United Brachial Plexus Network, Inc.

well, my myelogram came back a normal cervical myelogram with mild disc bulges at c3-c4 and c4-c5. i'm excited that it does not report any avulsions like my dr was expecting. my dilema, dr zager at univ of penn has scheduled me for surgery on 5/19/06 and i'm wondering if i should still go through with the surgery if there are no avulsions. i still have very limited movement of my shoulder and no movement or sensation from the biceps down. any opinions would be greatly appreciated.

I would deffinately go ahead with the surgery, as no diagnostic test is as good as the exploratory surgery. If a nerve is avulsed and you don't find out for months, it will be too late to save the muscles to which that torn nerve innervated. I know it might seem foolish or frightening to have someone go ahead and open up your neck and look in to see if the diagnostic imaging was valid or not, but with this kind of injury, you hope for the best, and prepare for the worst. No need being surprised six months from now that you could have done more when you didn't. I pray that everything is intact and it be just a matter of time and good healing, but I don't think it is worth taking the chance, just in case there is something that needs fixing.

Of course this is just my opinion, but you asked for it. What ever you end up doing, I wish you the best of luck.

Chris

I agree with Christopher & want to add another point in favor of surgery: inevitably after a traumatic injury, there will be a lot of scar tissue that can severely impede natural recovery. During the exploratory surgery, the doctor can get that cleared up.

Let us know what you decide. Take care,

Ellen

thank you for you replies.has anyone on this forum had a false myleogram saying no avulsions, but after exploratory surgery found out that there was avulsions?

Hi,
I hate to be the bearer of bad news, but my son's myleogram showed only one avulsion (c7) turned out all five were avulsed. The accident was 30 months ago with surgeries up at the Mayo 5-6 months post accident. Good luck and hopefully no avulsions

Steve

I am a radiology resident- at my institution we perform about 3 myelograms a day. In my opinion they are barbaric and useless. 99% of the time the findings are identical to the patients recent MRI - and I have realized the neurosurgeons order them for insurance purposes to justify surgery. I have questioned many neurosurgeons on the purpose behind subjecting their patients to this barbaric outdated test. The neurosurgeons I questioned feel it gives them a better look at the boney structures , however this can be done with a CT and without the painful myelographic procedure. The only time this test should be ordered is if there is an absolute contraindication to having an MRI. The procedure can be extremely painful and you are at risk for bleeding and infection. Most patients do not realize they will have to lie flat for about 20 minutes (longer in patients with degenerative disease if access to the thecal sac cannot be obtained) on a hard fluoroscopy table.
Bottom line if your doctor orders a myelogram on you- FIND A NEW DOCTOR!

jpixstix, not knowing what anyone else has told you or your injury and cause of all I can tell you is this,
if test show no tears what is there to fix?
I have no memory of what my tests showed but discharged myself from the hospital after five months and not much progress and no treatment plan. In other words I was alone in a crowd of 'professionals' and nobody was doing anything for me except medicating me. In a moment of clarity I scrammed. Now I do a lot of things independently. Most all cause me great pain. I work my arm and shoulder as best I can and here is the good news;
I can raise my arm maybe 45^, I can flex my wrist maybe 15^ and my biceps seems to pull a few fingers in but not out. I was told once nerves grow back a millimeter a day-about an inch a month. I am clinging to that and hoping for the best. I will do the same for you if it's not too late. If I am totally wrong here about everything, and no one has anything better to tell me please don't tell me anything. Nothing maybe all I have?...

Timo,
I am reposting a response to another of your posts about the Myelogram procedure below because I don't want any BPI sufferer to look at your opinion as some kind of standard.

The purpose of having a Myelogram for someone with a Brachial Plexus Injury is to determine if any of the nerves have been torn from the spinal cord, NOT to give a "better look at the boney structures". A Myelogram has nothing to do with the "boney structures", it's purpose is to inject dye into the spinal cord and see if it leaks out anywhere, hence determining a tear in the outermost layer of the cord, or a nerve avulsion. Any pain the patient is subjected to, in my case none, is a small trade off for an accurate diagnosis. In my case it was the only procedure that gave one. With the use of fluoroscope, I could see dye pluming out of my spine where the nerves had been torn away, the damage done was clear as day for the first time!

I appreciate your posting, because it is obvious that you want to help patients avoid unnecessary pain, which is wonderful and needed. But it can be more damaging to misinform patients about a procedure that has the ability to assist in an accurate diagnosis, that without which a BPI suffer will be thwarted from life changing surgeries. Paralysis is no joke.

Christopher



repost
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Timo,
I couldn't disagree more with your statement and it frightens me that a resident of radiology would think this way. Maybe my case was unique, but I highly doubt it. I had countless MRIs for 2 months post injury (over 15 at 2 top rated US hospitals, UCLA & USC) and the best conclusion that came out of having them was that I had only one avulsed nerve from my spine (which would have been damn wonderful). One of the nations leading specialists who wrote the first books on BPI reconstruction, Dr. David Kline of LSU, ordered me to have a Myelogram before he would see me. That was the first accurate diagnoses I'd had, 3 nerve avulsions, which exploratory surgery confirmed.

I wish one of my 3 neurosurgeons in Los Angeles had the sense or education to have ordered a Myelogram procedure done from the start, because I wasted precious time not knowing the extent and seriousness of my injury because the MRIs were inconclusive and inaccurate.

It angers me to think that a Dr. is not willing to put a patient with an extremely life changing injury through a mild procedure that help all involved get a clearer picture so the appropriate course of action can be taken.

Christopher

I agree with Christopher. All the MRI's and CT scans that my daughter had done were inconclusive as to how many nerves were avulsed. When she had the myelogram we could see exactly how many were pulled from her spine - all 5. The myelogram was another annoying test but no more than any of the other tests she had done. I think the EMG was by far the worse test of them all.