Cervical 1 and 2 Posterior Decompression

[CheeWei]

Hi Friend,
I am from Malaysia.
I had done my posterior cervical decompression surgery about 8 months.Now i will tell what happen to me before my operation.I was playing basket ball with my friends,suddenly my neck become stiff and i fainted.When i was awake i realize that i was unable to move.It is just like paralyzed and only my eyes can see or move.Then i was sent to the hospital.I was unable to breath and having an unbearable pain on my whole body.So i was given a ventilator for breathing purpose.My 1st doctor couldn't diagnose what's the cause of problem at 1st.I couldn't eat or drink.After few days i started to move my limbs slowly but just a slight movement occur and my whole body was so stiff and numb.I was putted on the chair by the nurse and my leg start shaking(cloners).My left side of my limbs is very weak compare to my right side.The pain is still there,but after day by day the pain relief slowly by slowly.At last a neurosurgeon doctor came and he found out the problem.He told me and my parents it is nerve compression,the causes of it is either congenital or some accident that will damage the spinal cord.This is the MRI film of my cervical 1 and 2 before surgery:

After Surgery:

After the posterior surgery,the pain is gone and i can eat or drink and i can even walk.The numbness is lesser and also the cloners.The stiffness is lesser but until now i still have numbness sensation on my left side of my upper and lower limbs.The cloners is still there but just when i walk for a long distance.I have very sensitive tendon reflex.My neurosurgeon want me to consider for another operation that is very high risk,that is through the oral.In order to get me to 100% you need to do the 2nd time.But until now i am improving.

Do you guys have experienced this kind of problem before?Do i realy need to undergo this surgery?.What will happen if this operation fail?Will i die or become handicap?I am very afraid of it cause i am just 18 and i have a very long way to go.Please give a reply to me.

Thank you.

[SCI-Nurse]

There is risk with any spinal surgery of worsening your condition, but also risks for not doing surgery. I am going to ask Dr. Young to comment on your situation.

(KLD)

[Wise Young]

Dear CheeWei,

I assume that your doctors explained your situation. Your explanation is very clear and the pictures are very clear. You have, what looks like to me, an Arnold-Chiari syndrome. I see your brainstem being slightly compressed from the front, a very tight foramen magnum (this is the opening of the skull through which your spinal cord passes), and the tip of your cerebellum right at the opening. In addition, I see what appears to be a syringomyelic cyst in your lower cervical spinal cord (the white streak).

There is not much room for your brainstem and I can imagine why you had your episode of paralysis while you were playing basketfall, possibly from looking up at the basketball hoop. It is very tight and the posterior decompression and stabilization that you received may not be sufficient. I think that you probably need an anterior decompression, the procedure that is recommended by your neurosurgeon.

I believe that your neurosurgeon knows what he is doing. The approach through the back of your mouth is the only and best approach for the problem that you have. It is something that only an experienced neurosurgeon would have proposed. It should definitively resolve your problem.

Wise.

Hi Friend,
I am from Malaysia.
I had done my posterior cervical decompression surgery about 8 months.Now i will tell what happen to me before my operation.I was playing basket ball with my friends,suddenly my neck become stiff and i fainted.When i was awake i realize that i was unable to move.It is just like paralyzed and only my eyes can see or move.Then i was sent to the hospital.I was unable to breath and having an unbearable pain on my whole body.So i was given a ventilator for breathing purpose.My 1st doctor couldn't diagnose what's the cause of problem at 1st.I couldn't eat or drink.After few days i started to move my limbs slowly but just a slight movement occur and my whole body was so stiff and numb.I was putted on the chair by the nurse and my leg start shaking(cloners).My left side of my limbs is very weak compare to my right side.The pain is still there,but after day by day the pain relief slowly by slowly.At last a neurosurgeon doctor came and he found out the problem.He told me and my parents it is nerve compression,the causes of it is either congenital or some accident that will damage the spinal cord.This is the MRI film of my cervical 1 and 2 before surgery:

After Surgery:

After the posterior surgery,the pain is gone and i can eat or drink and i can even walk.The numbness is lesser and also the cloners.The stiffness is lesser but until now i still have numbness sensation on my left side of my upper and lower limbs.The cloners is still there but just when i walk for a long distance.I have very sensitive tendon reflex.My neurosurgeon want me to consider for another operation that is very high risk,that is through the oral.In order to get me to 100% you need to do the 2nd time.But until now i am improving.

Do you guys have experienced this kind of problem before?Do i realy need to undergo this surgery?.What will happen if this operation fail?Will i die or become handicap?I am very afraid of it cause i am just 18 and i have a very long way to go.Please give a reply to me.

Thank you.

[CheeWei]

My doctor also told me that,that is a syrinx inside my spinal cord.Everyday when i wake up or sitting on a chair for a certain period,my body started to get stiff and straighten up by itself and the stiffness is like this:is like something pump to my brain or head for a while,from leg to head the pump of stiffness.Since after i went back to school,my neck is having stiffness just because my head always look down to see the book?Is it true?But my neurosurgeon thought me "your head must always look forward".

