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CERVICAL STENOSIS SURGERY - IMPERATIVE OR ELECTIVE?

Posted by dwlandi @dwlandi, 2 days ago

I had an injury to the the C5-C6 & C6-C7 levels in 2014 exacerbated by herniated discs due to 25 years of using a laptop computer.
Starting in January of 2025, I started having pain in my right shoulder radiating down my right bicep and arm. An MRI was ordered by the Pain Management Specialist. Based on the findings in the radiology report below, is surgery imperative or can it be elective?

Findings: The cervical vertebral bodies are normal in height and alignment with normal marrow signal. There is partial straightening of the cervical spine. No prevertebral soft tissue swelling is noted. There is no evidence of a cervical cord mass, syrinx or Chiari malformation. There is desiccation of the cervical disks.

At C2-C3, there is mild posterior bulging of the disc. No spinal or neuroforaminal stenosis is noted.

At C3-C4, there is disc osteophyte complex with broad-based posterior bulging of the disc. There is flattening of the ventral surfaces of the thecal sac and the cervical cord. Mild central spinal stenosis is noted. There is moderate to severe bilateral neuroforaminal narrowing secondary to bony hypertrophy.

At C4-C5, there is central posterior bulging of the disc with focal effacement of the ventral surfaces of the thecal sac and the cervical cord. No overt spinal stenosis is noted. There is moderate narrowing of the left neuroforamen secondary to bony hypertrophy.

At C5-C6, there is posterior disc osteophyte complex with effacement of the ventral surfaces of the thecal sac and the cervical cord with significant narrowing of the central canal. Moderate to severe neuroforaminal stenosis is noted secondary to combination of the disc and facet hypertrophy. Disc height is diminished.

At C6-C7, there is posterior disc osteophyte complex with asymmetric narrowing of the central canal. Moderate to severe bilateral neuroforaminal stenosis is noted. Disc height is markedly diminished.

At C7-T1 there is posterior bulging of the disc. No spinal stenosis is noted. Severe neuroforaminal narrowing is noted. There is loss of disc height.

Impression: Degenerative disc disease involving the cervical spine. Multilevel disc bulging with spinal and neuroforaminal stenoses at C3-C4, C5-C6 and C6-C7. Neuroforaminal narrowing at the other levels as described above. Partial straightening of the cervical spine which may be secondary to muscle spasm.

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dlydailyhope | @dlydailyhope | 1 day ago

@dwlandi
I am in my mid 50s and if I had your MRI results, I would get surgery.

Your MRI shows that you have multiple levels of disc issues and bony growths that are compressing/flattening and injuring your spinal cord. If surgery is not done to decompress your spinal cord/nerve roots, there could be worsening symptoms and permanent damage. This is called degenerative cervical myelopathy (DCM) also called cervical spondylotic myelopathy (CSM). Definitely look this up to understand your condition. I really wish doctors did a better job communicating imaging/test results with their patients using terms people understand. You may also have radiculopathy if you have symptoms affecting arms/hands/fingers. Do you have headaches, neck shoulder/shoulder blade pain/tension/knots, weakness in arms/hands which impacts writing and notice you are dropping things, bladder/bowel control issues, and heaviness in legs when walking with balance issues?

I know this from experience. I was misdiagnosed for over 5 years and now have permanent spinal cord injury due to DCM. I was born with a congenitally narrow spinal canal and worked on a computer/desk job for over 30 years. I have straightening of my cervical spine, degenerative disc disease, spinal stenosis, myelopathy, osteoarthritis, etc. My spinal cord was flattened at C5-C6 and finally had a 3rd orthopedic spine specialist finally diagnose me properly (felt validated and heard for the first time in a long time) and recommended surgery right away to stop the worsening of my symptoms and permanent damage. I had ACDF surgery on C5-C6 in 2022 (helped with bladder control and walking) and now need to get C6-C7 done in May 2025 (symptoms worsened in 2024). I may have permanent damage at C5-C6 which affects arm/hand strength and I’ll need to see if surgery on C6-C7 regains better control of my bladder and walking/balance.

Have you seen a neurologist for EMG/nerve conduction studies of your upper and lower limbs and reviewed the results with your orthopedic spine specialist?

REPLY
1 reply
dwlandi | @dwlandi | 1 day ago
In reply to @dlydailyhope "@dwlandi I am in my mid 50s and if I had your MRI results, I would..." + (show)
@dlydailyhope

@dwlandi
I am in my mid 50s and if I had your MRI results, I would get surgery.

