Cervical Stenosis

@dream1649 Janet, that's a good question, and I probably should be using a better pillow. I also have thoracic outlet syndrome and when I lay on my side it compresses my shoulder and causes arm pain. If my head is not in line with my spine because of being above or below it, that is side bending my neck a bit and it will cause pain and aggravate the shoulder too. What I've been doing is stack pillows under my ribs and under my head leaving a slot for my arm and shoulder to take the pressure off while keeping things in line. I started using a bed wedge for this because it helps with acid reflux when you lay down. I make adjustments and still even end up rolling a pillow under my head sometimes. I used to have a firm foam pillow that helped keep my head level and probably need to get another one.
Jennifer

@rnlorena Thanks for the details from your imaging reports. There are a lot of significant findings there and anything flattening your spinal cord is not going to go away. The facet arthritis happens when discs start to collapse and it puts more pressure on those joints. The herniated discs cause inflammation that triggers bone spur growth. I would expect it to get worse for you, and it takes time to wait to see good surgeons. I agree that this doctor is brushing you off. There may be another reason he doesn't want to do surgery. I was refused surgery by 5 surgeons because they didn't understand how my symptoms were connected to the imaging and didn't want to risk their reputations on me. They want to keep their statistics of success and bragging rights higher and a potential poor outcome is a threat to that because they just didn't understand my case. I don't know if you have any other health issues that could affect a spine surgery outcome. They may want to cherry pick easy cases instead of multilevel involvement.

I came to Mayo with my imaging that had some mild cord compression at only one level, and no compression at the nerve roots (foramen), and that was a big enough problem that I was offered surgery right away. There were no games, and just an honest opinion about how surgery could help address my symptoms and at the time, I was loosing the coordination in may arms. When you have both spinal cord compression AND nerve root compression, you will get overlapping symptoms and they won't know specifically how to trace the pain. Spinal cord compression alone can cause pain all over the body anywhere below it that can seem to be random and changing. That is what I had that confused so many surgeons.

I would encourage you to find a better spine surgeon for another opinion. Coming to Mayo was the best choice I made for myself after striking out 5 times with local surgeons. The pain in your chest could also be spine related particularly if neck movement can generate it, and you are also right to ask for a diagnostic mammogram. Let the experts make the diagnosis because it's so easy to assume something and be wrong. If a spine surgeon isn't interested in you as a patient, move on for another opinion even it it means you have to travel to find the right specialist. It was worth it to me to drive 250 miles to Mayo, and many patients arrive there through the Rochester airport.

These doctors are just wasting your time, and you have the right to fire them. It took me 2 years jumping through hoops, but when I came to Mayo, only 2 days and I had an offer for surgery that was scheduled 5 weeks later. The wait to get into Mayo varies, and you need to have insurance they accept. I was expecting a 3 month wait, but there was a cancellation and I was at my first consultation 8 weeks after sending in my records and imaging.

Do you have another surgeon in mind for a second opinion? How do you want to proceed?
Jennifer

@jenniferhunter Sorry I was so wordy and still am. Well the orthopedist that I went to I will be going back to see him. He is an orthopedic surgeon. I can take him the discs and see what they have to say. I saw my eye Doctor regarding my cataracts. He use to be a neurologist but he is now an Ophthalmologist. He requested my neuro records from when I got diagnosed with small nerve fiber. He did answer a question before I asked it. I wondered how he would operate on cataracts knowing I had small nerve fiber and pin pricks in my eyes. He told me that I would have to be put to sleep versus them using a needle around my eyes so that is something to ask and think about if they want to give me some kind of a shot for back issues. I will look into Mayo for help. I have Medicare and Tricare for Life. When I was in England pain woke me up going down the side of my hip all the way down my leg. That's also when I had the pain in my upper chest. When I came home I bent over and had electrical pain go from my left hip down my leg but not all the way. When I sit I get pain in the back of my left thigh achy type. I also had it in my other thigh once. I also have been walking and it came in the front of my left leg and it went down my thigh and was like a disconnect at the knee and went down the lower leg. I have a disc and will get the other one for the MRI I had of my spine and will ask questions to see what the orthopedist has to say. I will check into Mayo for sure. I had an ultrasound of the abdomen done and I asked the tech about breast ultrasound and let me tell you she was great. She told me where to go to get a diagnostic mammogram and ultrasound done. I could not understand why the neurosurgeon said I had very little stenosis in my neck when the report stated that I did. He said that the stenosis would not have caused the pressure that I had. I will call Mayo in Florida and see what they tell me. I have lost a lot of trust in Doctors lately. I have seen some sitting Doctors. My definition of a sitting doctor is he sits there and talks to you then just listens to your heart and lungs. That is a sitting doctor. I have heard some things from Doctors that make no sense to me period. I have heard this from other people also. I am looking for an internal medicine doctor also. I did already fire two Doctors and I am fixing to fire a third. Thank you for the information and I will let you know what I find out. I am a determined woman I really am. The medical profession has gone down from what it used to be. I know they have good doctors out there I just need to find them. @rnlorena

