flattening of cervical spinal cord from bone spurs

@dmp19651989 Flattening of the spinal cord should be a concern. It can always get worse and it can compress the spinal cord so badly that the axons in the nerve fibers of the spinal cord start to die off. I'm not saying that to alarm you, and the questions are how much does it affect your functioning now, and is it getting worse and how quickly?

The nerves that exit between vertebrae carry impulses to specific areas of the body. The spinal cord is a big bundle of nerve fibers feeding all of that and you won't specifically know what will be affected if compression causes issues. I did not have nerve root compression, but I did have spinal cord compression that caused a lot of symptoms.

This finding needs interpretation by your doctor who hopefully is a spine specialist.

Jennifer

Some of the symptoms are shock like pains and weaknesses in the arms. There is lower lumbar pain as I have degeneration there also. My walking is slower due to pain; and also have a hard time standing for more than 15 minutes. Could these symptoms all be related to my cervical spine?

@dmp19651989 Yes. I had similar pains from cervical stenosis with cord compression. Cervical stenosis can cause pain anywhere in your body below the level of compression. I had a pronounced limp or uneven gait when walking and that kind of went back and forth for a bit depending on if muscle spasms were pulling the vertebrae out of alignment. When my physical therapist put things back in place, I walked better until the next spasm. Spine surgery fixed all of that. I don't have pain now.

Jennifer

Flattening of the spinal cord is essentially compression of the thecal sac which surrounds the cord and when severe will cause severe central canal stenosis. Did your MRI state what the diameter of the cord is in the area that you bring up? For instance this is a sentence from my last cervical MRI..."The anterior and posterior thecal sac defects cause a reduction in central canal diameter to an estimated 7 mm, a moderate to advanced AP central canal stenosis." Bone spurs are the result of arthritis, reflecting the body's way of defending against bone against bone pathology which can happen when the discs lose their sponginess or slip completely out of place. Spurs themselves can cause compression. In your case, it would appear your nerve roots themselves are not being compressed but the bone spur is threatening the sac. At this point it is mild but is something that should be watched carefully. What kind of symptoms are you having?

@sb4ca I presume your response here is for @dmp19651989 . When you type the @ sign and their member name, they will be notified of your response.

I thought it would be helpful to compare some measurements for a normal spinal canal. This link from Physiopedia has a description.

" Average anterior-posterior canal diameter at all levels is 14.1 +/- 1.6 mm.
The canal diameters range from 9.0 to 20.9 mm, with a median diameter of 14.4 mm.
Men have significantly larger cervical spinal canals than women at all of the levels[3]. "

I know this doctor in the first video link. He is the neurologist who examined me at Mayo in Rochester for my cervical canal stenosis that was caused by bone spurs and a ruptured disc referred to as a "Disc Osteophyte Complex". Inflammation from the ruptured disc nucleus caused bone spurs to grow.

Physiopedia - Cervical Stenosis
https://www.physio-pedia.com/Cervical_Stenosis

Hi Jennifer, First, I very much admire your dedication to Mayo Connect. I've been on here before and I've seen this myself. I guess I'm confused here with your response. Did I give bad information? I used the sentence from my MRI to give her a reference point to see if her MRI had calculated the level of stenosis from the bone spur. Is this your concern? I've had 3 cervical fusions myself, one a revision because of MRSA-driven osteomyelitis. ( I have a primary immune deficiency that was not being treated at that time). Given she has no actual nerve compression going through her vertebrae, I was just trying to explain how the osteophyte could impact the cord without any vertebral involvement as I believe that was her question. I am a strict rule follower, so please let me know where I errored even if you need to say it more directly lol.

@sb4ca Thank you very much! I do enjoy helping on Connect.

I thought your post was very informative, and It adds valuable information to the conversation. I didn't see the usual "in reply to" note at the top that is usually added automatically by Connect, and I wanted to make sure it would be seen. It also helps others learn how to use Connect with the "@ mention" note in order to send a notification to the person that you intend the post for. These posts are ready by many more people who learn from the dialog and who may never engage in the conversation. I wanted to bring in more information for that reason to help support the information that you posted.

I believe there are ranges of actual measurements that are defined as "moderate", "mild" or "severe" when describing spinal stenosis, but I just don't know what the actual numbers are. When you read a number for spinal canal diameter, and there is no context to compare how different that is from a normal reading, it's hard to interpret what the radiology report means. The Physiopedia page talked about differences in spinal canal sizes between men and women, and also differences in what part of the spinal canal they are describing. I thought that information would help others understand and add to the conversation.

I'm glad to see that you are asking questions to keep the conversation going. That's a good tactic to provide an opportunity for others to participate and something that mentors like to do too. Something I've learned about communications here is that members may understand things differently based on what experiences they have had, and that medical reports can cause anxiety to a patient when their doctors have not explained the context of what that means to them specifically.

