ITP and Surgery

It's been a while since I've been here, but I've been getting on with life without having to worry about my ITP. Now I could use some information and advice. Osteo in my neck has led to foraminal stenoses with cervical radiculopathy. That has led to a neurosurgeon who tells me I will have to have surgery to remove the excess bone. Although my platelet count is generally in the safe range (50 - 125), it's not as high as she'd like, and my hematologist, who is not an ITP specialist, is considering options.

I'm wondering how many people here have had major surgery with ITP, what if any special issues should be taken into consideration, and what (if anything) I should be asking my neurosurgeon and hematologist about.

A further issue is that I want to delay this surgery as long as possible. A close family member has cancer, and I do not want to be out of commission for months while recovering from a surgery. I'm currently on a lot of medication to control pain and parasthesias, including NSAIDs, which are causing the expected problems.

So any advice, suggestions, general information, or ideas on any of this would be greatly appreciated.

I've had 2 surgeries since being diagnosed with ITP. Before each, I did a couple of days of IVIG to bring my counts up. Is this a possibility for you?

Aoi:

I had surgery for spinal stenosis in my neck two years ago. I had a rod and screws placed in the spine because the disk had to be removed. The recovery wasn't that bad. I had a neck brace for 4 weeks and although I couldn't drive, I was able to do most other things. I wasn't able to really put it off for long because the bone spur was half-way into my spinal cord and paralysis was a concern. The pressure on my spinal cord was also causing loss of muscle that is pretty much permanent. Make sure that isn't the case for you before you decide to wait.

As for ITP, your counts don't seem to bad and 125 should certainly be safe, but you could treat before the surgery to bump them up more. Have you discussed that with your Hemo?

@CindyL: I don't know what my hematologist is considering. Maybe he'll want to try IVIG.

@Sandi: Thanks for sharing your experiences. My spurs aren't impinging on the cord itself, so I may have some room to maneuver. I see my neurosurgeon next week, so my current plan to wait may be changed.

Unfortunately, my recent counts aren't near the old 125 number, though the most recent one was 114. I tend to wobble between the 80s and 110s, which hasn't been an issue until now.

114 still isn't bad, most surgeries can be done with counts over 100. Do you respond to Prednisone? If so, a short round could bump you up for surgery.

The worst part of the surgery is the sore throat afterwards for a few days. Is it ACDF surgery? There really was no pain except for the stitches. I actually felt a lot better after it was fixed. All neck pain went away for about 8 months.

I've read that 100 is a threshold for surgery, but my neurosurgeon seems to want me in the 120s or 130s. I'll see what she says about that next week.

The surgical plan for now is a posterior approach, and I assume I'll have a sore throat after general anesthesia. I do respond to Prednisone to some extent, depending on dose and duration. I'm new to my current hematologist, and I'm not sure how much experience he has with ITP, or what his treatment preferences are. I'll find out soon enough.

Do you know why your neurosurgeon prefers the posterior approach? I don't know how the recovery is with that one. Maybe your throat won't be quite as bad because with the anterior method, they had to move vocal cords, etc out of the way and that contributes to the throat pain.

She thinks it'll give her better access to the osteophytes and reduce the impact of the surgery overall. From what I've read, the posterior approach generally results in a quicker recovery with less impact on the throat, esophagus, and everything else that is in front of the cervical spine. How has your neck been since your surgery?