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billandri (@billandri)

Cervical stenosis

Spine Health | Last Active: May 3 2:15pm | Replies (34)

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@jenniferhunter

@billandri Hello. Thanks for asking the question and cervical spine surgery is a big step. I am a Mayo spine surgery patient. I understand wanting to avoid surgery, and I would have done it a lot sooner, but no surgeon would help me (and I saw 5). The complicating factors were the pain I had all over my body from spinal cord compression in my neck and my MRI looked just like yours with a ruptured disc and bone spurs at C5/C6, and I also have thoracic outlet syndrome which is nerve compression in my shoulder. Leg and body pain is a symptom of cervical stenosis, but it was what all of the surgeons missed. They imagined problems I didn't have (like MS) and wouldn't take a risk on me. I found medical literature describing some similar cases and I contacted a surgeon at Mayo with that after reading his papers, and he had a paper that described leg pain from cervical stenosis. He did help me, and the recovery from the surgery was not as bad as I imagined. I have a biology degree and did a lot of research reading about spine surgery in the 2 years before I came to Mayo.

The only way to recover from spinal cord compression is surgery, and the sooner you do that, the less permanent damage you will have. Spinal cord damage doesn't always show up on MRI, but when it does, it is a white area within the cord. I did not have it on my MRI. I had muscle atrophy, and I lost about half my muscle in my arms and shoulders. Everything felt 3 times heavier than it really was, and I became so weak that I could not hold my arms up. Things like driving, pushing a shopping cart, and painting (I am an artist) became impossible and exhausting. That happened within 2 years of the first symptom which was ankle pain. Once I came to Mayo, I was offered surgical help right away, and everything about it was different and better than all the places that just wasted my time and wouldn't help me. Ask your doctors what will happen without surgery. I didn't want to be at risk of paralysis or live my life in a wheelchair. If your spinal cord is already compressed and you have a whiplash type injury, the consequences can be devastating and disabling.

I did have a diagnostic epidural injection, and when it took away all the preexisting pain (indicating what surgery could fix), the doctor ignored those results. I also had a bad reaction to it and got a new intense pain from the pressure of the injected fluid that had nowhere to go, a paraesthesia, and I had stabbing burning pain from that into my dominant hand and index finger, and I had to not move at all, or it would bring that on. I was convulsing right after that injection and nearly passed out. It was my deep breathing and relaxation techniques that saved me from loosing consciousness. That was the worst pain I have ever felt, and going through spine surgery didn't come close to that pain at all. It took a couple months for that to subside, and then I had cold sensitivity in my hand from that. Surgeons seem to like to put off surgery with injections, and epidurals pose a significant risk, and can have serious consequences if done improperly, and the injections are not FDA approved. I refused to do any more as it won't help, and I had to wait at least 6 weeks after one in order to get a clear MRI. Mayo never asked me to do an injection.

I was seeing a physical therapist during all of this time, and she bought me some time by realigning my neck from the muscle spasms, and she used a Dolphin Neuro-stimulator on the nerve roots which blocks the neuro-transmitters of the pain impulse signals. That reduced pain for about a week. Because of the tightness through my chest from TOS, I would get some rotation of thoracic vertebrae that caused numbness in my forearms, and with PT and myo-fascial release, I could get the feeling back that was due to the rotation.

In your MRI, the white area around the spinal cord is the fluid space, and you can see that it is compressed enough that there isn't much of the space left at all where the stenosis is. This will keep advancing. In my case, I saw the amount of bone spurs double on my MRI within 9 months. Just prior to surgery, if I bent my neck, I sent a electric shock down my entire body, and my disc had collapsed down about 50% so bending would cause the nerve roots to get compressed even though I didn't have stenosis or arthritis in the foramen (where nerve exit the spine).

My best advice would be to figure out which procedure you think is best and which surgeon you can trust to do it, so you are prepared when the time comes. I made maps of my pain on a body diagram over 6 months and tracked how it changed. You should do this to track how fast it changes. I suggest get opinions about artificial discs and fusion. My surgeon does both, but I also had 2 mm or retro-listhesis (backward slipping instability) so I was not a great candidate for artificial disc. Anything screwed into your bone has the possibility of pulling out or migrating. Foreign materials can cause immune reactions. Your body can grow bone spurs around an artificial disc trying to stabilize it. Artificial discs can fail. Both artificial disc and fusion patients can had adjacent segment disease, and that also happens to people who have had no spine surgery. I chose a one level fusion with cadaver bone (so I would not have hip pain for the rest of my life from harvesting), and my surgeon did not place hardware on my spine at my request. No plates, no screws, no cages, and only a disc of bone seeded with my removed bone spurs that fused beautifully. I stayed in a hard collar for 3 months until it fused and then did rehab. I didn't want a plate taking up space in my neck or causing discomfort. My surgery fixed all the pain. I have some tightness in my neck that I work on in physical therapy along with TOS.

You may want to be checked for other nerve entrapment issues like carpal tunnel, thoracic outlet syndrome, etc. just in case there are also problems with nerves in other places. If you have surgery for cervical stenosis, and still have an issue, it could be something like TOS. My TOS got worse because of the surgical scar tissue that is close to the TOS entrapment, but myofascial release helps and I made a lot of progress. I was immobile for the months in the neck brace, and had to wait for fusion before we could do therapy. see http://www.myofascialrelease.com

I know you were hoping for another answer, and this is a big change for your health, but you can recover and be active again, but you'll always need to maintain good posture, core strength and proper body mechanics to prevent future problems. Give yourself permission to take time off to recover. I wish I had come to Mayo first, as I could not find the quality of care that I needed locally. I am 2 years post op, and about half of my lost muscle has come back, and I'm still working on it. I would not have lost all that muscle with an earlier surgery, but no one would help me.

If you have any questions, just ask. You can read my Mayo story, Here's the link and another story about the Mayo story.
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
https://www.chicagotribune.com/suburbs/barrington/community/chi-ugc-article-local-artist-jennifer-hunter-has-her-patient-2019-01-30-story.html

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Replies to "@billandri Hello. Thanks for asking the question and cervical spine surgery is a big step. I..."

Did you have one of your Physicians request an appointment or refer you to Mayo or did you do it on your own? How did you you choose Dr Fogelson?