Has anyone dealt successfully with Cervical stenosis without surgery?

Hi!

I tried for several years to "work around" the need for surgery. Some success, but it got worse.

An MRI revealed what needed to be done and my PCP at Mayo setup the consultation and surgery.

My advantage - I live just a few blocks from Mayo here in Rochester.

My recommendation is get an MRI, have a Specialist review and, if surgery needed, do a Referral to Mayo to get it done.

I still have some pain if I violate the back surgery mantra - no BLT! No Bending, Lifting, or Twisting. Sometimes I forget and then here comes the pain.

Good luck!

--Paul Ray

@isabelle7 The simple answer is arthritis is affecting your neck. Anterior spurring at the C5/C6 disk means there are bone spurs projecting forward into the spinal canal, and the question is how large are they and is the spinal cord getting touched or compressed by any of this? Bone spurs grow from inflammation around a ruptured disk and because of uneven pressure on the bone of vertebral body. The uncovertebral joints are just kind of bumps on the vertebra bones to the sides of the disks that can touch between the 2 levels. These are only on the neck from C3 and below and those joints have enlarged a bit. You are also getting nerves pinched at the nerve roots which will cause pain to the area served by that particular nerve which is described as severe at C6/C7. This dermatome map explains how nerves leave the nerve root to go to the body. It sounds like you may have a disc rupture that extends into the nerve root area at C6/C7 that is causing bone spur growth there. That's my guess, and an MRI will confirm what is happening. I'm not a medical professional. I did have spinal cord compression from bone spurs in the central canal, but did not have nerve root compression. The good news is your disks are maintaining normal height, but there may be a damaged one.

This explains dermatomes.
https://my.clevelandclinic.org/health/body/24379-dermatomes.

I am a 76 yr old female and had severe cervical pain 40 years ago. It was diagnosed as osteoarthritis with bone spurs & pinched nerves. No surgery was recommended. I did have cortisone injections and used an over the door setup using a weird harness under my chin and a bag of water ( medicine has advanced in 40 years). Those things worked but I had to use the contraption 3x a day (luckily I could go home for lunch & lived 10 minutes from work). I was also told to gently stretch my neck by moving my head around. Since then I have had more spinal pain, injections were no help and I decided against surgery. I try to be as active as possible ( walking, no jarring running). I also tried CBD with THC capsules purchased online. They may have helped, I took them for about 3 months and I still have spinal pain. I am resisting any surgery and just try to remain active. Losing some weight helps me but I was never obese, just about 10 lbs overweight.

@jenniferhunter

Thank you for your response and explanation. And the link. I will definitely check it out. I like your last comment that my disks are maintaining normal height. At least something positive. LOL

I talked with my physical therapist and he recommends waiting for the MRI. He reviewed the x-rays with me and between what the x-rays show and my symptoms, he didn't feel this was the time. He thinks with caution and one exercise he gave me to do that I can manage this.

He's also very anti surgery unless you really absolutely need it. He said he's seen one spinal surgery lead to another and to another. Any thoughts on that? Or on his assessment that I can wait on the MRI?

Also, do you have any suggestion on a pillow that would be good for someone with spinal stenosis? I tried one I got on Amazon for over a week and I seem to be developing new aches and pains so I stopped using it last night. This is the one I bought and I had to use it on the shortest side. The other side was way too high for my neck.
https://www.amazon.com/dp/B0BHQC6TPV?ref=ppx_yo2ov_dt_b_product_details&th=1

@pdray

I don't live anywhere near the Mayo Clinic and I'm not sure my insurance would cover it. I do live closer to OHSU in Portland and I believe that hospital is covered. I'd have to look into it. My physical therapist, who is suggesting I hold off on the MRI and do everything in my power not to have surgery, feels after looking at the x-rays and hearing my symptoms that I still have time and that I might not ever need to have surgery. He says some people can live with this their whole lives and not know they have it.

It's hard to know what to do. What kind of surgery did you have and what was your recovery time? That's another issue for me because of my work schedule. And the work I do. I have to do some lifting so if after surgery I couldn't bend, lift or twist I'd be in trouble.

How bad was yours when you had to have surgery? The pain I have in my arms isn't horrible. Mostly annoying. For years my GP said I had tendinitis so we treated it as such. It wasn't until I had one episode where my wrist hurt and an urgent care doctor ordered the xray of my neck that I even knew I had this problem.

@mydogsbestfriend

Thank you for your response. Sorry I'm so late to reply. I applaud you for doing all you can to avoid surgery. I'm sorry you've had to deal with pain. I've heard the injections often don't work so I'm avoiding those. I'm doing all I can to be careful with my movements, the way I'm lifting, not twisting when I lift, things like that. My pain is tolerable and not constant. I can go through days where I'll have a week or two of pain in my arms or wrists. I can usually stop the pain with five days of Advil or Naproxen and sometimes using heat helps. I think there is a lot to remaining active without overdoing it. I also think you're right about losing some weight. I can stand to lose a good 20-25 pounds so I think I'm going to make that a priority. Thank you for the reminder. Anything I can do to help this along I will. I'm 68 and would really like to be able to manage this without surgery. And if I do eventually need surgery, I'd like to wait it out until I'm no longer working. I run a home childcare and preschool with 9 young children babies to age 5. I do some lifting of course but I'm extremely careful. Fortunately most of my kids are walking so I don't have to do much lifting. I'm due to lose a kindergartener and gain a new baby so I'll have to be extra careful. Not sure how many more years I'll be doing this. I love it and am hoping I can keep doing it for some time to come. If I have to, I could only take children who walk and are potty trained and turn this more into a preschool than daycare. I've thought about it.

