Re: Opinion requested regarding: surgical decompression of C3-C4

----- Original Message ----- 
From: "aegon" <[EMAIL PROTECTED]>
Newsgroups: misc.education.medical
Sent: Friday, September 19, 2003 9:18 PM
Subject: Re: surgical decompression of C3-C4 - opinion requested


> "Vince Cataldi" <[EMAIL PROTECTED]> wrote in message
news:<[EMAIL PROTECTED]>...
>
> What SYMPTOMS do you have?
>
> What evidence of myelopathy precisely?
>

"aegon" <[EMAIL PROTECTED]> wrote in message
news:[EMAIL PROTECTED]
> "Vince Cataldi" <[EMAIL PROTECTED]> wrote in message
news:<[EMAIL PROTECTED]>...
>
> What SYMPTOMS do you have?
>
> What evidence of myelopathy precisely?
>

"Vince Cataldi" <[EMAIL PROTECTED]> writes:

aegon

I worked to offer a small summary when I posted this initial request for
helpful ideas and questions, and I thank you very much for your time.  There
is more than 140 Mbytes of data on GiveHealthAChance.org/vince, but I post
below excerpts from three doctors, and two MRI scans, for your convince.
Ask and I will reply with the best answers I can.  The symptoms are quite
disabilitating.  These are recorded in detail in the doctors medical
opinions, and in my medical status journal also.

[http://givehealthachance.org/Vince/Opinions/default.htm]
[ http://givehealthachance.org/Vince/Status/History.htm]

Also, the initial MRI image most interesting to Dr Deckard is: - C2c
(center).
[http://givehealthachance.org/scans/cervical/C02c center.htm]

August 27, 2003 -- Dr Kurt R. Oelke
surgical-solution second opinion confirmed

IMPRESSION: This is an unfortunate 49-year-old male who presents to my
orifice as a self-pay patient and a serious C3-C4 stenosis with resultant
myelopathy. The neuro examination seems to suggest an ongoing myelopathy.
The hyperret1exic characteristics on his neurologic examination strongly
suggest that there is ongoing damage at the spinal cord level. I strongly
encouraged the patient to proceed quickly with obtaining insurance and
proceeding with the surgical procedure outlined by you.

August 6, 2003 -- Dr. Dicus

I reviewed the MRIs and would agree that there is very significant stenosis
at C3-4 and likely a myelopathic change in the cord at that level. The
lumbar MRI shows relatively lesser changes with some stenosis at L4-5 and
less at 3-4. There also is a suggestion of foraminal encroachment at L4-5
and 5-1 on the left. On both of these studies, he has some areas of  hyper
intense return in the vertebral bodies, which were interpreted as fatty
infiltration. Please see also a letter from Dr. Deckard to Dr. Wooten, which
is dated06/16/03.

The MRI performed at Columbia Hospital on 01/29/03, was interpreted as
showing possible multiple myeloma, whereas the later studies were said to
show fatty infiltration. It is easy to see why the patient is concerned.

July 29, 2003 -- Dr. Jack H. Deckard
surgical-solution opinion

I did have a lengthy discussion with Mr. Cataldi including reviewing the
films. He does have evidence of myelopathy and the abnormal signal within
the cord at C3-C4. I would recommend surgical decompression of the area and
in his case would probably favor an anterior decompression with arthrodesis
and cervical plating. The main goal of the surgery would be to prevent his
symptoms from increasing. Hopefully, however, he would gain some improvement
in his complaints



January 29, 2003 MRI Scan report

MRI OF THE CERVICAL SPINE INDICATION: MYELOPATHY.

SAGITTAL T1 - WEIGHTED, T2 ? WEIGHTED, AND STIR IMAGES AND GADOLINIUM
ENHANCED SAGITTAL IMAGES AND AXIAL IMAGES FROM C2-C3 THROUGH C7-T1 APE
SUBMITTED. CERVICAL VERTEBRAL BODY HEIGHTS ARE NORMAL.

