Severe spinal stenosis: Would you do surgery?

Hi @baltopat86 and @fde11, you notice that I moved your messages to this existing discussion in the Spine Health group https://connect.mayoclinic.org/group/spine-health/

I did this so you can meet other members talking about spinal stenosis like @collierga @jenniferhunter @wilcy @suerc @lilypaws and others. I encourage you to browse the discussion in the Spine Health group. You're not alone.

Baltopat, you ask an interesting question about spinal stenosis and losing the ability to maintain visual focus. Do you find that you also have difficulty with concentration or other cognitive abilities? Are you suspecting this is due to pain?

@baltopat86 I'm sorry you are suffering. I can share what I know from my experiences as a spine surgery patient and my background in biology, and what I have found in medical literature. You may want to consult a physician about your visual problems and perhaps they can be improved if they can figure out the cause.

Your optic nerves are at the base of your brain and they cross underneath there, so they connect into the visual cortex in the brain on the opposite side. Spinal stenosis would not touch that as those are different areas. I am not a doctor, so I can't diagnose things, but we can talk about possible issues. The only thing I can think of regarding vision that may be spine related is if there are circulation issues related to proper alignment of how the skull sits at the top of the spine. Migraines can be caused by physical problems of this misalignment and muscles spasms that add pressure and migraines can have visual disturbances. Spinal misalignment also causes vertigo which I have experienced from my spine issues when my vertebrae were independently twisted or tilted by spasms.

There are lots of other reasons for visual problems and that might be worth asking your doctor about. Vision can be affected by medications, diseases that affect the eye or the circulation to the eye, clouding of the lens with cataracts, or physical issues with the retina or vitamin deficiencies. Diabetes can affect the eye, internal pressure, and even cancers like melanoma. My husband has an issue on his retina where there are some folds and thinning of the retina that affects his vision that is happening right in the sweet spot where the lens focuses on the retina. Vision happens because of rods and cones in the eye that act like the sensors in our digital cameras and convert light into nerve impulses that are sent to the brain for interpretation. I have found some medical literature that the body has some ability to regenerate damaged parts of the retina.

(Spontaneous Regeneration of Human Photoreceptor Outer Segments https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515765/)

Here is a quote and link regarding migraines from MSK Neurology
https://mskneurology.com/treating-migraine-headaches-addressing-atlas-thoracic-outlet/
"There are five main causes of occlusion for the main cerebrovascular in- and outlets, as far as I am concerned:
Occlusion of the vertebral vein and artery due to vertebral “hinging”
Internal jugular vein occlusion due to forward movement (A-O torsion) of C1 transverse process
Vertebral artery occlusion due to rotation of the C1 and/or C2
Vertebral artery occlusion secondary to subclavian artery occlusion, between the anterior scalene and SCM
External jugular vein occlusion due to tightness of the sternocleidomastoid "

"A mimic of migraines: Suboccipital dysfunction
The suboccpitals attach between the skull and down to unto C1 as well as C2, and will help to syncronize the upper cervical with the skull’s movement, and prevent misalignment of the atlas joints due to its pulling angles. In other words, absolutely essential functions. They are also, when significantly weak, a common cause of vertigo as well as migraine-mimicking headaches such as cluster headaches in the eye."

For explanation of the terms -
The vertebral artery sends oxygenated blood to the brain. The vertebral "Hinging" is bad posture of slouching and sticking your neck forward. The C1 is the top vertebrae that supports the skull which has spines that extend sideways, the transverse processes, and the spine that extends backward. These are for muscle attachments to turn the head and neck. The vertebral artery runs right next the the cervical vertebrae, and turning the spine will stretch the artery. Compressing the subclavian artery between the scalene muscle in the neck and the "SCM" (Sterno Clavicular Mastoid) happens with thoracic outlet syndrome (or TOS) which I have. It is overly tight neck and chest muscles that affects circulation and compresses nerves that supply the arm, but also affects circulation to the brain. Some people with TOS can pass out when they turn their head because of occlusion of the blood supply to the brain. The SCM muscle is what turns your head and connects from near the ear to the sternum at the center between the 2 collar bones. The jugular vein drains blood from the brain. Suboccipitals are muscles attached to the scull and extend to the first and second vertebrae.

This quote about thoracic outlet syndrome describes some of the visual disturbances related to circulation. It comes from this article about TOS. https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/ (Syncope is passing out or fainting)

"Subclavian steal symptoms presents secondary to arterial insufficiency, created by a retrograde flow that “steals” blood from the brain circulation, more specifically from the basilar artery via the vertebral artery. Classically it presents with neurological symptoms from the posterior brain and cerebellum [4,6]. Decreased flow over the basilar artery gives rise to symptoms like lightheadedness, ataxia, vertigo, dizziness, confusion, headache, nystagmus, hearing loss, presyncope and syncope, visual disturbances, focal seizures, and in extremely rare cases, death [6–10]. However the vast majority of patients are asymptomatic and rarely require any intervention [3,5,11]. – Alcocer et al., 2013"

Hello fde11 and @baltopat86, I just thought of something. Did you tell your neurologist office to put you on a wait list to get you in sooner should someone cancel and a spot open for you? It doesn't hurt to let them know how severe or intolerable your pain is. I worked in healthcare for 20+ years and know the system and how it works. I just hate that you're in so much pain. I get it! I'm facing my 4th back surgery. First three were outside the spinal canal but this one will be inside to free up more room for the spinal cord and nerves. You know about that. My Neurosurgeon keeps telling me that I'm so high risk which I know I am. I'm going to try to put this off as long as I can but am already losing some function. Next to go is my legs and I'm already having loss there. It's never straight forward, always a now-win and risk in some way/s. That's where prayer comes in for me! I ask the Lord to give me direction and to make it clear b/c I'm pretty dense! LOL! I wish you all the best, I really do. Take care and warmest regards, Sunnyflower

@sunnyflower how can you not be scared to death? What happens if you don’t have this surgery?

Well the 2 neurosurgeons I saw, could see a little bit of fluid around my spinal nerves so it's not urgent but there's a lot of uncertainty. I'm so high risk that no one wants to touch me. I did my homework and the doc I want is the director of neurosciences and cheif of neurosurgery. I figured he didn't get there by having malpractice suits afainst him. It is very scary but I know either way I'm in God's hands and He knows what He is doing. That calms me. If I don't have it, I could lose function of my legs. Thank you for your concern and questions. These can take years to close (stenos) to that point. I think it's just a matter of when. I'm dealing with so much other stuff now too. I see vascular surgeon for my right brachial artery stenosis (50%+ and rare) 10/12. I am concerned about that and how it got that way. I think the diagnostics and fix are both invasive and that means pain! Take good care, Sunnyflower @fde11.fde11 @baltopat86

Agree. I had a great spine doc do my first 2 discectomies/laminectomies only 6 days apart. Guess I shouldn't have gotten up and cleaned the bathroom mirror! I was pain free and drugged so wasn't thinking. So glad mostvof your Sxs resolved bernese53

@sunnyflower are you serious, Sunny?

@sunnyflower I am so sorry to hear all of this. I am hear if you ever need to type

Yes. It was unreal!! The MRI showed that there was bleeding at the sight of my first surgery on the inside so they knew I was in trouble and also some of the the remaining disc from the first surgery, which is gelatinous, had slipped out and was squashing my nerve. Two surgeries 6 days apart but they sure worked!

So you weren’t following directions?! 😮 I always warned by back surgery patients that the ones I usually saw (too soon) again were one’s who didn’t take it easy. Of course I am sure many didn’t remember me at all, which is why written instructions are sent home!