Cervical stenosis: Leg weakness

Belated Happy New Year!

I am so glad you are getting into Mayo for an appointment. You are in good hands.

Please update us on your progress. I will be happy to answer any questions you may have about the procedures and PT.

Posterior is only approach surgeon can do. He had x-rays, ct's, mri's done specifically to view approach. I had 2 surgeries in front, spinal fusion in 2006, and thyroid removal and lymph nodes due to cancer in 2009. Surgeon said there is just too much scar tissue to safely do frontal approach.

@sallygirl Sarah, I'm not surprised by the posterior approach. When I had my anterior spine surgery, my surgeon said the first time, the approach is from the front, and if you need to do more, you go in from the back. I work on my scar tissue with myofascial release with my physical therapist which helps a lot. MFR can break up surgical scar tissue. Mine tends to re-tighten a bit, and I keep stretching it out and do a lot of that on my own. Of course you'll not be able to do this while healing after surgery for awhile.

Here is our discussion on Myofascial Release

Thanks for your update.
Jennifer

For MFR, do you see a massage therapist or a physical therapist?

@bernese53 Both physical therapists and massage therapists can be providers for myofascial release. The important piece is that they got their training in the John Barnes methods. There are certifications and advanced levels of certifications in these methods. My physical therapist is an "expert level" highest certification.

Here is provider search:
http://mfrtherapists.com/

There is more information at https://myofascialrelease.com/

Jennifer

So, I had my telehealth with Dr. Fox from Mayo/ Jax. It went about how I expected with the exception that he prefers going in from the back using rods instead of from the front (ACDF) and using plates. Also, I would end up being fused from C3 through T1 which doesn’t sound so great but if that is what it takes, I guess. Now for the hard decisions… That is an additional level from what other docs have said but Dr. Fox thinks that this will position best to not have to have more surgeries so I am all for that even if the initial surgery and recovery may not be as easy.
PT kicked me out after 7 or 8 sessions because I wasn’t showing any improvement, however, I stuck with the home exercises and the day before my appt. I woke up virtually pain free for the first time in about 6 months! So far, I am still a lot more pain free then I was before PT but now the question is, will it last? I still have cervicogenic headaches, stiffness and numbness in the back of the arm and fingers of my left hand but for now it is way more manageable. I know I will need to ask my surgeon this question but wanted to get others input as well based on their experience/things they have been told by their docs.
At what point should the numbness and tingling start to worry me? Or is it mainly whether I can manage the associated pain or not? I don’t want to get surgery again unless other things aren’t helping but I also don’t want to risk permanent damage.
In my pea brain, I think that it is the vertebrae above and below slipping out of place (noted in the xray/mri summary) that is causing the most issues rather than the bulging discs and osteophyte complexes. And, if that is correct then I’ll just have to wait and see how often that happens and how long it lasts when it does happen.
Thanks for any input or “food for thought” anyone can provide and I hope you all have a great day without pain! (Or at least manageable… )

@rdflash0788 Rick, thank you for your update from Dr. Fox. I don't think it is possible to predict exactly when symptoms like numbness and tingling should be a concern and a lot of that comes down to how you feel about it. This can be generated from spinal problems, and these symptoms can also be caused by other conditions that pinch the same nerves as they travel into your arm. I have had that situation in having carpal tunnel syndrome and thoracic outlet syndrome in addition to a herniated cervical disc. I've had numbness and tingling as well as diffuse pain in my left arm for several years associated with these problems. My herniated C5/C6 was replaced with a fusion, and I had carpal tunnel surgery on my wrist. I have done a lot of physical therapy and myofascial release to work on the TOS which helps a lot, but I can also aggravate it and it kicks up again, so I stretch a lot on my own to try to prevent it from getting worse. If nerves are damaged or dying from compression, it may cause wasting and loss of muscle mass in muscles connected to those nerves. I had some of that on the back of my arm and shoulder, and a lot of muscle came back after my spine surgery during rehab.

TOS can be common in spine patients because it can be caused by injuries or repetitive stress. Unfortunately, finding a doctor who understands TOS is difficult and many patients with TOS are misdiagnosed or it is missed like mine was for several years. My spine issues were caused by a whiplash years earlier, and the thoracic outlet containing the brachial plexus of nerves and vessels exists right next to the spine and connected to it, and it can be injured as well. It may be worth asking your spine doctor about TOS and being evaluated for it. If you have this, cervical surgery will likely aggravate it for a bit after spine surgery because of the proximity of swelling and inflammation. When surgical scar tissue tightens up, it can also tighten other areas such as scar tissue from TOS and this is where myofascial release helps to loosen that. I had to wait for about 4 months after my fusion before I could resume therapy for TOS. I was evaluated at Mayo Rochester for TOS in the vascular lab prior to spine surgery.