THERE IS DIFFUSE HYPOINTENSE SIGNAL ON Tl ? WEIGHTED IMAGES, HYPERINTENSE
SIGNAL ON T2 ? WEIGHTED AND STIR IMAGES, ABNORMAL CONTRAST ENHANCEMENT OF
THE C3 AND C4 VERTEBRAL BODIES.

THERE IS DESICCATION OF THE C2-C3, C3-C4, AND C4-C5 DISKS.

AT C5 ? C6, DIFFUSE HYPERINTENSE SIGNAL ON T1 ? WEIGHTED AND T2 ? WEIGHTED
IMAGES, DESICCATION AND LOSS OF HEIGHT OF THE DISK, AND ANTERIOR OSTEOPHYTE
FORMATION ARE PRESENT.

AT C6?C7, DESICCATION INVOLVES THE HEIGHT OF THE DISK, ANTERIOR OSTEOPHYTE
FORMATION, AND HYPERINTENSE SIGNAL IN THE SUPERIOR END PLATE OF C7 ON
T1 -WEIGHTED AND T2-WEIGHTED IMAGES ARE PRESENT.

THERE IS NO HERNIATED DISK.

AT C3?C4, THERE IS MARKED AP NARROWING OF THE THECAL SAC COMPATIBLE WITH
CENTRAL CANAL STENOSIS. NO OTHER ABNORMAL CENTRAL STENOSIS IS PRESENT.

THE CERVICAL SPINAL CORD IS NORMAL IN SIZE AND SIGNAL INTENSITY.

THERE IS NO ABNORMAL CONTRAST ENHANCEMENT OF THE CERVICAL SPINAL CORD.

IMPRESSION:: 1. CENTRAL CANAL STENOSIS IS PRESENT AT C3-C4.

2. DIFFERENTIAL DIAGNOSIS OF ABNORMAL SIGNAL INTENSITY AND CONTRAST ENHANCE
OF C3 AND C4 VERTEBRAL BODIES INCLUDES METASTASES AND MULTIPLE MYELOMA.

3. CERVICAL DEGENERATIVE DISK DISEASE AND SPONDYLOSIS ARE DESCRIBED ABOVE.

RAD ORDER #: 90001 INV ORD #: 2

EXAMINATION: MRI THORACIC SPINE COMBINATION 01/29/2003

PROCEDURE REASON: MYELOPATHY

RESULT

MRI OF THE THORACIC SPINE

SAGITTAL T1 ? WEIGHTED, T2?WEIGHTED, AND STIR IMAGES, AXIAL T2-WEIGHTED
IMAGES FROM T6?T7 THROUGH T9?T10, AND GADOLINIUM ENHANCED SAGITTAL
T1 -WEIGHTED IMAGES ARE SUBMITTED.

THERE IS A COMPRESSION FRACTURE OF T9 VERTEBRAL BODY WITH MINIMAL LOSS OF
HEIGHT OF THE ANTERIOR VERTEBRAL BODY AND CENTRAL. THERE IS MINIMAL
HYPERINTENSE SIGNAL OF THE SUPERIOR END PLATE OF T9 ONT2?WEIGHTED AND STIR
IMAGES. THERE IS MINIMAL ENHANCE MEN T OF THE SUPERIOR END PLATE OF T9 ON
THE T1 ?WEIGHTED, IMAGES.

NO OTHER COMPRESSION FRACTURE IS PRESENT.

THE THORACIC SPINAL CORD IS NORMAL IN SIZE AND SIGNAL INTENSITY. THERE IS NO
ABNORMAL CONTRAST ENHANCEMENT OF THE CORD.

THERE IS NO HERNIATED DISK.

NO ABNORMALITY OF THE SPINAL CANAL.

IMPRESSION:: THERE IS A T9 COMPRESSION FRACTURE WITH THE DIFFERENTIAL

DIAGNOSIS INCLUDING TRAUMA AND PATHOLOGICAL FRACTURE. CORRELATION WITH
HISTORY OF TRAUMA IS RECOMMENDED.


