Recommendation for a neurologist to evaluate me for spinal stenosis.

@dgcosentino831
Doug, that's wonderful news! I'm glad you are on the schedule for an evaluation. Thank you for providing the surgeon's name, and so of course I looked him up! Have you see the video interview of him? It's very informative. He communicates well, and he seems to be well respected.

I was impressed by how well he answered questions and explained the issues, and he seemed very genuine in wanting to help patients, and also conservative in that he wouldn't rush a patient to surgery with early spine disease, so he seems very trustworthy. He described the process of what happens over time with spine conditions. He also explained some contraindications to surgical procedures. What I would challenge him on is the statement that central canal stenosis doesn't cause pain. While that may be true; it also may not be. He mentions muscles spasms causing pain. He may be speaking from the viewpoint of a person who likely has not experienced a spine issue himself. Spine patients do experience things differently and of course you have both central canal stenosis and radiculopathy. I have a friend who just had a C5/C6 fusion and she had significant pain radiating to the back of her neck, and doctors were dismissing that. I supported her in that the pain can be spine generated and that turned out to be true. A bad disc caused pain for me that I could feel in my neck, and I also had the funicular pain all over my body from cervical canal stenosis. We both experienced a resolution of that pain because of spinal fusion surgery. I think pain can be generated by movement of vertebrae from spondylolythesis. I woke up from my fusion surgery and all that pre-existing pain was gone. I only had the incision pain from the surgical path.

Here is the literature that changed the course of my spine care that told me that my symptoms had been misunderstood by all of the surgeons up to that point. This is what I sent to Mayo with my request to be seen.

Case Reports
Eur Spine J

"Cervical cord compression presenting with sciatica-like leg pain "
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111492/

That being said, the surgery is the same, and can solve those types of pain as it did for me and the other patient even if the surgeon doesn't believe that. They can't promise to cure pain, and he is right that the goal is to prevent the progression of further functional issues. What I liked was when he talked about where to place the anterior incision, he touched the left side of his neck. Is this where he does his incisions? My surgeon told me that he trained himself to place the incision on the left, and with the incision on the left front side, there are lesser complications than a right sided incision. It may be easier for the surgeon to put it on the right side for their dominant hand, etc.

This surgeon spoke about both fusion and artificial discs, and the imaging he showed looked like a Mobi C disc. He spoke about adjacent segment disease being lesser because of artificial discs instead of fusion because motion is spared. There is literature that adjacent segment disease happens both with ADR and fusion, although a lesser degree with ADR. It also happens when a patient has had no surgery, so that can be a question of what came first, the disc being already in the process of degenerating or the degeneration happening faster because of extra strain on it from a fusion? There is also literature that the longer the plate length on the front of the spine is related to higher risks of adjacent segment disease. I asked that question and my surgeon said, that fusions shrink a bit during healing, and with a multilevel fusion this is multiplied, if the plate is too long, as it settles, the plate can rub on the adjacent disc. My surgeon used donor bone disc spacers that had a milled out place to put the removed bone spurs inside to seed bone growth. He said it heals best with natural bone. Some surgeons use PEEK cages instead of bone spacers and also seed them with removed bone spurs.

I am so glad that you find my suggestions valuable. That is a very high compliment coming from someone with your training, and I'm glad you're participating here in spite of some disappointments. My insights come from thinking creatively outside the box, understanding human anatomy in 3 dimensions, and learning from medical literature and patient experiences here on Connect, and my own experiences as well. When I got my first CD of my spine MRI and looked at it before I met with the first spine surgeon, I could find the ruptured disc in sagital and cross sections, and I knew I was in trouble because I knew it would mean spine surgery some time in my future, and I had a lot of work to do to get over my fear of it. I actually talked to some of my doctors about that, and it helped me to know that they were scared too when going through a major surgery like a coronary bypass. I found out that we were not so different after all, and have similar experiences when we are the patient. It helped me a lot to see my surgeon as a compassionate human being instead of a technician with advanced degrees and reconstruction skills. I felt better knowing my surgeon was taking time to be relaxed and thorough with fewer surgeries in a single day than the guy who would do 10 procedures a day in his doctor group-owned surgery center. I didn't want to feel like I was on an assembly line. I needed to feel like I was on my surgeon's team, and really... they couldn't do the job without me! The surgeon also needed to see me as a person, and not just another job to do. That disqualified the ones who wouldn't take time to explain the imaging or answer questions.... and he had to be smart and well respected.

I have an extensive list of questions I compiled that could be asked at a spine consult. No specialist has time to answer every one, but it is a starting point to a conversation. I can share them if you wish. What questions would you prepare to ask your spine specialist at your upcoming appointment?

Jennifer, yes, I was impressed by the video. I'm looking forward to meeting Dr Celestre. I will give you followup after my visit.
Doug

@dgcosentino831 Doug, I'm checking in with you to see how your appointment went with your spine specialist. Do you have a treatment plan? I hope everything is going well for you.

Jennifer

Hi Jennifer, I met with Dr Paul Celestre at Ochsner Clinic in New Orleans. He reviewed my X-rays, MRI, and examined me. My two worst levels were C5-C6, and C6-C7. His opinion was that I do not require surgery at this time. He added that there were surgeons who would perform a fusion based on the imaging, but again he advised no surgery at this time, with physical therapy, and follow up MRI in about a year. I questioned the need for PT, and he responded that it could help with balance. I have not yet scheduled PT. I’m not in any pain. I still have some positional hand numbness. I guess I’ll give PT a try and reevaluate in a year, or sooner in my symptoms worsen. Thank you for your interest, Doug.

@dgcosentino831
Doug, thanks for your update. You may want to keep records of your symptoms on body diagrams and date them so you'll know if something changes over time and how fast it is changing. I did that on a dermatome map, and I could correlate exacerbation of my symptoms with the changes on new MR imaging. Diagrams can help if you need to take next steps toward surgery or also if you improve because of good core strength, you can chart your progress there too.

Are you going to get any other spine surgical opinions or where you happy with Dr. Celestre and have confidence in his ability to help you if your condition worsens? If you are progressing toward a need for surgery, other opinions can be helpful..... or not... I had 5 opinions from surgeons who had not figured out the problems, and one excellent opinion, so you know which one I chose, but the confusion of the other specialists also told me how good my surgeon was.

Jennifer

Hi Jennifer, I like the idea of a dated dermatome map to follow the progression of my symptoms. I felt comfortable with Dr Celestre. My plan is to stay active, with the hope of avoiding surgery … you have been a great source of ideas as well as a sounding board for me. I am certain the many people who follow spine disease on this site feel the same. All the best, Doug