Every night before i go to bed,i went to toilet frequently to release my bladder and the amount of urine is not much,is quit little.I am also having a problem on controlling my temper.When i get angry,i vented and it is hard for me to stop it.Any idea what the problem is?

What will happen if i dont consider for this?
I am afraid of it if i realy need to consider this.
Can tell what is the risk if i dont do?As my doctor say it wont worst until i couldn't breath,the only thing he said your spasticity could become worst.
I dont realy looking forward for the operation because it is too risky.Anything define my problem please tell me.
Thank You

Chee Wei.

[CheeWei]

Dear Sir,

Is there any alternative apart from getting another operation proposed?
Will my condition be worsen if i forego the second operation as proposed kindly name me the obstacles/prob that i'll be encountering in the long run as in the future cause from my understanding,the operation should the only option available now but it could also worsen my current condition compared to before correct me if i am wrong.

Will it affect my daily life/daily activities as my main concern now is my spasticity?

Base on your expertize in this field,what do you think?

[CheeWei]

Dr Young can reply me?Cause i am curious now.

[CheeWei]

Can Doctor giv me a reply?Does endoscopic surgery helps?

[Wise Young]

CheeWei, I am sorry that I did not answer earlier. I had seen your earlier two posts and did not have enough information to be able to provide an opinion concerning the second surgery. Much depends on the appearance of your post-operative MRI or CT scan. You had posted only your pre-operative MRI and just a plain x-ray of your post-operative spine. I assumed that your doctor had seen the post-operative CT and had recommended to you the second surgery on the basis of what he had. I also know that this is an operation only a very experienced neurosurgeon would recommend.

Based on what you describe, you have some residual spasticity and possible urinary frequency, both of which seem to be acceptable to you. Your temper is probably related to the stress that you are having. With the posterior decompression and your head relatively immobilized, I believe that the danger of a catastrophic brainstem compression has been averted. On the other hand, if your spasticity gets worse, I would consider the anterior decompression as well. While the surgery through the mouth may seem a bit extreme, it really is not so bad and patients recover quite well without problems. As I pointed out, it would provide definitive decompression of your spinal cord and brainstem.

In summary, you are young and your continuing spasticity indicates that the compressive incident that you had while playing basketball did damage your spinal cord. If your spasticity is getting worse, it suggests that you have continuing compression. If the CT scans show a very tight foramen magnum, suggesting that this is the cause of the continuing spasticity, you should consider the anterior decompression procedure. I don't think that there is any alternative. I am not aware of any endoscopic approach to the area. On the other hand, if your spasticity is stable or getting better, you can probably let this go for several years before having to consider the surgery.

Wise.

[CheeWei]

The spasticity compared to the time i started to walk,means 11months ago,i think they could be a slightly better compare to last time.Cause when i started to walk,there is way to bumpy for me and i could not stabilize my steps and i used the walking stick to supoort myself.But after i go for physiotherapist activities,my walking is way improving and i can walk without a walking stick now,but there is still abit of bumpy when i was walking.I can give the bumpy level for last time and now.Last time was 10/10 but i think now is about 3.5/10.

There is also stiffness on my whole body when i wake up,my whole body will be straighten up by itself and abit of cloners will be seen on my hands and legs,but its just for awhile,about 2second.When was i laying on my bed,i heard a sound,probally something like a drilling sound.When i do squatting exercise about 20 to 30 times,there are abit of cloners on my knee.

Does stem cell or botox helps?

[Wise Young]

The spasticity compared to the time i started to walk,means 11months ago,i think they could be a slightly better compare to last time.Cause when i started to walk,there is way to bumpy for me and i could not stabilize my steps and i used the walking stick to supoort myself.But after i go for physiotherapist activities,my walking is way improving and i can walk without a walking stick now,but there is still abit of bumpy when i was walking.I can give the bumpy level for last time and now.Last time was 10/10 but i think now is about 3.5/10.

There is also stiffness on my whole body when i wake up,my whole body will be straighten up by itself and abit of cloners will be seen on my hands and legs,but its just for awhile,about 2second.When was i laying on my bed,i heard a sound,probally something like a drilling sound.When i do squatting exercise about 20 to 30 times,there are abit of cloners on my knee.

Does stem cell or botox helps?

Cheewei,

Forgive me but let me correct some of your mispellings so that communication would be easier:

• "cloners" = clonus. This is a condition where there is repeated occurrences of a reflex. This is common at the ankle or knee, for example, when the tendon is stretched and the knee or ankle would respond two or three times.

• "bumpy". I think that perhaps the word that you are thinking of using is "jerky". Your movements are not accurate and tend to be too much and overshoots. Is that what you mean when you say "bumpy"? Another medical word is ataxia which refers to loss of control and coordination.

• "stiffness". This is a good word. What you are describing is spasticity with some spasms. Your limbs resist bending and is hyper-reflexic. When you say that your body straightens, you are describing what sounds like extensor spasms.

All of this is suggestive of damage to your spinal cord that is improving. I am very happy to hear that you describe the improvement of your spasticity from 10 out of 10 to 3.5 out of 10. That is good. You ask about stem cells and botox. What are you taking at the present? Are you taking any baclofen or tizanidine? How much exercise do you do? Do you use the treadmill or bicycle? Do you swim?

Wise.