Neuropathy and Cervical Stenosis?

@ray666 I think you are in a situation where it is hard to know what problem is causing your symptoms or if it may be a combination of things. Cervical stenosis does cause problems like balance issues, dizziness and vertigo, lower body pain and actually pain anywhere in the body, weakness in legs, uneven gait and problems with incontinence or normal emptying of the bladder or bowel and many surgeons miss that connection. That is the problem I had in finding a surgeon to help me, because they didn't understand that connection until I found this described in medical literature and came to Mayo. Have you thought about the possibility that the cervical stenosis may be the cause of the neuropathy? It also may not be. How did this develop? Was there a spine injury like a whiplash? Did a spine injury happen before the lower body pain began?

The surgeon doesn't know for sure, so he can't make any promises, but that's OK. My surgeon didn't promise to cure my pain either, but cervical spinal cord decompression did solve the problem. The big clue I had was that I had an epidural injection that stopped all the pain I had all over my body temporarily, and then it slowly came back as that wore off over a few weeks, but there were 5 or 6 totally pain free days. I also had a lot of details on how this developed for me over a few years. I knew the all over body pain was connected to my cervical stenosis even though there is no diagnostic test for this. My fusion at C5/C6 did solve all of the pain I was experiencing which proved that it was generated by spinal cord compression.

My other question is about the about the wait and see approach. Will the neuropathy obscure worsening of the symptoms that are coming from the spine? If these are separate problems, neuropathy could prevent the normal warnings that would come from pain if there were no peripheral neuropathy. When damage shows up on an MRI, it may not be reversible with surgery. Surgery can prevent something from getting worse and it can also leave you in more pain than before surgery. It is a big decision and you need to know from your surgeon an accurate assessment of your condition. Surgeons cannot tell you exactly when permanent nerve damage will occur if the spine is not decompressed. What if there is no change in symptoms, but the MRI imaging starts to show nerve damage within the spinal cord? Would that be the indicator to proceed with decompression? Is that really worth waiting for? For a patient who does not have dignosed idopathic neuropathy, waiting for damage to occur just doesn't make sense. I know in my case, an earlier intervention gave me the best chance to not have lingering nerve pain after surgery. That is the result I have with a very successful recovery. I also had surgery with out hardware, and I know from a later experience with a fractured ankle, that metals inside my body were causing additional pain, so that was a good choice on my part and my surgeon made that solution available to me.

Hi Ray -
My decompression and fusion of L2 to pelvis was in early 2021 after 3 years of epidural injections which worked for a few days and became less and less effective over time. I had very bad stenosis (along with arthritis and spondelosisthesis ) and already had neuropathy in my feet for about 20 years. The result of the spinal surgery (done at the U of Iowa Hospitals) was amazing, as far as the stenosis and other spinal issues were concerned. But there has been no improvement to my imbalance and gait issues, which have become worse, likely at least in part because I fell and had to have a partial hip replacement in Apr.-May of the same year. You can identify your stenosis, right? For me, prior to surgery, the pain during standing/walking was severe, and the minute I sat down it disappeared completely. I had only to give it a few minutes' rest and could get up and resume, only to have the pain return and have to sit down. If I had to do it over, I would definitely get that spinal surgery done with the same surgeon (or at Mayo if I had a way to get there) but I would not fall again and break my hip!!🙄
Hope you have a great weekend!

Good morning, Jennifer (@jenniferhunter)

Thank you for such a careful reply! I have tried going over all of the points you make with equal care.

