Cervical stenosis

Posted by billandri @billandri, Feb 3, 2019

I am a healthy and active 32 year old male. Last month I was diagnosed with cervical stenosis (C5-C6) after having morning finger numbness for 2 months. All 3 doctors I asked suggest surgery, either disk replacement or merging of spines. Has anyone dealt succesfully with such conditions via non surgical means? Thank you.

Thank you. My husband is coming with me but needs to leave about two days after surgery. I have some idea about what to expect; your post was very helpful.

Liked by Jennifer Hunter

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@bernese53

Thank you. My husband is coming with me but needs to leave about two days after surgery. I have some idea about what to expect; your post was very helpful.

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@bernese53 I had to report at 6 AM at the check in desk at St. Mary's, so staying in walking distance and not having to worry about catching a bus to the hospital was easier. The rooms have DVD players so you can bring something to watch or borrow something from the hotel. You'll be nervous enough wihout having to worry about catching a shuttle bus. You might want to ask what your check in time is likely to be so you can plan. I think you'll be fine leaving 2 days after surgery. I could have done that. This recovery takes a while, so you'll need to just rest. The first 6 weeks are the hardest, and after that pain is less, but your body will put all it's energy into healing so you'll be tired. I did feel a lot better at 3 months, and I've had to rehab muscle that I lost from atrophy and I'm still working at that 2 years later, but this surgery gave me my life back. Good luck and please check back in and share how you are doing or if you have other questions.

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@jenniferhunter

@badbonz
Thanks for asking. I referred myself to Mayo Clinic and specifically to Dr. Fogelson because I read his research papers and looked at his medical training ( Neurosurgeon trained at Mayo & also Orthopedic spine fellowship ) and having both specialties for spine surgery was a bonus. I found that he was teaching neurosurgery at Mayo and co-directing surgical lab courses at the Spine Research Society Annual meeting for other surgeons in cervical surgeries, both fusion and artificial disc, and was a spinal deformity expert, and someone who takes the complex cases. He had also been recognized by his undergraduate university with a full scholarship and graduated with honors.

See https://www.bsualumni.org/young-alumni-award-dr.-jeremy-fogelson

After my surgery, he was listed in the Becker Spine Review as a spine surgeon leader to know
https://www.beckersspine.com/spine-leaders/item/37080-spine-surgeon-leader-to-know-dr-jeremy-l-fogelson-of-mayo-clinic.html
It was by reading one of Dr. Fogelson's papers, I came across a term I had to look up, and in doing that, I found medical literature with cases similar to mine, and I had found what 5 other surgeons had missed completely.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111492/
I knew I had found a surgeon in Dr. Fogelson who would understand the complexity of my case, and it was because of the paper her co-authored, that I knew there was an answer. I had been trying to get help for 2 years, and none of the 5 surgeons I consulted would help me. I also have thoracic outlet syndrome that complicated it a bit because of overlapping symptoms, and I needed to be seen somewhere where both would be understood.

I had "funicular" pain or referred pain that confused 5 local surgeons and none recognized that this pain was being caused by cervical stenosis. I literally had pain all over my body caused by spinal cord compression in my neck, and there is no definitive test to prove that this happens, except that surgery to decompress the spinal cord fixes it. The indication that predicts this is having an epidural spinal injection that takes away all the pain; but it isn't definitive proof. I had that experience where the spinal injection temporarily took away all the pain, by the doctor ignored the results and looked no further. I had documented it completely on body diagrams, and there was no doubt in my mind, but that was what flagged me as a complicated case. When I got worse, the last surgeon dismissed me after I had done everything he asked of me over 5 months.

I called Mayo and asked about Dr. Fogelson and they told me that patients really like him. I asked to send my imaging in to him, and I wrote him a letter explaining my symptoms and I sent the medical study I found and told him I found it because of his paper. I was offered an appointment, and I was impressed when I met him. He was intelligent, kind and compassionate, and down to earth. He answered all my detailed questions well. I knew a lot about spine procedures since I'd been reading literature for 2 years and watching online videos of surgeons presenting lectures for other neurosurgeons at conferences and that is also how I knew that the surgeons before I came to Mayo were not getting it right. They were looking for easy cases with no complications, and they didn't want to risk their reputation on something they didn't understand.

At my first meeting with Dr. Fogelson, he wanted to see the painting that I brought, and he liked it and said he wouldn't mind having something like that in his house. I told him that could be arranged and we all laughed. So that is how it began, and I was relieved. I had found a surgeon who respected me as a patient. I was relieved that he was going to help me regain my ability to do my art work.