July 14  MRI Scans
CERVICAL SPINE MRI WITHOUT CONTRAST

THE EXAMINATION IS DONE FOR EVALUATION OF MYELOPATHY,

THERE IS SOME SWALLOWING ARTIFACT AND SOME MOTION ARTIFACT WHICH CAUSE SOME
DEGRADATION OF THE AXIAL IMAGES.

THE MIDLINE STRUCTURES AND THE PARASAGITTAL STRUCTURES IN THE POSTERIOR
FOSSA APPEAR UNREMARKABLE. THERE ARE SIGNIFICANT-AREAS OF HIGH SIGNAL
INTENSITY THROUGHOUT THE CERVICAL SPINE INVOLVING C3, C4, C5, C6, ANDC7.
THESE ARE ALL CONSISTENT WITH AREAS OF FATTY INFILTRATION BECAUSE OF
DECREASED SIGNAL WHEN FAT SUPPRESSION IS APPLIED. THESE ARE ALL CONSISTENT
WITH DEGENERATIVE CHANGES WITHIN THE VERTEBRAL BODIES.

C2-3: AT THIS LEVEL, THERE IS A NORMAL APPEARING DISC. THE DISC SPACE IS
WELL MAINTAINED.

C3-4: AT THIS LEVEL, THE DISC SPACE IS SLIGHTLY NARROWED. THERE IS A
DIFFUSELY BULGING DISC . AT THIS LEVEL, THERE IS SIGNIFICANT FACET
HYPERTROPHY , AND THE COMBINATION WITH THE MILD DISC BULGE CAUSES ENTRAPMENT
OF THE CORD AT THIS LEVEL. THERE IS FLATTENING AND IMPINGEMENT OF THE CORD.
JUST BELOW THIS LEVEL, THERE IS AN AREA OF FOCAL HIGH SIGNAL INTENSITY
WITHIN THE CORD CONSISTENT WITH AN AREA OF MYELOPATHIC CHANGES.

C4-5: AT THIS LEVEL, THERE IS A DIFFUSELY BULGING DISC WITH AN ASSOCIATED
POSTERIOR OSTEOPHYTE . THE DISC IS MINIMALLY BULGING. THE VENTRAL CSF SPACE
IS MAINTAINED, ALTHOUGH NARROWED.

C5-6: AT THIS LEVEL, THE DISC SPACE IS MARKEDLY NARROWED. THERE IS A
POSTERIOR BONY RIDGE THAT CAUSES SOME FLATTENING OF THE VENTRAL THECAL SAC
BUT NO IMPINGEMENT OF THE CORD.

C6-7: AT THIS LEVEL, THERE IS DISC SPACE NARROWING. THERE IS A POSTERIOR
OSTEOPHYTE AS WELL AS A DIFFUSELY BULGING DISC POSTERIORLY . ON THE RIGHT
SIDE, PARTICULARLY ON THE SAGITTAL SLICE 10 OF THE T2 WEIGHTED IMAGES. THERE
IS A FOCAL DISC HERNIATION . THIS IS NOT WELL VISUALIZED ON THE AXIAL
IMAGES. THERE IS NO EVIDENCE OF MYELOPATHY.

IMPRESSION: MULTILEVEL DEGENERATIVE DISC DISEASE WITH AREAS OF BULGING AS
WELL AS BONY OSTEOPHYTES, AS DESCRIBED ABOVE. THE BONY CHANGES ARE MOST
PRONOUNCED AT THE C5-6 AND C6- 7 LEVELS. FOCAL DISC HERNIATION IS IDENTIFIED
ON THE RIGHT SIDE AT C6-7 ON THE SAGITTAL VIEW ONLY. THE MOST PRONOUNCED
LEVEL IS AT THE C3-4 LEVEL WHERE THERE IS A SLIGHT ANTERIOR
SPONDYLOLISTHESIS OF C3 ON C4 WITH A DIFFUSELY BULGING DISC AND SIGNIFICANT
FACET HYPERTROPHY . THE CHANGES CAUSE IMPINGEMENT OF THE CORD AS WELL AS
INCREASED SIGNAL WITHIN THE CORD CONSISTENT WITH MYELOPATHY . THERE IS-
MULTILEVEL NEURAL FORAMINAL NARROWING ,PARTICULARLY BILATERALLY AT THE LOWER
THREE CERVICAL LEVELS.