Your post also describes what my spine condition was prior to my C5/C6 fusion because I did have a disc osteophyte complex pressing 5 mm into the spinal canal and contacting my spinal cord. I did not have any damage that was visible on the MRI to the spinal cord, and my surgery was done before that happened. I had MRIs that demonstrated that the area of bone spurs doubled within 9 months, and I see that as change happening kind of quickly in my case.

You do have a lot of experience with fusions, and sharing that helps others, so I'm glad you're here!

Were you able to track symptom and imaging changes in your spine prior to spinal fusion surgery?

Jennifer

Darn, I just lost a draft! I very much appreciate your comments. It is a sad state of affairs when a doctor leaves a patient hanging in not explaining what it says. The use of patient portals can make this worse but to me the benefits of those outweigh the drawbacks.

When my MRI's have shown cord compression by diameter, I have looked at the normals only to fall back and feel it was somewhat useless as everyone is so variable. What mattered was the radiologist saying it was abnormal for me. In the MRI that my comment came from, there was a entire paragraph of what was going on. Basically, one disc "fell" under the one above it. I had a sudden upshot of pain when I traveled. I had been warned by the infectious disease doctor that those symptoms could mean the MRSA came back. When I returned home I went to the ER at my primary's recommendation. No, I wasn't showing MRSA and a cervical x-ray was "normal". But I did contact my surgeon's office to tell them what happened and my surgeon looked at the x-ray and didn't agree with the ER physicians. He ordered that MRI. I so very much wished I could have told that arrogant ER doctor that my pain was legit and he was wrong. I do have after images as that surgery failed to exclude all of my cervical pain and he repeated an MRI in 2023. That radiologist reported a fusion which had never been done, but my surgeon reads his own reports. I have unfused vertebrae sandwiched between fused vertebrae. The artifacts from the hardware make it very difficult to get a clear image. That's something you might want to know. The surgeon either ordered the study done on a specific MRI machine or used a different software protocol or both in order to tone down the artifacts. Despite that, it's possible this is why a radiologist thought he saw fusion hardware where there wasn't any. Even with two courses of physical therapy, I continue with issues in my neck. And you've likely seen that I now I have lumbar issues. I don't think I will be as agreeable to lumbar surgery. When I had my revision ACDF from the MRSA, they also used screws in the back of my neck and that was far more painful than the original frontal surgery. If the before and after MRI's would be helpful for learning I would gladly upload those for you and I have two sets as well-one for each surgery. First was C5-7 and second was for C3/4. I was the unlucky one who inherited my mother's bad arthritis-neither of my sisters have it like I do.

@sb4ca
Thanks for your description. I have seen MRIs that show prior fusions with hardware where there are dark areas, like cast shadows that kind of obscure those levels, and I can understand why it may look confusing when 3/4 is fused, 4/5 is not, and 5/6/7 is fused. If you do want to upload images, you are welcome to do that as long as identifying information is removed (names, birth date, medical facility, etc ) I do understand what you mean by your description, so it's your choice.

My surgeon also told me that cervical operations through the back of the neck are more painful and longer recoveries than a frontal approach. That goes through a lot of muscle that you use to hold your head up.

Not to make excuses for an arrogant doctor, but anyone can make a mistake, and his job is in emergency care is extremely stressful. With emergency visits and patients with extremes of fear and/or pain, that doctor will receive the wrath of patients who are upset and scared. I thanked an ER doctor once when I was there for a breathing problem, and that is what he told me that they rarely get compliments. One of the spine surgeons I consulted was pretty arrogant which I did not appreciate. He also was one of five spine surgeons who missed my correct diagnosis and he wouldn't take time to answer my questions. I did not hire him for the job.

I would be hesitant about a lumbar spine surgery too and recovery from that is difficult because the spine is bearing most of your body weight there, and then there is loss of spine mobility and that can affect normal movement like walking. My surgeon told me the best way NOT to need his services was to maintain core strength to support the spine. I get a great spine and core workout by riding my horse, just at a walk because I have to compensate for the horse's movement and I am moving my back and pelvis like I am walking, but with weight in the stirrups. It makes me really strong and supports my spine from the bottom up, so my neck is better supported and my posture is better.

Good posture that supports the spine is preventing wear and tear that may be caused by bad posture and the uneven pressure that it puts on the spine. Arthritic bone growth in the spine can happen because of extra pressure, so when a disc bulges, it can put more pressure on one side of a vertebrae bone. It's also common that with aging, that the vertebral "endplates" get a bit of a protruding edge on them, and those edges on the endplates may start fusing vertebrae if the disc between them collapses. Discs do loose moisture with age and get thinner and elderly people loose height this way, and also by bending of the spine.

It really does come down to a benefit to risk comparison and the expectation of how things will be different after a lumbar surgery. I'm sure it is a difficult decision to make.

Jennifer