It might also be worth asking if the posterior surgical approach would be better if you do have TOS. TOS does involve the scalene muscles at the side of the neck just above the collar bone and more in the front, although with neck spinal muscles also connecting to the shoulder blade, if can create tension there too, and for me TOS does cause my cervical vertebrae to rotate a bit because I have more tension on one side of my neck. If you have a multilevel fusion, that won't be possible for you to have that rotation, and when that happens for me, I do get some occipital headaches on the back of my head.

C1 & C2 do most of the head turning, with some help from C3 & C4. If you are fused from C3 to T1, you would loose a bit of head turning range. That would also be a good question to ask if your surgeon hasn't mentioned it so you have a better understanding of what to expect. Slipping vertebrae and osteophyte complexes could be contacting and compressing the spinal cord, and your surgeon should have showed this to you on your imaging and explained how that can cause your symptoms. With the recommendation for multiple level fusion, I'm guessing you gave some of this gong on. If you do have concerns, you may want to send a message on the patient portal to your surgeon.

Jennifer

Well, I just wanted to stop back in and provide an update on my situation. I had the following done just over 2 weeks ago:

• C3 – T1 fused posteriorly with 2 rods and screws, old fusion from prior ACDF was left in place.
• C6 – C7 Lamina Facetectomy and laminotomy

I ended up staying in the hospital, Mayo – Jacksonville, from Thursday around dinnertime when I got to the room until discharge on Monday around lunch. It ended up being an extra day or so just because they wanted to make sure the drains came out OK and that my pain was well controlled with just oral meds and not IV meds since I live about 6 hours away from Jacksonville.
While the surgery was more invasive due to the posterior approach and will likely mean a longer, more painful recovery than the anterior approach, I am glad they opted for that since it allowed them to tackle the issues at C3/C4. During the surgery Dr. Fox found that the facet was severely overgrown with bone spurs which was pain there. Had this been a strictly anterior approach then this would not have been addressed and not been found to be more severe than the MRI’s were showing. Both local docs wanted to stick with the anterior approach so, even though the posterior approach was worse for pain and recovery, I am glad the approach chosen was one that could possibly prevent me from needing yet another surgery down the line. Out of about 7 major symptoms that could be related to my issues, 5 are much, much better, 1 unresolved but probably back related and the last 1 we most likely won’t know until everything is healed and PT completed.
Nearly off the pain meds now as I started the taper a few days ago and muscle relaxers will be next to go as I am able. Frustratingly, most docs up to this point prior to Mayo, wrote off the lower extremity symptoms saying they didn’t think they were related. However, cervical issues are all that was addressed and all but one of my lower body symptoms appears to be fixed after nearly 10 years.
Do as much research as you can to stay informed and don’t be shy about advocating for yourself! Sometimes, you just have to keep digging and asking questions in order to get to the resolution. My hope for everyone here is relief from the symptoms you are having and also the strength to push through.

@rdflash0788 Rick, I'm so glad to hear your surgery went well with Dr. Fox. I know how frustrating it is to have surgeons not understand why leg pain symptoms may be caused by cervical spine pathology because I went through that too. That is a big reason why I share my experience here and for you to share yours as well because patients need to know of this possibility and to keep looking for an informed surgeon and advocating for themselves.

You'll have some months of recovery and rehab ahead of you, and already, you have had a big improvement. Congratulations! That was my experience too in that all the leg and body pain I had prior to my cervical spine surgery was gone when I woke up. After that, it was just healing pain of the surgical path, and later on releasing some tight scar tissue. Incisions usually take about 6 weeks to heal, and the next month the scar tissue may begin to tighten and cause some pain. Your physical therapist can help you with that.

For now, just relax and heal. I slept a lot, and the body needs that when healing from a significant surgery. This is a big change for you too with your entire neck fused except for C1 & C2. It would be good to discuss with your physical therapist when you get to the rehab stage, what are the best ways to avoid adding extra stress to those upper levels.

I didn't find a surgeon who understood this cervical spine related "funicular" pain in the body and legs until I came to Mayo. My having this pain that they didn't understand made them refuse to help even though all of them could read the MRI and see the cervical spinal cord compression.

I am glad you are on the healing side of this journey. Take care.

Jennifer

Thanks! I too am glad this went the way it did after fighting with it for what seemed like forever. One final note, if given the option for a "pain pump", go for it! That worked out way better for me than other surgeries where they just did IV pain meds every 4 hours. Usually, after about 2.5 to 3 hours those would start to wear off and I'd be in pain for a bit waiting until the due time. With the pain pump, I was allowed to hit the button once every hour and it gave me a tiny dose of meds in my IV, then wait an hour and do it again. Mine even had a light on it that would light up when I had meds available. Granted they only used that for a day or 2 after and then switched me to just oral pain meds but still, it helped a bunch!