Your MRI shows that you have multiple levels of disc issues and bony growths that are compressing/flattening and injuring your spinal cord. If surgery is not done to decompress your spinal cord/nerve roots, there could be worsening symptoms and permanent damage. This is called degenerative cervical myelopathy (DCM) also called cervical spondylotic myelopathy (CSM). Definitely look this up to understand your condition. I really wish doctors did a better job communicating imaging/test results with their patients using terms people understand. You may also have radiculopathy if you have symptoms affecting arms/hands/fingers. Do you have headaches, neck shoulder/shoulder blade pain/tension/knots, weakness in arms/hands which impacts writing and notice you are dropping things, bladder/bowel control issues, and heaviness in legs when walking with balance issues?

I know this from experience. I was misdiagnosed for over 5 years and now have permanent spinal cord injury due to DCM. I was born with a congenitally narrow spinal canal and worked on a computer/desk job for over 30 years. I have straightening of my cervical spine, degenerative disc disease, spinal stenosis, myelopathy, osteoarthritis, etc. My spinal cord was flattened at C5-C6 and finally had a 3rd orthopedic spine specialist finally diagnose me properly (felt validated and heard for the first time in a long time) and recommended surgery right away to stop the worsening of my symptoms and permanent damage. I had ACDF surgery on C5-C6 in 2022 (helped with bladder control and walking) and now need to get C6-C7 done in May 2025 (symptoms worsened in 2024). I may have permanent damage at C5-C6 which affects arm/hand strength and I’ll need to see if surgery on C6-C7 regains better control of my bladder and walking/balance.

Have you seen a neurologist for EMG/nerve conduction studies of your upper and lower limbs and reviewed the results with your orthopedic spine specialist?

Jump to this post

Good morning, dlydailyhope --

I appreciate the quick reply. My primary symptom is pain in the right shoulder which radiates down through the bicep and arm with tingling. It is interesting you mention about bladder control. I don't have a problem controlling the bladder but certainly go frequently at night (2-3 times) and have seen multiple urologist over the years without any improvement. I wonder if it could be from the cervical issues? Lastly, the Pain Management specialist did perform and EMG/nerve conduction study and the result was slight Carpal Tunnel in the right hand. I am scheduled to see a Neurosurgeon next Thursday, April 10th. Thank you for your input.

REPLY
2 replies
dlydailyhope | @dlydailyhope | 1 day ago
In reply to @dwlandi "Good morning, dlydailyhope -- I appreciate the quick reply. My primary symptom is pain in the..." + (show)
@dwlandi

Good morning, dlydailyhope --

I appreciate the quick reply. My primary symptom is pain in the right shoulder which radiates down through the bicep and arm with tingling. It is interesting you mention about bladder control. I don't have a problem controlling the bladder but certainly go frequently at night (2-3 times) and have seen multiple urologist over the years without any improvement. I wonder if it could be from the cervical issues? Lastly, the Pain Management specialist did perform and EMG/nerve conduction study and the result was slight Carpal Tunnel in the right hand. I am scheduled to see a Neurosurgeon next Thursday, April 10th. Thank you for your input.

Jump to this post

@dwlandi
I hope you like your neurosurgeon. If they are highly rated by others and you feel comfortable with them and they listen to your symptoms and answer your questions, that is a good match. If they do not, you may want to get a 2nd or 3rd opinion. My 3rd (may actually have been my 4th), was a really good match for me. He was very personable, listened, answered questions, was respectful, etc. Make sure you check out the hospitals your surgeon does surgery at and its ratings. You will want to also make sure the surgeon and hospital is in your network for insurance coverage.