@rnlorena No apologies, please. You deserve to be heard and you stayed on the topic of your spine. The electric shock you described may be caused by bone spurs contacting the spinal cord because of the central canal stenosis. I could reproduce that and send an electric shock down my entire body if I bent my neck forward. This was of course before my stenosis was surgically corrected. Cervical central canal stenosis can send pain to your lower body and legs, and if a surgeon tells you this is not possible, then they have missed something. I hear this a lot from patients and I heard that too. My surgeon at Mayo Rochester knew better.

I think a consult at Mayo is an excellent idea and it sounds like Jacksonville may be convenient for you. I recommend calling the Insurance & Billing department to confirm your insurance is accepted, and that can be different at each Mayo campus on what they accept.

Mayo Billing and Insurance
https://www.mayoclinic.org/patient-visitor-guide/billing-insurance
Gather your records, reports, and imaging discs because you will be asked to submit these with your request for an appointment. The next step is contact Mayo, and here is a convenient link to get started. You can contact them first if you wish, and they will set up an account and tell you how to mail in your records.

Appointment Link for any Mayo Campus
http://mayocl.in/1mtmR63
They should assign you to a surgeon who matches what you need. You can also request a specific surgeon to review your case if you wish. I don't have information about neurosurgeons at Jacksonville other than a member here talking about seeing Dr. Fox there in this post https://connect.mayoclinic.org/comment/994872/ and this one https://connect.mayoclinic.org/comment/1012459/. I like to look up published literature from surgeons I'm considering so I understand if their area of interest matches what I need. That is actually how I found medical literature that talked about a case like mine with leg pain from cervical stenosis.

My neurosurgeon in Rochester is Jeremy Fogelson who is excellent. I was very impressed with the time spent and level of care, and I had excellent surgical results. A spine surgeon will likely send you to a neurologist that they work with for evaluation, so you don't need to see one on your own.

Jennifer

Hello Jennifer,
The surgery performed at the Mayo Clinic by your surgeon, understand it was a neurosurgeon.
But the actual procedure, was it using the ultra-sonic tool or drill, etc.
Lastly, did you experience any of the symptoms I previously described, dizziness, out of balance ,etc. ?
I believe symptoms are being brought on by Cervical Stenosis ?

Thank You,

@otavares Oly, I described my surgeon's procedure to you in this post earlier in this discussion. https://connect.mayoclinic.org/comment/1007939/

He did not use a vibrating scalpel because that is a bone cutting tool, and he didn't need to do that. I wouldn't think that pointing a sharp vibrating instrument at the spinal cord in close proximity when you can't see the spinal cord is a good idea. It is better to go slower with easily controlled rongeurs in your hand. If you hit the spinal cord while going through a disc, it will cause damage. Surgeons don't want to touch it and you can't move the spinal cord as told to me by my surgeon.

I'm not a surgeon, but think about it. My surgeon's notes say he used a bur to grind the vertebral end plates because they need to straighten them so they can put a straight milled bone disc in there. That is a power tool used gently after the disc end plate can be completely visualized.

If you think you can watch, you can search and find spine surgery videos online and see what this procedure looks like. It's kind of messy looking if you don't know what you are looking at. Sometimes a surgeon's tools are specialized for whatever implant (such as a artificial disc) that he is implanting. If you start looking up the various implants available and go to manufacturer's websites you can find that information that is there for surgeons to view.

Patients are not qualified to pick the tools for surgeons. That shouldn't be the reason to choose a surgeon or surgery because you don't know how, why or where the use of a tool is appropriate. If a surgeon explains what he does in this much detail and you understand his reasoning, then it may make sense, but most surgeons try to explain things in common language so as not to freak out their patients because patients won't understand unless they are trained in surgical careers.

