Cervical Spinal Stenosis

Posted by kellynormand @kellynormand, Sat, Feb 9 12:33pm

I have been having pain in my right shoulder/arm for over a year. I also have been having upper back pain and pain under my left breast/rib area (that pain has been going on for over 5 years). I had a cervical MRI in October 2018 and it shows stenosis, bulging disks, and bone spurs. Here is part of the MRI report that my doctor gave me:

1. C3-4: Posterior marginal osteophytes most pronounced on the RIGHT with mile stenosis RIGHT lateral recess zone. Uncovertebral joint osteophytes on the RIGHT with mile stenosis of the RIGHT foramen.
2. C4-5: Slight posterior annular protrusion and marginal spurs on the LEFT. No significant stenosis.
3. C5-6: Mild posterior annular protrusion and endplate spurring most pronounced in the lateral recess zones LEFT slightly more so than RIGHT mildly narrows the lateral recess zones bilaterally. Central AP diameter of the canal 8.2 mm.
4. c6-7: Disc mildly narrowed with Modic type II signal in the endplates. Mild disc protrusion. Central AP diameter of the canal 8.1 mm.

I was sent to physical therapy and have been going twice a week since October. The shoulder pain is somewhat better and I now have much better range of motion in my shoulder (still can’t really put my hand behind my back). The upper back pain is actually worse and is now radiating into my upper chest/pec area, sometimes on the left and sometimes on the right. That area is even very tender to the touch when I’m having pain. The below left breast/rib pain seems slightly worse as well. It also comes and goes and very often is extremely uncomfortable at night and sometimes have to sleep half sitting up (I’ve been using a bean bag as a pillow to prop myself up.

My doctor didn’t seem very concerned about the MRI results and said I should get good relief from PT. Here’s my issue – I’m going on 4 months of PT and not seeing as much relief as I’d hoped and today I was doing some “Googling” about stenosis and read that normal AP diameter should be approximately 17 mm and anything below 10 mm is called “absolute stenosis” – mine is 8.1 mm and 8.2 mm. That seems like more than “nothing”.

Should I see someone else about this issue? I don’t want to jump right to seeing a surgeon, but I’m not sure who I should see – or should I just go back to my PCP and ask her these questions?

@kellynormand I also had shoulder pain for a couple of years where I couldn’t lift my arm higher than my chin. My MRI showed bone spur as well. I did PT for 3 months. It temporarily felt good but still couldn’t move my arm. So I saw an orthopedic surgeon. He read my MRI results and xrays and could see that bone spurs were ripping my tendons in my shoulder. I had a minimally invasive outpatient surgery done. I was in at 9:00 and going home by 2:00. Turned out to have multiple bone spurs that he removed. I’m almost out 3 months now from that surgery and have regained total range of motion with no pain. I’ve also been able to return to my regular low impact exercises that I have always done.
I had tried all the PT, creams, rubs and pain pills previously to no avail. I was getting care at a pain clinic and they recommended seeing an orthopedic surgeon because they felt with my lack of motion that there was something going on that needed attention. My PCP had no idea of what to do other than the PT.
I’m 66 years old and am so glad I did this. I really recommend seeing an orthopedic surgeon. I really didn’t want to have surgery either. There are so many minimally invasive procedures now. I had three small 1” incisions with only a few stitches.
Hope this helps, best of luck to you.

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Thanks so much for the reply @bonnieh218 I am 59 and have always been very active. Up until this happened I was doing P90X and running on aver 20 – 25 miles per week. I'm so frustrated at not being able to do hardly any of that any more. I'm afraid to run much because of what I've read about cervical stenosis. I guess I really should ask for a referral to an orthopedic surgeon. Thanks again for sharing your experience with me.

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@kellynormand I am a Mayo cervical spine surgery patient, and I also have thoracic outlet syndrome. My surgeon is a neurosugeon and also with orthopedic spine fellowship training and is one of Mayos' best.

The pain in your upper chest and pec muscle is a common symptom of TOS and I have had that. TOS is more common in spine patients and a lot of doctors miss it. Usually physical therapy doesn't help TOS, unless the PT knows how to do myofascial release work to stretch the tight fascia that is compressing nerves and vessels as they pass through tight spaces and spasms make this worse. It sounds like you have stenosis at your nerve roots with bone spurs there. I had spinal cord compression with bone spurs and a ruptured C5/C6 disc and had the TOS complications at the same time. I had decompression surgery at Mayo and I am still in physical therapy for TOS which is improving. The surgery made it worse for awhile because of a surgical scar path through the fascia near the problem of entrapment from TOS. It's like wearing a straight jacket.

If you can come to Mayo, they are good at diagnosing TOS. Your symptoms could be more from TOS than the spine at this time. A neurologist can help figure that out. If you can come to Mayo for that, I would recommend it. Let me know if you have more questions. I would investigate TOS as a possibility, if yes, get a good PT and do myofascial work to see of you improve, and work with a spine surgeon who understands both of these issues (like mine if you are able to come to Rochester). He wouldn't jump in just to do surgery, and you would get an honest evaluation. If you look at your imaging, look for the fluid space around your spinal cord. With stenosis in the central canal, if you see no space (white space) around the cord, it will get compressed. That was my situation. If you do still have space where your cord can move with your body position, it is not as bad. If you do need spine surgery, and if you have done a lot of MFR work, it will give you an easier surgery because tissue will be more mobile. Here's my story https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

TOS causes tingling in the pinky from the ulnar nerve. It is a compression in the chest between the collar bone and ribs, or from tight scalene muscles in the neck, and there is a compression point under pectoralis minor in the chest. My PT does myofascial release work to stretch the front of my chest and neck, and exercise to strengthen the back and muscles around the shoulder blades. TOS is a positional problem. When you read or type, your head is likely forward and shoulders moved forward which puts pressure on the compression points. Sleeping does this too because of raised arm positions. One test for this is the doctor raises your arm in a bent arm position and checks for your pulse to stop, and also when turning your head. A lot of doctors miss this and don't understand TOS because it's glossed over in med school (per my neurologist). Specialists in TOS are usually at university teaching med centers that treat it (check on website for conditions treated). If you have more questions, I'd be happy to answer.

Here is some information for you about TOS and MFR.
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
https://trainingandrehabilitation.com/how-truly-treat-thoracic-outlet-syndrome/
Directory search for MFR therapists on myofascialrelease.com
https://www.mfrtherapists.com/app/interim.asp
Problems that MFR helps
https://myofascialrelease.com/about/problems-mfr-helps.aspx
Use Fascia as a Lever John Barnes
https://myofascialrelease.com/downloads/articles/FasciaAsALever.pdf
Lumbo Sacral Decompression video with John Barnes

Therapeutic Insight: The John F. Barnes' Myofascial Release Perspective—Rufus, the Cat
https://www.massagemag.com/therapeutic-insight-the-john-f-barnes-myofascial-release-perspectiverufus-the-cat-12559/
There's the Rub
https://myofascialrelease.com/downloads/articles/TheresTheRub.pdf
Therapeutic Insight: The Myofascial Release Perspective—Myofascial/Osseous Release
https://www.massagemag.com/therapeutic-insight-the-myofascial-release-perspective-myofascialosseous-release-7597/
Therapeutic Insight Articles
https://myofascialrelease.com/resources/therapeutic-insight.aspx

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I would definitely see another Dr. I stayed with a Dr I liked for years only to find out later he did me no good at all. Sorry to hear your going through this.

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