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mlerin (@mlerin)

Excruciating pain from cervical (C7/T1) radiculopathy

Spine Health | Last Active: Mar 3 11:43am | Replies (22)

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@jenniferhunter

@mlerin With stenosis, when it is bad enough and causing nerve compression, epidurals may not have an effect. An epidural works by reducing inflammation which takes a little bit of pressure off, but if it is too far advanced, the pressure will be caused by arthritic changes, abnormal bone growth or a ruptured disc. If there is any instability or a collapsed disc, it can put extra pressure on the compressed nerves. I had one epidural injection and it only stopped all the pain for 5 days, and then it slowly returned over the next few weeks. I can tell you that cervical spine surgery is not that bad at least in my experience. I had an ACDF or anterior procedure which is an easier recovery that a posterior approach that goes through muscle layers. If your issues are just in the foramen where the nerve roots exit, there are some procedures that just clean out the compression without removing a disc. If you have stenosis in the central canal, they access it by removing a disc. I had spinal cord compression in the central canal from a collapsed disc and bone spurs at C5/C6, and had a fusion. I had a great recovery and had a fusion without hardware, and only a bone graft. I stayed in a cervical collar until it fused. I took it easy during my recovery. You may want to get other surgical opinions before deciding. Ask your doctor about prolotherapy. I have heard about it, and it relies on an injection that causes some inflammation which is a step toward healing, but it will not fix any stenosis that exists. If you have muscle spasms causing mal-alignment, physical therapy may help realign your spine and could help if alignment or instability is adding to the problem. It will not fix stenosis either, but could buy some time.

Generally, fixing this by decompressing the stenosis is best done before permanent nerve damage happens. Ask your surgeon's opinion on that and about how soon they think that should be done, and ask what will happen if you don't have surgery or wait too long. I had to make that choice too, and I didn't want to become disabled because of my spinal cord compression. I was also loosing the ability to use my arms and coordinate my movement. I lost about half my muscle in my arms and shoulders to atrophy. I tried to find surgical help for 2 years and was turned down by 5 surgeons, so I came to Mayo and had a wonderful gifted surgeon who gave me back my ability to do my artwork. I wish I had come there first and not wasted time with doctors who didn't want to help me. Epidural injections can also take a couple days to work, so time will tell. When I woke up from surgery, all of my pre-existing pain was gone, and I only had pain from the incision and surgical path. I also had a great physical therapist who did myofascial release before and after surgery. You need to trust your surgeon completely, so ask lots of questions and get as many opinions as you need. I'm glad that the others didn't want to help me because I had a better choice of fusion without hardware and probably would not have had that choice if one of the others had operated. I understand the anxiety, and I had a lot of that, but I learned to understand and control my fear and was able to be calm on my surgery day. I expected spine surgery to really hurt a lot, and it did not. Other patients who waited too long and have permanent damage talk about having pain that is not resolved by surgery. Doctors can't promise the surgery will take away pain, and they tell you it will keep it from getting worse. My surgery resolved all my pain and my range of motion is normal. Do your homework and research so you'll be able to make an informed decision. Here is my story on Sharing Mayo Clinic. https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

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Replies to "@mlerin With stenosis, when it is bad enough and causing nerve compression, epidurals may not have..."

Thanks for the nicely detailed message. My main issue is foraminal narrowing which is most significant at C5-C6 on the left and at c7-T1, right. Interestingly enough, both areas have narrowing but my pain and all symptoms are on the right only, seem to be stemming from c7-t1. I’m 4 days out of an epidural injection and it’s not working making me think it didn’t take. I heard a lot about prolotherapy and PRP and prolo seems to be the next step I’ll pursue before considering surgery. I’m so glad you had such a positive outcome with surgery. I live in northern CA but am willing to go to Mayo Clinic to consult with good physicians. Do you mind sharing the name of your spine surgeon? Thanks again for the wealth of info. We should all live a life free of chronic pain.