@isabelle7 One of the best things you can do is keep a journal with dated notes about your symptoms and if things are improving with PT or getting worse. That will tell you how fast symptoms are changing if they are changing. Keep track of what you are doing and body positions that can bring on pain symptoms. An MR is certainly expensive, and it could show you more detail of what you already know. If you had pain symptoms that worsened when you move or change neck positions, that might be the time to do an MRI. Your insurance company may not want to cover an MRI unless you have enough symptoms to warrant it, and your doctor probably needs to get a pre-authorizarion. Surgeons tend to think that an MRI is current for about a year. Sometimes the spine doesn't change that fast, but it also depends on your habits and if you play sports that pound on your spine, etc.

Adjacent segment disease does happen. It can happen after surgery for a fusion or artificial disk, and there can be multiple levels with issues even if there has been no surgery. If multiple levels have been fused, the risk of adjacent segment disease is greater because of greater stress. It doesn't happen to everyone. You surgeon can give you statistics on this. Generally speaking, the rate of adjacent disease is a bit more with a fusion over an artificial disk. Those have other risks too.

Having spinal hardware causes more rigidity on the spine. In comparison, my single level fusion was done without hardware and only a bone disk spacer. Bone has a bit of natural ability to flex. That may not be a lot in the spine. The other factor that I think is involved is scar tissue, and all surgery creates scar tissue that gets tight and it connects right to the operated spinal site. That can restrict movement, cause pain, and put pressure on the spine, and pressure can affect the spine. If you have a disc that is degenerating, pressure won't help that situation. Uneven pressure on vertebrae can cause remodeling of bone and can generate bone spurs. If you have a bulging disc that throws the force off in any direction, it can cause uneven pressure on a vertebrae. To ease this, I periodically stretch my scar tissue, and my PT does myofascial release work and has taught me how to self treat. I believe that this will help prevent further disc issues. I am 8 years past my C5/C6 fusion with no other issues. I was doing this MFR before spine surgery and it helped by making my tissues more supple and easier to retract, so it probably led to an easier recovery. This is my plan to avoid further spine surgery. My surgeon recommended maintaining core strength to support the spine as the best way to avoid further spine surgery. With stretching out scar tissue, I maintain better movement.

With all of this, I pay attention, and when I get tight, I make sure to stretch. With pillows, I have to make sure to keep my neck supported so it is not bent either up or down. If I get neck pain, I change position, and I stretch out the kinks.

Here is our discussion about Myofascial Release that you may be of interest.
Myofascial Release Therapy (MFR) for treating compression and pain
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Has your physical therapist made recommendations on exercises to maintain core strength?

@isabelle7
I think you may want to get an orthopedic doctor to have you get a cervical MRI to see if your spinal cord is being affected. I would not rely on a PT to advise on medical tests and procedures. They are supposed to help you strengthen muscles and improve function, not diagnose. I had cervical spondylotic myelopathy c5c6 and had ACDF surgery. Myelopathy is spinal cord compression that can cause permanent damage/injury if not decompressed. No amount of physical therapy would have improved my spinal cord compression. Surgery was necessary to stop the further progression of arm/hand/leg weakness and loss of bladder control. I was diagnosed with this at 52. I am now 55 and have permanent damage due to my condition not being properly diagnosed over 3 years. I took myself to an orthopedic spine doctor who immediately diagnosed me based on clinical symptoms and MRI.

@dlydailyhope

Thanks for this info. I'm so sorry you went through that. I do not have any weakness or loss of bladder control. I just have some pain in my arm at times that has always been thought to be from tendinitis. But it could be from my neck issue. I think the reason the PT said he didn't think I needed the MRI yet is because I don't have any sort of weakness, or tingling or numbness. Any thoughts on that? He said many people have what I have and live with it for their lives without needing surgery. I don't have spondylotic myelopahty. Here's what the results showed on my recent cervical x-ray.

No acute fracture.
Vertebral body heights are maintained.
Intervertebral disc heights are normal.
There is worsening anterior spurring spanning C5 and C6.
There is similar uncovertebral joint hypertrophy.
There is worsening, now severe narrowing of the right neuroforamina at C6-C7 secondary to progressing degenerative changes. The remaining levels on the right side have also shown worsening neuroforaminal stenosis.
The left side is stable, with narrowing noted at C6 to C7.
Prevertebral soft tissues are unremarkable.

@isabelle7
If that was my X-ray, I would definitely want an orthopedic doctor to have me get a cervical MRI. The X-ray clearly shows you are getting bone spurs and arthritis C5-C6, narrowing of foramina on right/stenosis which may be compressing C6-C7 nerve roots/nerves on right. The MRI will help show nerves/discs/spinal cord/soft tissues that an X-ray cannot show. You may have radiculopathy and disc/nerve compression issues. Earlier symptoms start with pain and then progress to numbness and weakness. You don’t want to wait for things to get too bad because you could get permanent nerve damage, depending on cause.