I believe it is so true for many of us with idiopathic PN, and especially those of us with additional conditions, either related or unrelated, to know which therapies may help relieve some if not all of our symptoms. That's undoubtedly the conundrum I'm facing with my PN and cervical stenosis. You do refer to pain throughout your post. Here's where we encounter one of my situation's oddities, the source of considerable frustration when I speak with my clinicians, notably when I'm presenting for the first time: I have no pain. I have neither pain that I can associate with my stenosis nor pain linked to my PN. I only learned that I have cervical stenosis due to the MRI my neurologist's MA sent me to get in an attempt to decode my balance and gait issues. That led to my being referred to the neurosurgeon who further diagnosed my cervical malformity, offered surgery, but at the same time called my condition "borderline" and, as I had no cervical symptoms (at least none of the typical symptoms that might cry for urgent cervical surgery), we take a wait-and-see approach. I got that diagnosis a little under two years ago, and I've still no pain that I (as a person who has no pretensions of being a doctor) think of as stenosis-related pain; no dizziness or vertigo-like symptoms, either. An EMG a year ago pinpointed (bad pun!) sensation-loss in my feet. Even that sensation loss – if it hadn't been for the EMG – is yet another condition of which I might not be aware if it hadn't been for the EMG. I tell my clinicians: "It's a weirdness. I've no pain, but my balance is poor, my walking is wonky, and I don't know why." I should add that I've not been injured. One curious note: a brain MRI, which was otherwise A-Okay, did reveal my having been a heavy drinker, although my drinking days ended more than 30 years ago and I've had nothing alcoholic since. You ask toward the end of your wonderful message, regarding the wait-and-see approach, "Will the neuropathy obscure worsening of the symptoms that are coming from the spine?" That is a question weighing heavily on my mind. Should I get a fresh cervical MRI and return to meet with the neurosurgeon? I trust he'll not pressure me into surgery. He'll expect me to consider seriously what he has to tell me, but he'll also expect me to make that surgery decision. That the decision is ultimately mine? Therein lies the crux of my conundrum.

Again, Jennifer, thank you a millionfold for your thought-provoking reply!

Ray (@ray666)

Good morning, bjk3 (@bjk3)

Yes, falling and breaking a hip is never a good idea! 🙂

If you'll allow me, I'll make this a short reply. You'll see I just now posted a rather lengthy reply to Jennifer, and now I'm afraid I need to get started on a project that's due later today. Your saying that your spine surgery did not help with your balance and gait is precisely what my neurosurgeon warned, but it is still on my mind: Maybe I should get that cervical surgery done anyway? Surgery's a big deal, making the deciding tough.

I wish you a fantastic weekend!
Ray (@ray666)

@ray666 Ray, the decision is yours. Some spine patients never feel pain at all and are shocked to learn of spinal cord compression. That confuses this even more doesn't it?

When you say that your walking is "wonky" I imagine weakness and a limp. I also had a limp when there was enough pressure on my spinal cord and there was nothing I could do to stop that when it happened. My condition was at a borderline point too- not bad enough to cause debilitating symptoms, and sometimes pretty normal depending on my neck position. It was intermittent because my physical therapist would realign the vertebrae taking the pressure off, and I walked normally again. I had muscle spasms moving the vertebrae around and altering the normal neck curve and effectively that made the spinal canal smaller when that happened. The vertebrae also had a degree of slipping forward and back slightly. The other evidence I had was the epidural injection that took the pain away completely. That works by reducing inflammation in the spine which buys a little bit of space. Epidural injections carry some risks. My surgeon at the time did this as a diagnostic test although ultimately he did not offer surgery because he missed the diagnosis. He had no answer as to why this injection took away ALL my pain, so he ignored that result, but this is a clue to the correct diagnosis of funicular pain (all over the body) which is what I had. If you can cause symptoms of pain or jumping muscles by changing the position of your head (Flexion and extension or head turning), that may be happening because those movements would increase pressure on the nerves in the spine. The spinal cord has to float and move within the spinal canal when you change position and stenosis can interfere with that normal movement. Another symptom of spinal cord compression are changes to normal functioning of the bladder or bowels. I had trouble emptying my bladder unless I consciously did it because it would stop half way. That also stopped and was normal again when my therapist realigned my neck. That can progress to incontinence caused by spinal cord compression which can become permanent without intervention.

