Why is there such major differences in the diagnosis between different medical specialists [Neurosurgeons and orthopedic].
Copy of reports:
1: Surgery. Condition to be severe, and your spinal cord will be injured if you do not undergo treatment as soon as possible. The recommended surgical treatment utilizes the anterior cervical approach, at C3-C4 and C4-C5 levels with complete decompression and fusion, using peek cages and anterior plating system.
The surgical procedure will include implantation of autologous centrifuged bone marrow stem cells to further enhance the fusion process. Decreasing the motion at a painful motion segment should decrease the pain at that segment. Achieving the fusion also serves to maintain adequate space for the decompressed spinal cord and/or nerve roots.
For the level C5-C6 the proposed procedure is a Total Disc Replacement (TDR), which is an anterior cervical disc replacement with artificial disc that mimics the normal motion of the intervertebral disc.
2: Scans clearly show a multi-level degenerative problem which only has two options for treatment, surgical reconstruction or conservative measures. All other things being equal and assuming there is no other reason not to offer surgery I would perform fusions from C4/5 to C6/7 (ACDF) and Cervical TDR at C3/4.
The results from 4 level reconstructions are AVERAGE no matter what anyone else tells you. It is vital you understand this. The commonest result from this kind of surgery is relief of arm pain (radiculopathy) and some relief from neck pain.
3: MRI scan of his cervical spine which shows that he is developing degenerative change at multiple levels and at the C3/4 level. He is developing some mild to moderate canal stenosis, however, there is still CSF present on the axial views.
On examination there is some query of some mild myelomalacia at the C3/4 level. He may require surgical intervention at some stage.
At this stage, we will continue with the gentle physiotherapy program for him. I will review him in six months time. If his upper motor neuron signs are increasing, we may have to suggest decompressive surgery and fusion.
Avoid looking up and any heavy lifting.
Radiologist's report on MRI - CERVICAL SPINE:
Clinical indications: Degenerative disc disease narrowing on cervical x-ray. Sensory symptoms. Hands bilaterally. Decreased range of movement and pain cervical spine right and left shoulders. ? nerve impingement.
There is a reduced cervical lordosis and moderate to severe multilevel disc degeneration with marked narrowing of the C5/6 intervertebral disc and desiccation of the intervertebral discs at all levels. There is a moderate to severe C3/4 and mild to moderate C4/5 central canal stenosis. Cranio-Cervical Junction: Normal.
C2/3: Disc desiccation with central high signal in the disc ? calcification. No discrete disc protrusion seen. Left sided facet joint OA change.
C3/4: Mild loss of disc height with desiccation of the intervertebral disc, There is a broad based posterior and left paracentral disc osteophyte complex which is effacing the CSF anterior and posterior to the cord. The cord is flattened and there is some intermediate signal demonstrated on the sagittal T2 weighted imaging consistent with mild myelomalacia (series 2, image 8). There is bilateral foraminal narrowing due to neuro-central joint osteophytes worse on the left hand side.
C4/5: The disc is degenerate and desiccated. There is broad based posterior disc osteophyte complex resulting in a mild to moderate central canal stenosis effacing the CSF anterior to the cord. A small amount of CSF remains posterior to the cord and no myelomalacia is seen at this level. There is bilateral foraminal narrowing due to neuro-central joint teophytes.
C5/6: Severe disc degeneration with near complete loss of disc height. Shallow posterior disc osteophyte complex causing a mild central canal stenosis. There is left sided foraminal narrowing due to neuro-central joint osteophytes.
C6/7: The disc is degenerate. No central canal stenosis is seen but there is
moderate to severe right foraminal stenosis and mild left foraminal stenosis due to neuro-central joint osteophytes.
No pre-vertebral soft tissue swelling or compression fracture.
Multilevel disc degeneration and foraminal stenosis as described above. There is moderate to severe central canal stenosis at the, C3/4 level with abnormal increased inter-medullary signal consistent with myelomalacia but no syrinx seen. This is secondary to a hard disc osteophyte complex. There is
moderate left foraminal stenosis due to neuro-central joint osteophytes at this level.
At the C4/5 1evel there is a mild to moderate central canal stenosis due to disc osteophyte complex and bilateral foraminal narrowing secondary to facet joint degeneration.