decompression & fusing C3-C4 - step one?

Dear  Group Member:

decompression & fusing C3-C4 - step one?

Please consider posting my message below.  I am interested in the
special knowledge of your group for the newly emerging field of
spinal solutions.  I am trying to make decisions to save my life.
Please review the summary below, designed for efficiency of the
reader.  I am sincere, I need the help, and I am an interesting
problem too.

Thank you very much,

Vince
=============================


Below I submit a summary of my situation, seeking good
questions, ideas, suggested testing, or opinions
regarding: surgical decompression of C3-C4 with
anterior decompression using arthrodesis and cervical
plating, then perhaps additional surgical intervention
for a posterior decompression.


I am still concerned about the possibility of a
posterior decompression after surgical intervention
using anterior decompression and the fusing of these
vertebrae. I find it difficult to understand how the
second procedure,which made become required, could be
accomplished in order to decompress. After the
vertebrae have been anteriorly fused,  would a
posterior decompression cause seriously increased
stress on some other point of the spinal column, or
perhaps  break the fusion of the vertebrae corrected
during the first suggested surgery.

I have been informed that working on the spinal column
to perform a posterior decompression is much more
risky especially with regard to working around the
arteries. I wish to understand more clearly the
risk/benefit trade-offs, the likelihood of success in
the first process so that the second process is never
required, and the possibility of doing both the
anterior and a posterior decompression and fusion
simultaneously.

I am also somewhat troubled by the apparent
symmetrical nature of my spine with respect to its
abnormalities overall.  There are slight
abnormalities at the very top and the very
bottom of the spine. There is also an apparent
asymmetrical nature correlating the cervical and
lumbar abnormalities, and  stress fractures in the
center, in the thoracic vertebra. It worries me that
decompression of C3-4 especially during the
second posterior process, might precipitously
exacerbate problems in other areas in ways, which I
do not yet understand well enough.

"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.. I did discuss with him also that he
may need a posterior decompression at some point in
time if he continues to have stenosis from
posteriorly."  Jack H. Deckard, M.D.

===================================

I built an Internet web site with 140 million bytes of
information pertaining to my medical status: including
all the medical opinions from my doctors, all the lab
work I could get my hands on, MRI and x-ray images.
There is also my medical status journal, and all of
this information is highly index, and therefore easy
to find and navigate through.

Below I submit a summary of my situation, seeking
questions, ideas, or opinions. Although complete
details are all available on the web site, I have
included bits and pieces of the medical opinions
below, so that you could conveniently understand the
situation in summary form.

I initially went to my friend of 35 years, Dr.
William Dicus, he sent me to Dr. Marvin Wooten, and
he sent me to Dr. Jack Deckard:  I have great trust,
admiration, and respect for all these doctors, and
then on my own, I found Dr. R. Oelke, also of the
Columbia St. Mary's group. Each of these doctors
agree that I need immediate surgery to decompress and
fuse C3-4 anteriorly, and then perhaps further
procedures to fuse them posteriorly.

My scientific nature, it's curiosity, tugs at me,
pulling me to find a second opinion from a totally
different group of medical experts, with different
ideas, different technology, and different
experiences.


Medical opinions and report
www.givehealthachance.org/Vince/Opinions/default.htm

My medical journal has further details
www.givehealthachance.org/Vince/Status/
www.givehealthachance.org/Vince/Status/History.htm

The MRI image most interesting to Dr Deckard is
MRI Cervical Scan- 02c (center): .
www.givehealthachance.org/scans/cervical/C02c_center.htm

Thank you very much for your time and attention

Most Gratefully and Most Respectfully,

Vincent J. Cataldi

===================================

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 foraminaln
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 dated 06//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 ARE 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 ON T2-WEIGHTED AND
STIR IMAGES. THERE IS MINIMAL ENHANCEMENT 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 COMMENDED.

===================================

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, AND C7.

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 PONDYLOLIS-
THESIS 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 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 WELL AS THE L5-S1 DISC
SPACE CONSISTENT WITH FATTY DEGENERATIVE
MARROW CHANGES . THE SPINAL CORD ENDS AT
APROXIMATELY 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
DISC 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.