Excruciating pain from cervical (C7/T1) radiculopathy

@pamelaombres @lebanon100 Thank you for asking. My Mayo Rochester neurosurgeon is Dr. Jeremy Fogelson. I had great results and he is a kind compassionate doctor. He also has orthopedic spine fellowship training in addition to being trained in neurosurgery at Mayo, and he stayed to teach and practice at Mayo. He is a deformity expert, and also does both fusion and artificial disc replacements.

Here are some links and stories about him, including mine.

If you wish to seek care at any of the Mayo Clinic campuses, you may get started with this link. http://mayocl.in/1mtmR63
If you have spine imaging already, you can arrange to send it in for evaluation when you contact Mayo. They will give you instructions on how to send it in after first setting up an account.
Do you have any other questions about my spine surgery? Can you share more about your spine condition?

@pamelaombres @lebanon100 I just found this video of Dr. Fogelson talking about treatments for scoliosis and spine surgery. For me, it helps to see a video of a surgeon talking so I can get some familiarity with them prior to meeting them even if the video subject isn't exactly what I need. At the time I met Dr. Fogelson the first time as a spine patient, there were not any videos of him, and all I had was his photo on the website. I thought you may be interested in seeing this.
https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/videos/adult-scoliosis-diagnosis-and-treatment-options/vid-20527937

Thank you do much!

@lebanon100 You are welcome!

I am not sure what your research was. Can you share? My daughter has had incredible success with PRP, a form of prolotherapy. The doctor works for a rehab organization that is part of Mass. General Hospital-a top hospital in the world- and has reams of years long research. The doc very carefully screens patients, using imaging and requiring PT first, so that those who have PRP are those who can most benefit. PRP works with soft tissue problems, not anything related to bones. It most definitely works for those it is intended for, and is not quackery.

Jennifer, Thank you for asking. This is my spine condition from a recent CT scan. I'm an 82 going on 83 female.

L1-2 - subcentimeter right intraforaminal disc extrusion. This may be compressed the right intraforaminal L5 nerve. Mild facet osteoarthrosis in the right. No central canal stenosis.

L2-L3 - Severe disc height loss. Small disc bulge. Mild left foraminal narrowing. No central canal stenosis. Mild facet osteothrosis.

L3-4 - Moderate disc height loss. Moderate facet osteoarthrosis. Small posterior disc osteophyte complex. Mild central canal stenosis. No foarminal narrowing.

L4-L5 - Severe disc height loss. Severe facet osteoarthrosis. Severe foraminal narrowing compressing the right intraforaminal L4 nerve. Mild central canal stenosis.

L5-S1 - Moderate disc height loss. Moderate facet osteparthrosis. Severe left foraminal narrowing compressing the intraforaminal left L5 nerve. Mild central canal stenosis.

IMPRESSION: Multilevel degenerative changes. Multiple levels of facet osteothrosis. Disc herniation loss of disc height. No compression vertebral deformaties or listhesis. Central canal stenosis, foraminal narrowing and nerve compression.

@lebanon100 Thanks for sharing your report. How is your bone quality? My 92 year old mom has had a spine compression fracture and has severe osteoporosis, and that disqualified her from having a procedure to cement the pieces back together after the fracture. I would guess that you may be in some pain because of nerves that are compressed between the vertebrae, and some of that compression comes from the loss of disc height. With my cervical spine, I had lost about 50% of the disc height in C5/C6, and if I side bent my neck, it caused severe pain down my arms when it pressed on the nerves because the bones were closer together making the space smaller and I bent that and caused it to touch the nerve. I didn't have narrowing of the space other than loss of disc height. When I had the spinal fusion, it restored that proper disc height by putting a bone spacer in the space left from removing the disc.

What can happen when discs collapse completely is that the spine begins to fuse itself when the vertebrae bones start to touch each other. The good news in your report is that the vertebrae are staying in line and not slipping past each other (listhesis) and there are no fractures. The foraminal narrowing talks about the spaces between vertebrae (foramen) where the nerves exit the spinal cord. Central canal stenosis means that there is narrowing in the central canal around the spinal cord. That was exactly what happened in my neck, and I had spinal cord compression until my surgery with Dr. Fogelson that took away the bad disc and the bone spurs that were pressing on it. The facets are the joints that let the vertebrae slide when you twist the spine.

Are you having loss of mobility and function that prompted your CT exam? Is your pain being managed? Are you under any treatment for thinning of the bones? (I ask that because it is so important, and I see what my mom has gone through because of osteoporosis.)

Jennifer, Thank you for your welcome, detailed explanation about my back issue and for your questions.

I do have osteoporosis but I don't know the severity of my condition. I"m on Prolia injections, take vitamin D and am increasing milk intake to three glasses a day.

For pain, I'm on six tablets of acetaminophen 500mg. My doctor has recommended back injections. I've had one bad episode of harsh pain two months ago; my pain now seems to be moderate and is located in my thorax and in my lower back. Sometimes I have some pretty good days until I have a flare-up. I haven't recently experienced the harsh nerve pain of two months ago but have a lesser degree of pain and discomfort. I also have pins and needles in my buttocks, legs and feet. A physio-therapist is working with me to help resolve these. Presently, he is focussing on my neck. Frankly, I haven't been faithful with the exercises he's given me because I fear a return of my one episode of nerve pain.. But I do think that there is improvement. I also stretch my back by holding on to an overhead bar and hanging from it with my feet on the ground and sensing the natural curves of my back. I also walk slowly 10 - 20 minutes daily on my treadmill. I do housework and cooking, carefully, but lifting even moderate weights is a challenge. I make accommodations when working around the house, bending, lifting, climbing stairs. I ice and warm my back throughout the day.

What prompted the CT scan was pain in my lower back; it was recommended by my physio-therapist, gratefully. That's when I learned about my back problems.

I am more than thankful for your explanation and questions and regret that my doctor hadn't been more forthcoming with information. It was very difficult to get a copy of my CT scan. My doctor, as well as others, are so busy these days with back logs of patients, especially during COVID, that office visits are few and brief. I do have an appointment in two weeks.

If you have further comments, they are welcome.

Thank you!
Diana

Jennifer, I forgot to mention that I wish and hope for all the best for your mother.

@lebanon100 Thank you, Diana for your concern about my mom.

It sounds like you are doing all the right things for yourself in therapy. If you decide to do back injections, you may want to research that thoroughly because there are some serious risks to them. I have heard of the injections causing arachnoiditis which is an inflammation around the nerves of the lower spine that can form scar tissue and adhere the nerves together. Here is some information.
https://my.clevelandclinic.org/health/diseases/12062-arachnoiditis?msclkid=a8735698a95b11ec90fc254b45a9ca2a

I have had one cervical steroid injection and it caused me a problem and created a new electric burning stabbing pain in my hand that went on for a few months and nothing would stop it. It was the worst pain I had ever experienced and I was shaking uncontrollably and had to work to avoid passing out right after they did it. That was before I had spine surgery, and I said never again. if someone makes a mistake with one of these injections it can cause paralysis or worse. We do have some discussions about the injections, and it is worth noting that the FDA has not approved steroids for injection in the spine, although many doctors do them. It is up to you what risks you want to take. I wanted you to know if you are going to discuss this with your doctor.

These are patient opinions in this discussion, but I have included links to the FDA's statement about steroid injections in the spine.

Do you have a list of questions ready for your doctor appointment? I would also ask about how your osteoporosis would influence any future decisions about possible spine treatment. Bone quality would be a factor if any hardware would need to be screwed into the bones. ( in case that is offered in the future ) Good luck at your appointment!

Jennifer