RAD ORDER # : 90001 INV ORD 3

EXAMINATION: MRI LUMBAR SPINE W/O I CONTRAST 07/14/2003

PROCEDURE REASON: MYELOPATHY

RESULT

LUMBAR SPINE MRI WITHOUT CONTRAST

THE EXAMINATION IS DONE FOR EVALUATION OF MYELOPATHY.

SAGITTAL AND AXIAL T1 AND T2 WEIGHTED IMAGES WERE OBTAINED.

THERE IS SLIGHT RETROLISTHESIS OF L5 ON S1 . THERE IS INCREASED SIGNAL ON T1
AND T2 WEIGHTED IMAGING ALONG THE END PLATES OF THE L4-5 DISC SPACE AS
WELLAS THE L5-S1 DISC

CATALDI, VINCENT J #660995

PAGE 3

SPACE CONSISTENT WITH FATTY DEGENERATIVE MARROW CHANGES . THE SPINAL CORD
ENDS AT APPROXIMATELY THE L1 LEVEL.

L1-2: THE DISC IS NORMAL

L2-3: THE DISC IS NORMAL

L3-4: AT THIS LEVEL, THERE IS DISC DEHYDRATION . THERE IS A DIFFUSELY
BULGING DISC AND MODERATE BILATERAL NEURAL FORAMINAL NARROWING . THE BULGING
DISC DOES EXTEND INTO THE FORAMINAL REGIONS . THE BULGING  ISC IS SLIGHTLY
ASYMMETRIC IN A RIGHT PARACENTRAL LOCATION AND RIGHT FORAMINAL REGION. .THIS
IS THOUGHT TO REPRESENT A SMALL DISC HERNIATION.

L4-5: AT THIS LEVEL, THERE IS DISC DEHYDRATION AND DISC SPACE
NARROWING.THERE IS A DIFFUSELY BULGING DISC WHICH IS FAIRLY SYMMETRIC AND
EXTENDS INTO THE FORAMINAL REGIONS BILATERALLY. THIS IS MUCH MORE PRONOUNCED
IN THE LEFT
FORAMINAL REGION AND IS CONSISTENT WITH A LEFT FORAMINAL DISC HERNIATION ,
AND THIS WOULD AFFECT THE EXITING NERVE ROOT . THERE IS SOME MODERATE SPINAL
 STENOSIS AT THIS LEVEL.

L5-S1: AT THIS LEVEL, THE DISC IS DEHYDRATED AND THE DISC SPACE IS
NARROWED.THERE IS A DIFFUSELY BULGING DISC SIMILAR TO THE LEVEL ABOVE. IT IS
MORE PRONOUNCED IN THE LEFT FORAMINAL REGION. THIS WOULD BE CONSISTENT WITH
A FORAMINAL HERNIATION. THIS WOULD AFFECT THE NERVE ROOT THAT IS EXITED
THROUGH THE FORAMINA .THERE IS BILATERAL FORAMINAL NARROWING WHICH IS FAIRLY
SEVERE BILATERALLY AND PRIMARILY DUE TO THE INTERFACET DISEASE .

IMPRESSION

MODERATE STENOSIS AT L4-5 WITH MILD STENOSIS AT L3-4. THERE ARE DIFFUSE
BULGES AT L3-4, L4 -5, AND L5- S1 FOCAL DISC HERNIATION IS IDENTIFIED
PRIMARILY IN THE FORAMINAL REGIONS AT L4-5 AND L5-S1: ON THE LEFT SIDE
AFFECTING THE EXITING NERVE ROOTS.

Gratefully, Vince Cataldi