Cervical stenosis: Wait or treat?

@ray666 Good morning Ray! My surgeon measured the X ray in the program that they use. They drag a line form the cursor and it gives them a number. My C5/C6 level was slipping by 2mm on flexion. I also had slight slipping at other cervical levels. 2 mm does make a difference if the spinal cord is compressed. If the slippage is 4 mm, that is too much for doing artificial disk replacement. I was not a great candidate for that at 2mm and fusion was a better choice. You're welcome.

Hi, Jennifer. With each of your letters, I learn more. Your telling me about your C5/C6 slippage seems related to my surgeon's saying my vertebrae appear stable and therefore advising we not consider surgery at this time. I suspect he didn't see any slippage. I intend to ask. I know he's a busy fellow, but his nurse/assistant has always been very quick with answers to my questions. ––Ray

I am learning a lot from your correspondence. I hope that is OK with you two. (Cervical mystery so far.)

May I jump in here with Jennifer and Ray as I have the same Cervical Stenosis with C4-7, with the possibility of Myelopathy in play. Do either of you experience extreme burning in your hands and arms upon lying down to sleep? When I am upright, I am fine... my neurologist believes it is from Carpel Tunnel! I do not, and I have never heard the term “slippage” used in any of my diagnosis. Thanks for your info!
Nance

Hi, Nance. I may be proving to be a bit of a head-scratcher to my doctors. I have no troubling symptoms in my extremities. My only complaint is my weird wobbly gait. Although I've not fallen, I'm always afraid I'm about to. I have to be extra-cautious going about. As you must have read in one of my earlier posts, I've been diagnosed with C5-C7 stenosis, but with only minimal (my doctor calls it "borderline") intrusion on my spinal column and no direct compression of the cord itself. He's advised I stick with PT, at least for six months, then get a fresh MRI and go back to talk to him. Your situation also sounds like a bit of a head-scratcher: extreme burning in your hands and arms upon lying down, but none of that when you're upright. To my untrained mind, that does sound like a puzzler. Let's see what Jennifer has to say. I've come to have high respect for Jennifer's knowledge of this whole stenosis business. And, Nance, I'm so glad you've found us! I look forward to our conversations. ––Ray

@amberrose @ray666 Hello Nance and Ray. The term is actually spondylolisthesis, but I was trying to use common language that would make sense. Think of it like this. You have a string with large beads on it. The string is the spinal cord and each bead is a vertebra. If you pull on a bead to offset it, it pulls on the string of you pull it hard enough. If a spinal disc is allowing movement of the vertebrae in any forward, back or sideways direction, that is called listhesis. My reports stated I had retrolisthesis which is (backward movement) of C5 over C6. It meant that when I bent my neck, my C5 vertebra was sliding backward past C6 by 2 millimeters, so my vertebrae were not stacked perfectly in line with each other. Your spine changes position when you lay down, and if you have spondylolisthesis, it can cause spinal nerves to get compressed if the vertebrae are moving out of alignment. The spinal nerve exit the spine between the vertebrae. If that is something that you can change and reproduce the results with a change in position, make sure you explain that to your doctor. Sometimes spine surgeons take a standing full body X-ray of the spine for this reason, to show if the vertebrae are slipping past each other which can be common with spinal deformity cases. The standing vs laying down images can show very different alignment.

Thank you, Ray and Jennifer....your explanations are spot on! My diagnosis is different from either of yours as I have Degenerative Disc Disease with osteophytes or bone spurs pressing on my spinal cord at three levels, possibly displacing the cord at this time. I receive my MRI interpretation on Monday.

Ray, I also have the gait disturbance ...from all I have researched, just keep walking!

Jennifer, wish you could give your fine explanation of disc pressure on the nerves to my neurologist !

Diagnosis remains the most difficult area of medicine!! Thank you both for your information! Nance

Jennifer, this explanation, as your many others, really sheds a lot of light on my situation. I, too, have the balance problem when walking. I get my MRIs, (cervical and thoracic) done Monday the 20th. Hearing your conversations, I think I know what the results are going to be. Thank you all so much for your info.

@marilynnovak Thank you Marilyn. Balance can be affected by many things other than spine issues, and spine issues can certainly play a part. I just had ankle surgery which affected my balance since my foot wasn't giving my brain normal sensations and feedback. I had fixation hardware removed from my ankle that had been placed there when I broke my ankle last year. I also just had an MRI on my cervical spine because I have had some strange symptoms of feeling like bugs crawling all over my skin and pains in my feet when I changed the position of my neck and looked down at the floor. My results showed that I have a bone spur that grew out from the site of my C5/C6 cervical fusion and it is pressing into the thecal sac (sheath around the spinal cord) and there is plenty of space around my spinal cord. With movement and changing positions of the spinal cord inside the canal, it may be touching that bone spur temporarily from time to time. I also have some arthritic bone growth in the foramen (the space between vertebrae where the nerve exits). I have been feeling that with some sharp pains in my arm. My physical therapist has been able to help a lot by loosening things up, so it doesn't put as much pressure on the spine. Because these vertebrae are fused, there is no movement in the foramen. 5 years ago when I had my spine surgery, there was no bone growth within the foramen. I did have arthritis in the facet joints which is the surface (other than the discs) where the vertebrae contact each other. This joint allows you to turn your head and lets the vertebrae slide in a twisting motion. My disc had collapsed about 50% in height which put pressure on the facet joints that caused wear and tear. I imagine in my future, a surgeon may need to reopen the space in the foramen. This nerve is also affected by thoracic outlet syndrome as it passes into my shoulder and under the collar bone through some tight spaces there. You can learn a lot about how the spine is put together with a chicken or turkey neck. If you boil it so the bones can be easily separated, you can then stack and reassemble the vertebrae and see how the facet joints fit together. They won't fit perfectly without the cartilage discs intact, but you can understand how it works and see the space inside the spinal canal.

Will these MRIs be your first for your spine or are you tracking changes over time? I always find them interesting and I like to understand how things work in 3 dimensions.

I have had several MRIs because of having had one knee replacement. Other MRIs were done as my doctors hunted for a reason for my "central buttock-to-central buttock" pain. However, I have never had a cervical MRI, and I am having one at 9 AM tomorrow; I am very excited to find out about my pain, and I hope I am a candidate for surgery, because when I get up in the AM the pain is really bad until I take a dose of Percocet generic.
Re: boiling the chicken neck--my husband & I love our recipes for chicken soup and other soups, so--to get the neck, I will have to ask the butchers because nowadays in our Smith's grocery store they do not enclose the neck and giblets anymore.
Thanks for your additional info. Now that I am older, I am witnessing my body deteriorating, and now that I understand more, thanks to you, I feel that I will continue to have my vertebral column continue to degrade. My uncles died quickly of heart attacks, but no, I will have to see this through!
Thanks, again, for your info.
You, too, Ray. I have the same imbalance that you do.
Marilyn