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Little Ali
9th February 2006, 12:35 PM
Hi everyone.

I got a letter from my consultant this morning saying that he's looked at my MRI scan (not sure whether he's looked at the CAT scan) and that he wants to a Localiased Laminectomy as there is a narrowing of the spine above the original fusion.

I've researched it and he's obviously hoping to get rid of the nerve pain by removing some of the bone and giving the nerves more room, which I think is a good idea, although it wouldn't do anything for the kyphosis pain or get me any correction (I don't think) He does that if he finds the spine to be unstable (he thinks this is unlikely), he would put some more metalwork in.

I need to ring the secretary to put myself on the waiting list for surgery, but I was wondering if anyone knew anything about this procedure. Is it major? Would I have to stay in hospital for long afterwards? Bracing etc etc?

He says that we can discuss the details in the Pre-op Clinic, but I would like to know what I'm letting myself in for before then!

Any help appreciated!

Thanks :help: :squeeze:

titch
9th February 2006, 01:43 PM
I expect what they have found in that case is central canal stenosis. I have this below my fusion, which they believe is why I keep falling over and have reduced sensation in various places. I've got foraminal stenosis as well, so it's not just the spinal canal that is narrowed, but the nerve root exit on the right at that level is severely narrowed.

This is the reason for the steroid epidural that I am (all being well) having in a couple of weeks time. There may be reasons related to the spina bifida as to why an epidural wouldn't be suitable for you, but I think it could be worth asking about - if nothing else, at least if it *does* work, then you not only get some relief but also know that the laminectomy is likely to do the trick. I know that they are reluctant to do a laminectomy on me, but I believe this is because for one thing, it's lumbar and lumbar laminectomies can destabilise the spine in some cases, but also I am still stuck leaning forward somewhat, so I guess for me it would be even more likely to destabilise than it normally is. Also, I believe they are hoping that initially at least, a foraminotomy would do the trick (I'm not convinced, but what do I know).

I guess part of the complication for you is that it will be difficult to know how much of the pain is from kyphosis per se and how much is secondary to the nerve root impingement. The positive thing is that a laminectomy should not in any way preclude future fusion, and it is a comparatively minor thing - certainly if it is only a laminectomy, then it should be a fairly easy recovery by the standards of these things.

So I guess I would ask about whether it's feasible to try an epidural first, and as regards the surgery ask what state the nerve root exits are in, and what the risks are of the spine destabilising secondary to the laminectomy. You should also bring up (as often and loudly as required) the fact that you're finding it increasingly difficult to stay upright - it's important that he knows how much that is coming to affect you as well, because it may be that his plan is formed almost entirely on the basis of your pain, whereas there is more to think about - but I know from doing it myself that when the pain was such a concern I didn't make a fuss about other things to the extent I should have done.

No matter that you are sure that further surgery is needed, the confirmation and especially in writing is always a shock :squeeze:

mark
11th February 2006, 05:13 PM
Hi ali i hope these links may help

http://www.aafp.org/afp/980415ap/alvarez.html

http://www.emedicine.com/pmr/topic129.htm

http://www.orthop.washington.edu/uw/lamine...es/Default.aspx (http://www.orthop.washington.edu/uw/laminectomy/tabID__3347/ItemID__283/PageID__2/Articles/Default.aspx)

http://www.orthop.washington.edu/uw/lamine...es/Default.aspx (http://www.orthop.washington.edu/uw/laminectomy/tabID__3347/ItemID__283/PageID__2/qview__true/Articles/Default.aspx)

Little Ali
13th February 2006, 05:08 PM
Thanks Mark! :squeeze: I've done lots of research and also asked my physio about the procedure and he said it sounds like a good idea. Athough, he couldn't answer alot of my questions because I'm 'complex'

I've got my consultant's e-mail address so I'm going to e-mail him loads of questions.

Titch, I don't think an epidural would work for me because my nerves and sensation are a bit screwed up cos of the Spina Bifdia. At the moment, my main concern is the stenosis pain cos, as you know, it's excrutiating, turns you into a right grump (I nearly killed a small child in a shop on Friday) and stops you from conentrating on anything! :nutter: I will ask him about the Kyphosis pain as that does make me uncomfortable too, especially my neck and right shoulder! :mope: Although I did go to the physio on Saturday which did help (after the intial 'done a few rounds in a boxing ring' feeling)

Thanks for all of your support guys! You're fab!
:niceone:

titch
14th February 2006, 09:30 AM
The epidural isn't really to try to bring back sensation (I got the impression that what I've lost is probably just gone and that's an end to the matter) but rather to reduce the inflammation of the nerves where the stenosis is and hope that stops me falling over (thanks to the signals getting completely cut off periodically - intermittent neurogenic claudication), and reduce the pain. It can be done purely as a pain control procedure, but they're hoping mine will be partly diagnostic as well. So there's certainly the potential that it could work for you with your pain, but what I'm not sure of is if they would actually be able to do one for you. But I think it has to be worth asking, because if they can do one and the pain goes, you're going to feel that much more confident about the surgery. Hope I've explained a bit better this time!

Anyway, emailing your surgeon with a load of questions has to be a good idea :-) [list=1] Just make sure to bring up the difficulty you're having staying upright </nag>

Little Ali
14th February 2006, 06:49 PM
Thanks Titch! I appreciate your nagging! :squeeze: I am definately going to mention my balance problems to him as it makes the right side of me work extremely hard so the right side of my neck and right shoulder really cop it!