I have had cervical and lumbar surgeries and the lumbar surgery was much more painful and a longer recovery than cervical spine surgery if they do not need to cut through muscle to get to the spine. ACDF surgery is from the front but it you have multiple levels to do, they may need to go through the back of the neck.
1.
https://orthoinfo.aaos.org/en/diseases--conditions/cervical-spondylotic-myelopathy-spinal-cord-compression/
2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/cervical-myelopathy

3. https://www.spine-health.com/conditions/neck-pain/cervical-spondylosis-myelopathy

4. https://my.clevelandclinic.org/health/diseases/cervical-myelopathy

5. https://www.aafp.org/pubs/afp/issues/2020/1215/p740.html

6. https://www.neurosurgery.columbia.edu/patient-care/conditions/cervical-spondylotic-myelopathy

7. https://www.mayoclinic.org/diseases-conditions/cervical-spondylosis/diagnosis-treatment/drc-20370792

8. https://www.massgeneral.org/orthopaedics/spine/conditions-and-treatments/cervical-spondylotic-myelopathy

REPLY
dlydailyhope | @dlydailyhope | 1 day ago
In reply to @dwlandi "Good morning, dlydailyhope -- I appreciate the quick reply. My primary symptom is pain in the..." + (show)
@dwlandi

Good morning, dlydailyhope --

I appreciate the quick reply. My primary symptom is pain in the right shoulder which radiates down through the bicep and arm with tingling. It is interesting you mention about bladder control. I don't have a problem controlling the bladder but certainly go frequently at night (2-3 times) and have seen multiple urologist over the years without any improvement. I wonder if it could be from the cervical issues? Lastly, the Pain Management specialist did perform and EMG/nerve conduction study and the result was slight Carpal Tunnel in the right hand. I am scheduled to see a Neurosurgeon next Thursday, April 10th. Thank you for your input.

Jump to this post

@dwlandi
One thing to keep in mind that many doctors don’t know a lot about myelopathy symptoms and how to diagnose. I had a good neurologist miss my spinal cord flattening in my MRI and did not connect the dots with all of my symptoms. Cervical myelopathy can cause many symptoms below the level of spinal cord flattening/compression. Many don’t realize cervical myelopathy can affect bowel/bladder and legs/walking.

Your bladder may be affected only at night, depending on how you sleep. During the day, your neck position may not compress your spinal cord and affect your bladder.

I have had EMGs done at different times and by different specialists and have had different results each time. Your neurosurgeon may have someone they really trust to do a good job on EMGs/nerve conduction studies. My surgeon recently referred me to someone he trusts before I get my next cervical spine surgery.

Also, keep in mind that EMGs don’t measure what is going on in your spine according to my surgeon. For example, I had a “normal” EMG for lower limbs but had severe spinal stenosis of lumbar spine, degenerative disc disease and neurogenic claudication (pain/numbness and weakness in lower back, hips, buttocks, legs and feet). I had surgery on my lumbar spine in 2024 and it relieved many of the symptoms. The doctor who did my EMG told me surgery wouldn’t help my back. My spine specialist/surgeon said that doctor did not know what he was talking about. EMGs measure peripheral neuropathy, not spinal cord. If you have pinched spinal nerves, that should get picked up by an EMG as radiculopathy with radiating pain to extremities.

REPLY
1 reply
dwlandi | @dwlandi | 1 day ago
In reply to @dlydailyhope "@dwlandi One thing to keep in mind that many doctors don’t know a lot about myelopathy..." + (show)
@dlydailyhope

@dwlandi
One thing to keep in mind that many doctors don’t know a lot about myelopathy symptoms and how to diagnose. I had a good neurologist miss my spinal cord flattening in my MRI and did not connect the dots with all of my symptoms. Cervical myelopathy can cause many symptoms below the level of spinal cord flattening/compression. Many don’t realize cervical myelopathy can affect bowel/bladder and legs/walking.

Your bladder may be affected only at night, depending on how you sleep. During the day, your neck position may not compress your spinal cord and affect your bladder.

I have had EMGs done at different times and by different specialists and have had different results each time. Your neurosurgeon may have someone they really trust to do a good job on EMGs/nerve conduction studies. My surgeon recently referred me to someone he trusts before I get my next cervical spine surgery.

Also, keep in mind that EMGs don’t measure what is going on in your spine according to my surgeon. For example, I had a “normal” EMG for lower limbs but had severe spinal stenosis of lumbar spine, degenerative disc disease and neurogenic claudication (pain/numbness and weakness in lower back, hips, buttocks, legs and feet). I had surgery on my lumbar spine in 2024 and it relieved many of the symptoms. The doctor who did my EMG told me surgery wouldn’t help my back. My spine specialist/surgeon said that doctor did not know what he was talking about. EMGs measure peripheral neuropathy, not spinal cord. If you have pinched spinal nerves, that should get picked up by an EMG as radiculopathy with radiating pain to extremities.

Jump to this post

Thank you for the additional information!

REPLY
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