Jennifer

Thank You.

@otavares Oly, I forgot to respond to your question about dizziness. I did experience dizziness and vertigo where the world appeared to be spinning around me, and that was because of my cervical spine issues.

When you have cervical spine issues, it tends to cause muscle spasms, and I also had thoracic outlet syndrome which s a condition that makes one side of my neck tighter than the other. What was happening was a spasm was rotating and tilting my C1 & C2 vertebra by themselves without me turning my head. This causes the vertebral arteries inside the bones to be stretched, and that is part of the blood supply to the brain. It was with my vertebrae rotated, I looked upward at birds flying overhead, and it started vertigo by kinking the stretched arteries. I actually lost my balance and fell backward. After I got myself inside, I called my physical therapist and she gave me some things to do to calm it down before I could get in to see her.

A physical therapist can get the spine better aligned by dealing with the muscle spasms and electrical stimulation to disrupt the pain signals. After I had surgery for the spine issues, all of the spasms calmed down. It doesn't just happen anymore, but if I sleep with my neck in an awkward position, it can start a little bit of vertebrae rotating, but not to the same degree. I have not had any more episodes of vertigo.

Are you experiencing balance and dizziness issues with a cervical spine problem?

Jennifer

My husband had neck surgery in 2021. He has weakness in his arms and legs. It is getting difficult for him to even open a door. He is 61 and is on disability for degnerative disc disease, ankylosing spondolytis, spinal stenosis. He has been seeing a pain management doctor and has had several injections. This is not the same doctor that did the neck surgery. He is sick of seeing doctors. This is the results from his last Cervical WO Contrast-CT in 2022. Can someone help me out? The doctor who did his surgery says there is nothing wrong and even though his arms felt better for about six months, he says there is nothing else he can do.

Neck and bilateral arm pain with weakness.History of ACDF in March 2021. COMPARISON: None TECHNICAL INFORMATION: High resolution thinsection CT imaging was performed through the postoperative levels and adjacent transition levels. Highresolution coronal and sagittal reformatted images were produced. Bilateral artifact reduction imageswere also obtained. INTERPRETATION: Digital scout radiographs show anterior screw and plate at C5-6and C6-7, status post ACDF. Lung apices appear clear. Craniocervical junction structures areunremarkable. Congruent occipitocervical and C1-2 articulations. Adequate space available for the cordat C1. C2-3: Mild central stenosis, 1 mm spondylolisthesis, right hypertrophic facet degeneration andmoderate to severe right foraminal stenosis. C3-4: Central disc protrusion contacts and indents the cordwith mild central stenosis. Right hypertrophic facet arthropathy and severe right foraminal stenosis. C4-5: 1.5 mm spondylolisthesis, osteophyte and bulge abut the cord with mild central stenosis andadvanced right hypertrophic facet arthropathy. Moderate to severe right foraminal stenosis and patentleft nerve root canal. C5-6 and C6-7: Interbody fusions appear solid. Anterior screws and plate are intact without loosening or fatigue. Mild recumbent kyphosis at C6-7 and mild residual central stenosis at each level. Left greater than right facet degeneration at C5-6 and right greater than left facet degeneration at C6-7, severe chronic bilateral foraminal stenosis at C6-7 and severe on the left at C5-6.C7-T1: No disc herniation or central stenosis, hypertrophic facet arthropathy and patent foramina. CONCLUSION: 1. Solid interbody fusion at C5-6 and C6-7 with residual facet degeneration and foraminal stenosis, as reported. 2. Central disc protrusion at C3-4 contacts the cord, mild central stenosis and severe right facet degeneration/severe right foraminal stenosis. 3. Right hypertrophic facet degeneration and foraminal stenosis at C2-3 and C4-5. 4. No fractures identified.
Thanks in advance

@dmp19651989 Hello and welcome to Connect. I am a cervical spine surgery patient. There is a significant list of issues on your husband's report and problems listed as severe. I can understand your husband's frustration with doctors and it doesn't sound like his doctor wants to help address the issues causing pain and nerve compression. I think it would be worth it to see a different surgeon for an opinion. I would suggest a doctor in a different medical facility because if he sees a doctor who knows his surgeon, they wouldn't want to interfere with their patent.

Do you have another good surgeon in mind?

Jennifer