I was highly impressed with my care and recovery, and when I got the survey about my experience from the then Mayo CEO, Dr. John Noseworthy, just filling out a multiple choice questions was not enough, so I wrote him with a personal letter praising Dr. Fogelson and his nurse. She was also very kind and helpful and always called me back to answer my questions. I got a personal letter back from Dr. Noseworthy thanking me, and he said that Dr. Fogelson was one of their best neurosurgeons and that he valued working with him. I was so excited to get that letter, and I gave Dr. Fogelson a copy at my next appointment… as you can imagine that is how you really make a surgeon happy, and he was so humble and thankful to receive it.

As a patient who was anxious, having a kind doctor made a difference for me in facing my fears. Dr. Fogelson is a gifted surgeon, and I don't have any of that pain any more, and I believe that this type of healing atmosphere benefits both the doctor and the patient. I couldn't find that anywhere else. He also gave me a choice that the others usually do not in having a single level fusion without hardware because I agreed to stay in a neck brace for 3 months which lets me avoid any possible future hardware problems. I had seen that possibility in one of his papers too, and I asked him and he agreed. That really is putting the needs of the patient first.

When I delivered his portrait to him, I asked him why he wanted to be a neurosurgeon, and how told me he chose that because it was difficult and he wanted the challenge. I don't remember his exact words, but he likes solving difficult problems… unlike the others who didn't want my case. If I should need anything spine related in my future, I will go back to Dr. Fogelson at Mayo, and he told me he will be my doctor until such time as he retires. (That will be quite a while.)

Some other stories about Dr. Fogelson-
https://sharing.mayoclinic.org/2012/12/23/repaying-a-gift-scholarship-recipient-says-thanks-in-a-special-way/?utm_campaign=search
https://sharing.mayoclinic.org/2017/07/26/spinal-surgery-saves-teen-swimmers-mobility/?utm_campaign=search
http://www.startribune.com/in-second-term-minnesota-gov-markdayton-dealing-with-more-health-problems/361662931/
http://www.startribune.com/gov-mark-dayton-to-undergo-third-back-surgery/497015811/
https://www.mayoclinic.org/medical-professionals/trauma/news/geriatric-winter-falls-when-a-simple-bump-on-the-ice-can-be-serious/mac-20451017@
Mayo Clinic Minute
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-scoliosis-screening/

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Thank you Jennifer for your reply. You had almost exactly what I have been going through for a number of years. Did you call his specific number or did you request an apppintment through the Spine Center and ask for him? When they asked for specific records did you send them through the Spine Center or directly to him?

Thank you so very much

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@badbonz

Thank you Jennifer for your reply. You had almost exactly what I have been going through for a number of years. Did you call his specific number or did you request an apppintment through the Spine Center and ask for him? When they asked for specific records did you send them through the Spine Center or directly to him?

Thank you so very much

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@badbonz What you need to do is contact Mayo and they will set up a temporary patient number for you that you will use to send in your imaging studies and a letter about your symptoms since they have to track and organize it in their system. You can request (like I did) that imaging studies be sent to Dr. Fogelson. They will also ask you questions about your diagnosis and symptoms when they set up the number. The most efficient way to do that is call his appointments phone number that I'll send to you in a private message and you'll talk to a nurse. (and please tell them how highly I recommended him). It doesn't cost anything to have them review your imaging and it can be returned to you. Then you'll be contacted by phone if they offer an appointment. I think that because all the other surgeons had misunderstood my case and how advanced the stenosis was, it helped me get treatment at Mayo. They do prioritize based on need and urgency. I was called a month after sending my imaging because of a cancellation, but they told me the wait was usually 3 months to get in at that time. You can find the insurance information on the website. Once you get accepted, they give you a permanent patient number and schedule appointments to evaluate all the issues you have that could relate to the problem. For me that was a neurologist evaluation (and he ordered tests- nerve conduction, blood work, MRI). I also had an evaluation for thoracic outlet syndrome and physical testing for that. All of that happened the day before and the morning of the evaluation with Dr. Fogelson, and the doctor who evaluated the TOS called Dr. Folgelson with his results while I was in the room at my appointment. That is how efficient they are and thorough. So when I met Dr. Fogelson and he reviewed my imaging with me that I had sent in, he offered surgery and we talked about my choices. I did have to wait for the results of one blood test that took a couple weeks, and results were good, so I asked to be scheduled for surgery. A few weeks later when they were setting up his surgery schedule, they scheduled me, and it was about 5 weeks after that first appointment. if you do see him, I hope you'll share your experience. My patient story is listed with his profile on the website. Thanks for asking.

