Spinal pain management

@germangirlvt Welcome to Connect. I see you've already met @upstatephil who shares valuable experience with both cervical and lumbar surgeries. I am a cervical spine surgery patient and I also have thoracic outlet syndrome (TOS).

I wanted you to know that cervical central canal stenosis can present as problems with legs, gait abnormalities, sciatic pain and difficulty walking and I had those symptoms. When you also have a lumbar problem, it gets difficult to determine which area is the bigger cause of the spine symptoms. If you have significant spinal cord compression in your neck that also carries the risk of paralysis if there would be another injury.

Having TOS affects the cervical spine as well by causing more pressure on the vertebrae with muscle tightness and spasms. For me, TOS is worse on my left side and makes tension greater there, and it can often start turning my cervical vertebrae with a muscle spasm. That has contributed to vertigo if I looked upward not knowing my vertebrae were rotated, and I lost my balance and fell backward. The reason is that there is a vertebral artery inside each side of the cervical vertebrae which is part of the blood supply to the brain, and twisting stretches these arteries, and then looking up and craning the neck would kink them and decrease blood supply further. That happened before I had any spine surgery, and since cervical surgery, my neck is more stable, has fewer spasms, and I do stretch to maintain function.

I have managed my TOS with physical therapy and specifically Myofascial Release to loosen all the tight fascia that binds everything. This helps my neck and surgical scar tissue. I did have surgery for the central stenosis 8 years ago with a C5/C6 fusion. I continue to work on MFR type stretching that I learned from my PT which helps. I need to periodically release my surgical scar tissue on my neck and it kind of links to the TOS tightness because those areas are very close together. Here is our discussion about MFR 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/
Here is a link to a medical paper that explains how cervical stenosis can present with leg symptoms. Not all surgeons would get this, and the symptoms can be misunderstood, and they need to be certain they are addressing the correct issue before they operate. It's best to put this question on the table at the beginning before you get a complete diagnosis because if you come back with this after you have a surgeon's opinion, it puts you in the position of correcting them, and they may not listen to any of it and miss the diagnosis. That happened to me after several surgeons missed this, so I came to Mayo asking about this funicular pain. My surgery fixed all of this which is proof that I had this type of pain and dysfunction.

Eur Spine J. 2011 Jul; 20(Suppl 2): 217–221.

"Cervical cord compression presenting with sciatica-like leg pain"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111492/
I can tell you that I didn't think cervical spine surgery was that bad, at least for my single level fusion which was done without hardware. After I got past the waiting period during healing and saw my PT, I felt much better, but initially the surgery increased the TOS pain because of inflammation in the same area. I was able to manage without pain medicine after surgery, and it nauseated me and made me constipated, so it was best to just stop taking it. Lumbar spine surgery is a more difficult recovery because you bear most of your weight on the lumbar spine.

Have your surgical consults discussed cervical spine issues as well as lumbar spine issues?

Seriously? I have a spinal cord stimulator that needs to be replaced, about once every 10 years. Charging yourself up every few days would be ridiculous. There are much better products out there than that nonsense. No reprogramming unless I need it which so far in 4 years hasn't happened.

tjjordan1, you’ve been truly blessed! Maybe it was just the brand SCS! I’m glad it’s working for you!

I wished it was for you too ! Mine is a Abbott, and the battery needs replaced about once every 10 years. Maybe find another provider who gives you a up to date excellent product, rather than a very high maintenance piece of crap. There are MUCH better products out there.

Thanks for replying, but mine just didn’t help at all in the 3 years I had it with multiple programming by the reps & an additional lead added. It’s made by Boston Scientific. I finally had it removed 2/23/24, so now I’m starting over with a new pain management Dr.

Did your pain mgmt Dr to a trial, test to see if I worked ? That's the normal prodical. Was it actually implanted ?? We did a 2 week test before actually putting mine in. It helps a lot. Good luck, I hope you get the right pain mgmt place to help you !!!

Could I get feedback on how long the permanent implants were successful ( 50% or better pain relief)?

Which SCS do you have? I am in the process of getting one implanted. It is a Medtronic. I am still researching to find the most effective one.

Mine is a Abbott, and I'm VERY happy with it !!! Make sure they do the trial 1st before implanting to make SURE, it will work. im VERY PLEASED with mine

Thank you for the information. I am having the Radio Frequency Ablation on both sides sensory nerves at L3-L5 on September 10. The two trials reduced my pain over 80%. I had a Lamenectomy in 2014 from L1-L4. They can't operate due my scoliosis rotates where those vertebrae are at. This RFA is my last resort after being denied at other options and treatments. My S1, L5 and L4 are fused together because of spinal stenosis. I am already fused at C2-T2, rods on both sides. My scoliosis was fixed in my Cervical by bending the rods. Fusing my Lumbar would cause my spine to rigid. My Lumbar works ok mechanically. It is the constant pain that is taking my life. I pray that this works and both of us won't have to burn the nerves for long time to never!!!