Have you had physical therapy? Physical therapists, particularly if they also do myofascial release can help figure some of this out. Myofascial release works on the overly tight tissue in the body and releases that tension and gets the body moving better and with better ergonomics. I have done a lot of MFR with an expert level certified therapist which helped me a lot. That may be something to try to see if you can improve your condition or pinpoint where the problem may be. There are some conditions where pelvic tightness causes symptoms similar to a lumbar spine problem and can compress nerves to the legs. Some neuropathy is helped by MFR if it has a physical component. You can search for a provider a t https://www.mfrtherapists.com/

Here is our MFR discussion where you can learn more.

Neuropathy - Myofascial Release Therapy (MFR) for treating compression and pain
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Ray, I just found this discussion from a patient who did have spine surgery and has neuropathy. You may want to look at this discussion where you can connect with @domiha https://connect.mayoclinic.org/discussion/neuropathy-in-feet-post-laminectomy/

Jennifer

I had AC/DC surgery this spring and my condition has improved

A spine surgeon examined me about 4 years ago and showed me an MRI image my stenosis in my neck . He said the disc between 3 and 4 was pressing on my spinal cord and may be contributing to my problems. He said he would operate on me but said I was welcome to get a second opinion

I saw. A neurologist who said the spine surgeon didn’t know what he was talking about. So I declined the surgery

My condition continued to worsen and regressed to a wheel chair

I went back to the spine surgeon who agreed to operate

The operation was very helpful. Improving balance, feeling returning to arm, hands , legs, and feet, better bowel movements.

I’m 81 years old and will never be young again but I’m out of the wheel chair and can walk short distances

I have no pain

That was a c d f surgery

Is pain so bad for some. Takes my breath away. If you don't have it people tell you about their neck hurt. I am 69 and have a back with everything. When a surgeon tells you surgery would not work and will not even suggest. Just scary and don't know if others have the same.

Welcome, @josiegir2. I moved your comment about stenosis and neuropathy to this existing discussion on the topic:
- Neuropathy and Cervical Stenosis?: https://connect.mayoclinic.org/discussion/neuropathy-and-cervical-stenosis/

I think you'll appreciate the knowledgeable posts by @ray666 @jenniferhunter @bjk3 @wood and connecting with them.

I had cervical surgery. Mine did not take. The neurosurgeon said the doctor that performed that the acdf cervical fusion should have never been done. They should have done a laminectomy. That's what they did on my lower back. I had severe axonal sensorimotor peripherial polyneuropathy/ cardiac autonomic neuropathy/small fiber way before the stenosis. The problem they did not tell me about is I have to have my esophagus ballooned open every six months otherwise it closes off and you choke. It will not change the neuropathy problems. Motor neuropathy causes tremors in hands/arms/legs. It says movement disorders. I had to go to Boston to put two and two together. They kept calling it essential tremors but that is one sided. Now I am being tested for CIDP. Peripheral neuropathy caused by diabetes, autoimmune, chemotherapy, some medications ( on the insert it does not say neuropathy it says pins and needles) and idiopathic. Mine is autoimmune and I test negative for everything almost. I tested 13 for rheumatoid arthritis and you have to test 14. Strong family history. I posted all the labs that I had to have done in order to see a research neurologist based out of Boston. I live in Texas. These are the doctors she recommended that I have. Immunologist,
Neuromuscular neurologist and Neuromusclar physical therapist. I get severe muscle spasms, tremors (can't hold a glass or cut up my food. Sometimes my husband holds my glass and if I can't get the food to my mouth he feeds me. I can't feel my hands so I constantly cut them needing stitches, bladder problems) I think the worst is the muscle spasms and tremors. Nerve pain wakes me up every morning at 230 am. The surgeries for my cervical and lumbar made no differences for me. Instead, it caused more problems. My cervical was done due to injury from a seizure. I could not hold a empty glass. I would drop it. I fractured T7 due to a seizure. I have spinal bifida also in my lower back causing problems.You can get seizures from neuropathy just an fyi.