REPLY
@jenniferhunter

@badbonz What you need to do is contact Mayo and they will set up a temporary patient number for you that you will use to send in your imaging studies and a letter about your symptoms since they have to track and organize it in their system. You can request (like I did) that imaging studies be sent to Dr. Fogelson. They will also ask you questions about your diagnosis and symptoms when they set up the number. The most efficient way to do that is call his appointments phone number that I'll send to you in a private message and you'll talk to a nurse. (and please tell them how highly I recommended him). It doesn't cost anything to have them review your imaging and it can be returned to you. Then you'll be contacted by phone if they offer an appointment. I think that because all the other surgeons had misunderstood my case and how advanced the stenosis was, it helped me get treatment at Mayo. They do prioritize based on need and urgency. I was called a month after sending my imaging because of a cancellation, but they told me the wait was usually 3 months to get in at that time. You can find the insurance information on the website. Once you get accepted, they give you a permanent patient number and schedule appointments to evaluate all the issues you have that could relate to the problem. For me that was a neurologist evaluation (and he ordered tests- nerve conduction, blood work, MRI). I also had an evaluation for thoracic outlet syndrome and physical testing for that. All of that happened the day before and the morning of the evaluation with Dr. Fogelson, and the doctor who evaluated the TOS called Dr. Folgelson with his results while I was in the room at my appointment. That is how efficient they are and thorough. So when I met Dr. Fogelson and he reviewed my imaging with me that I had sent in, he offered surgery and we talked about my choices. I did have to wait for the results of one blood test that took a couple weeks, and results were good, so I asked to be scheduled for surgery. A few weeks later when they were setting up his surgery schedule, they scheduled me, and it was about 5 weeks after that first appointment. if you do see him, I hope you'll share your experience. My patient story is listed with his profile on the website. Thanks for asking.

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Thank you so very much!

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@sandytoes14

@billandri Welcome to Mayo Clinic Connect. I have had disc degeneration and cervical stenosis for over 20 years. I have had 4 doctors review my MRI's and history and tell me I am not a surgical canidate (I would not see a benefit in operating) To help deal with the pain, a combination of epidural injections and pain relievers gives me the most benefit. Billandri, can you share with us what you have tried to help with your condition?

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Hello Jen: I just recently joined Mayo Clinic Connect. Tomorrow I'm having my first appointment at the Rehab Centre for atrophy in my left leg, numbness on the bottoms of my feet, and diabetic neuropathy. Even though I have kept my blood sugar low (5.2 – 5.8) in the past year or so, I'm just starting to experience neuropathy now. In the past couple of weeks, I have developed a rash on my shins and around the ankle area, which is as itchy as the devil and brings on a burning, stabbing pain. It's disturbing my sleep. Well, even with all these complaints, I at least felt as though I knew what was causing it — i.e., my Type 2 Diabetes. Then I joined Mayo Clinic Connect! Now I see posts and links to articles that seem to indicate statin drugs can cause neuropathy. Another post led me to what I had thought in the first place, which is that my cervical and spinal stenosis could be causing my problems. I've been taking statins on and off for years, my cervical MRI indicates "severe stenosis" and my lumbar problems have caused marked stenosis in that region. So here I am back to being puzzled as to what's causing this neuropathy. What questions do you think I should ask my rehab therapist tomorrow when I see her at my appointment?

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@miflowers

Bill I can tell you the surgery is not that big of a deal. I’m 35 and had a fusion done a year and a half ago on c4c5. It started as you said In fingers. Eventually both of my arms were numb. I was unable to wake them. I researched my surgeon and picked the best one in my opinion. Can honestly say I had a 100% improvement. I felt and was ready to go back to normal activities in two days. Honestly wish I’d had done it sooner. I understand not wanting to go the surgical route. But I definitely suggest you research all your options. And if you do surgery talk to a lot of people in your area n find a good surgeon.

