Cervical stenosis: Leg weakness

How did the PT clear it up?

This is very familiar--similar to what I have. How has it turned out?

Thanks for the info on that! I have come up with some questions for my doc based on some info I have seen regarding whether I need to look into an EMG for the numbness in the extremities, whether the cervical issues could be causing my intermittent swallowing issues (I had always chalked that up to my ongoing GI issues but... ) and also I've started to notice some breathing issues that feel a lot like "tired" lungs, like after a big day of hiking or swimming, so I need to ask about that too. I thought maybe that was related to seasonal allergies as FL has something blooming all year round but now I am not so sure...

@cudabinacontenda I can tell you from experience that the spinal cord does not want to be touched at all. When you have an existing disc and bone spur complex in the central canal, it can be raking across the spinal cord when you move your neck. When you add muscle spasms that happen with spine problems, it can be moving the vertebrae around and affecting alignment or rotating them and that can increase pressure on a place that is getting touched by essentially making the spinal canal a bit "smaller". That was happening to me, and I had vertigo because of it. Spasms can stretch the vertebral arteries that run inside the sides of the cervical vertebrae and then a movement like looking upward kinks a stretched artery. This is part of the blood supply to the brain. What are the movements you describe that are causing light headedness?

I have to say it makes me crazy to hear of another surgeon telling a patient that leg symptoms are not related to cervical central canal stenosis. I heard this from 5 surgeons, and they were all wrong. It was the 6th surgeon at Mayo who knew that these symptoms of cervical stenosis were related to leg pain, gait disturbances, nausea, vertigo, bladder or bowel disturbances or pain anywhere in the body below the level of compression.

The spinal cord is supposed to be free to move with the spinal canal and floats in spinal fluid. If you bend your neck, the cord needs to move inside to allow that to happen. Imagine a garden hose with a rope inside. Now bend the hose. Did the rope move a little bit? It has to move. If the rope is held tight, it will bind up against the inside of the hose. The bone spurs and bulging or ruptured discs can hold onto the spinal cord and that can be an intermittent problem at first depending on neck and body positions. As that progresses and bone spurs grow bigger and multiply, then the cord can be compressed and unable to move in what they call a tethered cord. Myelopathy (spinal cord damage) may show up as a white mottled area within the spinal cord at the point of compression on an MRI. My surgeon told me that myelopathy can be present when this compression is beginning and not yet show up on the MRI.

This would be something that would be good to discuss with your physical therapist because they understand how the body needs to move and what is normal and what is not. Your PT also has to write notes and reports and send that to the doctor who ordered it, so that should help if the doctor actually reads the notes. Sometimes they do not. You may want to look at my response to @rdflash0788 and look at the medical study link that I shared. You may want to ask if your surgeon thinks your case may be like that one in the literature. This is the literature I found after 5 surgeons refused to help me, and I sent it in to surgeon #6 and wrote a letter saying that this literature seemed to describe my experience. I asked if my case was like this one. I suggest always ASK that as a question so you won't be perceived as pointing out a mistake or telling a doctor how to do his job. A doctor can refuse to help and then you'd be looking for another surgeon for an opinion. That's not a bad idea either because multiple opinions can help you, and you can pose the question about the literature which describes "funicular pain" from the start. That is what I had to do after I'd been dismissed because the surgeon missed this, then I found the answer, and none of my doctors would help me approach the surgeon with this information and point out his mistake. I knew he wouldn't listen to me and that is when I turned to surgeon #6 at Mayo for help. That is the reason I help here on Connect to share this knowledge.

Sometimes bone spur growth can progress rapidly. I saw mine double in the area they covered within 9 months on MRIs. I was also charting my symptoms on body diagrams and dating those, so I knew how fast the symptoms were progressing. That helped me know that I needed help and a time frame, but it also scared surgeon #5 out of helping me because he could not explain the pain symptoms. I had this "funicular pain" which was described at the time as a "rare presentation" of pain related to spinal cord compression.

Jennifer, this is very helpful. Thank you so much for sharing your experience. Luckily, I do not have pain, but I do indeed suspect that my lower body symptoms are also due to my cervical issues. I’m willing to give PT a chance as it’s helped me with so many other issues. But if I improve, I’m still going to get an annual MRI of my neck, even if I have to pay OOP for it. If surgery becomes necessary, I want to know that as soon as possible.

@cudabinacontenda I think that is a good idea. You do have to advocate for yourself and you know what you are living with. It may not hurt to get another surgeon’s opinion. That may be different. It’s best to have surgery before nerve damage occurs because it may be permanent. When myelopathy shows up as white areas within the spinal cord, it represents missing nerve axons that have died. Hopefully a surgeon isn’t waiting for damage to show up.

@jenniferhunter I agree completely and did get a second opinion. Truth is that I don’t want surgery at this time. I’m willing to take the risk of waiting and trying conservative treatment first. Maybe I will regret that. But I’ve had 5 ortho surgeries to date including one botched knee surgery that created hell in my life for quite sometime and will never be right. So I’m very hesitant to go under the knife again unless absolutely necessary.

@cudabinacontenda I agree. Surgery is a big step and will have a long recovery. PT can help a lot. I went 2 years with my symptoms before surgery. I would have had surgery sooner if possible, but I was turned down by 5 surgeons who were confused about my case. It all turned out OK. The physical therapist was doing myofascial release which helped me move better and also doing neurostimulation at the nerve roots to stop the pain signals. I was being very careful and even used bead filled neck wraps to try to protect my neck and limit movement to prevent pain. It is different for everyone. With your prior surgical experience you should know when the time is right. Your plan of annual imaging is good to assess changes in your condition. Were your past recoveries from spine surgery difficult?

@jenniferhunter you clearly had a long process. I’m so glad it turned out well for you. I haven’t had any spine surgeries., but three shoulder surgeries and two knee surgeries. The shoulder issues most definitely complicated my neck issues, if not caused them.

Well, here is what today's cervical MRI showed. Although, I am still working my way through what this all means but it seems like I have vertebrae sliding in both directions?

" Straightening of the cervical spine. C4-C6 ACDF which appears
intact and well-seated. Grade 1 anterolisthesis of C2 and C3 and C3 and C4.
Grade 1 retrolisthesis of C6 on C7 disc space narrowing at the C6-7
transitional level with endplate sclerosis and ventral osteophytosis.
Diffuse facet arthropathy uncovertebral hypertrophy.
Flexion/extension views demonstrate no evidence of instability"