnar/median nerves EMG confirmed; resulting in loss of function three fingers, thumb, tremendous change in strength, movement and grip, rendering hand usless for most functions.
My assessment - ability to undergo surgeries & recovery: High anxiety with low coping skills for intense levels of pain now; sensitive to heavy duty pain medications; induce depression/anxiety levels already compromised with past recovery major MVA in t-bone broadside collision; low endurance and coping ability to undergo complex long (painful) recovery of two surgeries required; total duration of recovery 14-16 months; no significant other or family member to assist me; live alone.
Additional Perspectives: Spine-Health forum past 3 months, more people having very mixed results; higher incidence of complications and coping intense (painful) recovery with high incidence in short term and long-term return of symptoms and hardware complications/problems post-surgery.
First ACDF 3/4/5/6 15 years ago; 45 yrs of age; high level of pain in 9 months of recovery; successful fusion and reversal of bone spurs encroachment into spinal cord (whole left side of body radiculopathy). 8 yrs later symptomatic radiculopathy MVA rear-end; 15 rs. later MVA broadside t-bone collision.
My own assessment:
Experienced anterior surgery 15 yrs ago at 45 yrs age; difficult month recovery; no significant other and lived alone. Have had other surgeries within last 5 yrs. (less major) = my psyche No More Surgeries!
Prognosis/Risk: Not good ! (top surgeon, highly experienced cervical / thoracic spine head of dept. major univ.)
Prognosis to reverse symptoms = Not Good
Damage to voice box/swallowing nerve/ligements = High Risk
Low success for fusion with anterior decompression procedure = 60/40
Probability of posterior surgery necessary or fusion & stability = High
<2 Difficult Surgeries = 16 months Recovery = Unlikely to Reverse Symtoms / Nerve Damage>
Seasoned-Spineys please offer your thoughts/opinion –
64million dollar question:
How and what factors should be considered...determining...
What is prognosis of no surgery intervention; living with neuropathy; spinal nerve compression; deformed thecal sac spinal cord and c-spine becoming more unstable in remaining years 15 years with restrictive semi-retired activity?
Thank you ~ appreciate your input.