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Did they go in anterior or posterior

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I am a active 64 yr old with similar symptoms although my numbness has been going on for one year but does not limit my activity.
One doctor recommended 2 surgeries the other one did not..The thought of having the anterior approach scares me as heard it is very painful to swallow and talk after surgery. Does anyone have any experience with that?
Good luck with your decision. Your are young so as long as you have a good surgeon and hospital surgery should be uneventful. Do your research. i am in the medical profession and have learned a lot from this discussion group

REPLY
@jenniferhunter

@badbonz What you need to do is contact Mayo and they will set up a temporary patient number for you that you will use to send in your imaging studies and a letter about your symptoms since they have to track and organize it in their system. You can request (like I did) that imaging studies be sent to Dr. Fogelson. They will also ask you questions about your diagnosis and symptoms when they set up the number. The most efficient way to do that is call his appointments phone number that I'll send to you in a private message and you'll talk to a nurse. (and please tell them how highly I recommended him). It doesn't cost anything to have them review your imaging and it can be returned to you. Then you'll be contacted by phone if they offer an appointment. I think that because all the other surgeons had misunderstood my case and how advanced the stenosis was, it helped me get treatment at Mayo. They do prioritize based on need and urgency. I was called a month after sending my imaging because of a cancellation, but they told me the wait was usually 3 months to get in at that time. You can find the insurance information on the website. Once you get accepted, they give you a permanent patient number and schedule appointments to evaluate all the issues you have that could relate to the problem. For me that was a neurologist evaluation (and he ordered tests- nerve conduction, blood work, MRI). I also had an evaluation for thoracic outlet syndrome and physical testing for that. All of that happened the day before and the morning of the evaluation with Dr. Fogelson, and the doctor who evaluated the TOS called Dr. Folgelson with his results while I was in the room at my appointment. That is how efficient they are and thorough. So when I met Dr. Fogelson and he reviewed my imaging with me that I had sent in, he offered surgery and we talked about my choices. I did have to wait for the results of one blood test that took a couple weeks, and results were good, so I asked to be scheduled for surgery. A few weeks later when they were setting up his surgery schedule, they scheduled me, and it was about 5 weeks after that first appointment. if you do see him, I hope you'll share your experience. My patient story is listed with his profile on the website. Thanks for asking.

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Hi Jennifer
Could you also PM number of Dr. Fogelson's office i would like to send my imaging studies to him to review. i am very with Mayos as we have had my daughter there twice and my dad also went there years ago. Such a great place.
Thanks so much

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@collierga

I am a active 64 yr old with similar symptoms although my numbness has been going on for one year but does not limit my activity.
One doctor recommended 2 surgeries the other one did not..The thought of having the anterior approach scares me as heard it is very painful to swallow and talk after surgery. Does anyone have any experience with that?
Good luck with your decision. Your are young so as long as you have a good surgeon and hospital surgery should be uneventful. Do your research. i am in the medical profession and have learned a lot from this discussion group

Jump to this post

I've had 2 cervical surgeries through the anterior. I don't remember them being any more painful, than you would expect from a surgery. Yes it's a little hard to swallow for a few weeks, because they move your larinex during the surgery. But I had no pain with the swallowing itself.

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@collierga

Hi Jennifer
Could you also PM number of Dr. Fogelson's office i would like to send my imaging studies to him to review. i am very with Mayos as we have had my daughter there twice and my dad also went there years ago. Such a great place.
Thanks so much

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Hi @collierga You'll need to have Mayo set up a patient account for you first and give you the number. Then you will be able to send medical records and imaging studies in and ask them to be sent to Dr. Fogelson for review. The records office will input the information in the computer system so he will be able to view it when he logs in and they hold on to the imaging CDs. I got mine back long after my surgery, but you can ask how they handle returning discs if you need it back. You might ask for extra copies if case something is lost in the mail. You can contact Mayo online for this, and someone from triage calls you back. I will send you the triage phone number for neurosurgery privately, and they can set up the account for you and they will ask questions about your medical history.

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@miflowers

Bill I can tell you the surgery is not that big of a deal. I’m 35 and had a fusion done a year and a half ago on c4c5. It started as you said In fingers. Eventually both of my arms were numb. I was unable to wake them. I researched my surgeon and picked the best one in my opinion. Can honestly say I had a 100% improvement. I felt and was ready to go back to normal activities in two days. Honestly wish I’d had done it sooner. I understand not wanting to go the surgical route. But I definitely suggest you research all your options. And if you do surgery talk to a lot of people in your area n find a good surgeon.

Jump to this post

Did they do posterior or anterior approach with your surgery/
How much pain was involved and any difficulty in swallowing

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@jenniferhunter

Hi @collierga You'll need to have Mayo set up a patient account for you first and give you the number. Then you will be able to send medical records and imaging studies in and ask them to be sent to Dr. Fogelson for review. The records office will input the information in the computer system so he will be able to view it when he logs in and they hold on to the imaging CDs. I got mine back long after my surgery, but you can ask how they handle returning discs if you need it back. You might ask for extra copies if case something is lost in the mail. You can contact Mayo online for this, and someone from triage calls you back. I will send you the triage phone number for neurosurgery privately, and they can set up the account for you and they will ask questions about your medical history.

Jump to this post

Thank you

Liked by Jennifer Hunter

REPLY
@ww2valentine

Hello Jen: I just recently joined Mayo Clinic Connect. Tomorrow I'm having my first appointment at the Rehab Centre for atrophy in my left leg, numbness on the bottoms of my feet, and diabetic neuropathy. Even though I have kept my blood sugar low (5.2 – 5.8) in the past year or so, I'm just starting to experience neuropathy now. In the past couple of weeks, I have developed a rash on my shins and around the ankle area, which is as itchy as the devil and brings on a burning, stabbing pain. It's disturbing my sleep. Well, even with all these complaints, I at least felt as though I knew what was causing it — i.e., my Type 2 Diabetes. Then I joined Mayo Clinic Connect! Now I see posts and links to articles that seem to indicate statin drugs can cause neuropathy. Another post led me to what I had thought in the first place, which is that my cervical and spinal stenosis could be causing my problems. I've been taking statins on and off for years, my cervical MRI indicates "severe stenosis" and my lumbar problems have caused marked stenosis in that region. So here I am back to being puzzled as to what's causing this neuropathy. What questions do you think I should ask my rehab therapist tomorrow when I see her at my appointment?

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@ww2valentine I'm not sure if your question was directed to me. You can ask your rehab therapist about the pattern of muscle atrophy and weakness that you have, and if that matches what your imgaging and reports say about your stenosis and any nerve compression that you have. There can be multiple reasons for symptoms that overlap, so there may not just be one answer. Spine surgeons have to assess that as a "differential diagnosis" because they need to know if their surgery could help. If they do surgery, it may not fix a problem if there are multiple causes, and the surgery is to decompress something like a nerve or the spinal cord. From my own experience with muscle atrophy in my arms and shoulders, it was only after decompression surgery that my muscles began to recover and rebuild in physical therapy, and that takes a long time as the nerves heal. I don't have diabetes, and I don't know how much that will affect nerve function. It is possible that rehab is a test to see if you will improve before any spine surgery is considered. Often medical notes that state surgery is recommended also state that physical rehab had failed to improve the patient. I had central canal cervical stenosis with spinal cord compression, and physical therapy helped by realigning my spine and took a little bit of pressure off. The muscle spasms were pulling the normal neck curve out of alignment and twisting or turning the vertebrae and effectively making the spinal canal smaller. It was a temporary fix until the next spasms occurred. They also used electrical stimulation to calm the production of neurotransmitters which actually carry the pain impulses between nerve cells across the synapse (gap) between them.

Your rash should be evaluated, and it may not be related to diabetes. I know that shingles produces a rash that follows nerve pathways and is very painful. My mom had it, and she had dark red bumps in a line. Nerve pains can be burning, stabbing and like an electric shock. I have not had shingles myself. It's easy to assume something is related to something else, and make a mistake and go without treatment. A medical professional can intercept a problem before it gets serious, but only if they have a chance to evaluate it. I have made this mistake myself thinking I was having my normal allergy sinus problems, and in reality there was an infection in the root of a tooth causing the pain, and damaging jaw bone. I didn't recognize the problem until it had gone pretty far and then an oral surgeon cleaned out the infection and replaced the lost bone.

You might be interested in our Myofascial Release discussion. You can have compression of nerves and tissues from fascial tightness, and MFR therapy can help that if it is a physical problem. This helps neuropathy for some patients and there is mention of it in the neuropathy discussions here. Here is the link. https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

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@collierga

I am a active 64 yr old with similar symptoms although my numbness has been going on for one year but does not limit my activity.
One doctor recommended 2 surgeries the other one did not..The thought of having the anterior approach scares me as heard it is very painful to swallow and talk after surgery. Does anyone have any experience with that?
Good luck with your decision. Your are young so as long as you have a good surgeon and hospital surgery should be uneventful. Do your research. i am in the medical profession and have learned a lot from this discussion group

Jump to this post

I had a 2-level anterior cervical spine fusion in April, 2019 at the Mayo Clinic at the age of 65. Dr. Ahmad Nassr did the surgery; several people working at the Clinic told me he has an excellent reputation. I had no problems with swallowing or speaking after the surgery. My only problem has been times when I am extremely fatigued but the fatigue is lessening.

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