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CERVICAL STENOSIS SURGERY - IMPERATIVE OR ELECTIVE?
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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@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?
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2 ReactionsGood 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.
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1 Reaction@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
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1 Reaction@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.
Thank you for the additional information!
It really depends on you and your level of pain tolerance you’re willing to put up with. You certainly have a mess in your neck. I believe Colleen Young one of the mentors may address this as a fellow C-spine surgery patient.
@dwlandi Welcome to Connect. I am a cervical spine surgical patient. After reading your post, I would think that you must be living with a lot of related symptoms. Perhaps symptoms haven't yet been connected to the structural condition of your spine. In answer to your question, spine surgery is elective in that it must be your choice to proceed. In the years since your injury, your condition has gotten worse, and you can relate that to those 11 years of change. Aging affects it too in that discs naturally dry out and shrink as we age which can also open up cracks in the fibrous outer part of the disc causing bulges or herniations. Your report is describing the slow collapse of several disks. If the collapse is complete, it is possible for the extra bone spurs and remodeling that is happening to start to fuse the spine. Already, there are several places of spinal cord compression and significant nerve root compression from bone growths. That will likely continue to happen, and at some point, when the compression is too great, it kills the nerves cells causing permanent damage. In the spinal cord on MRI imaging, loss of nerve cells may show up as a whitish usually mottled appearance. Your best opportunity to have a good result from surgery will be before permanent damage happens, however, it is hard to know when that will happen.
No one wants to go through spine surgery, and we tend to try to bargain with ourselves to talk us out of it. There are risks for sure, but there are also very significant risks to avoiding surgery that may prevent paralysis or disability.
At this point, I'm guessing you have not had a follow up with your specialist yet who ordered the imaging. I would predict that surgery will be discussed and recommended. Obviously, you've lived with some related pain for several years from this. I did too. My surgery timeline was a bit longer and it may have been about 18 years after the whiplash from a traffic accident. I lived in denial too for a long time because I was afraid. Eventually, I had to come to terms with my fear, make friends with it and understand it before I could move forward. My situation was just one level C5/C6 and not as advanced as yours is; I have no regrets, this surgery gave me my life back, and without it, I would have lost the coordination of my arms among other things. Not everyone gets a choice on if they want to become disabled, but the choice to avoid disability was a gift.
I had pain all over my body from the spinal cord compression at one level, and I did not have nerve root compression. I did have problems emptying my bladder when muscle spasms were moving my neck around, effectively making the spinal canal smaller. It also caused me to walk with a limp. If my PT realigned the curve in my neck, that all got better and only because it was in an early stage of being affected, and my gait returned to being normal and equal. It was causing weakness, so when I limped, I couldn't walk normally at all if I tried. The bladder functioning could have progressed to incontinence that could become permanent.
What are your thoughts and concerns? What symptoms are you experiencing that you think are related to your spinal condition? How soon will you be seeing a specialist?
@jenniferhunter
Thank you for your input. All information is helpful in making a decision. I see a neurosurgeon on Thursday, Aprii 10, 2025. It was my pain management specialist who wrote the Rx for the MRI and is suggesting that I see a surgeon. @dwlandi
@dwlandi You may also want to consider other opinions as surgeons may have different ways to solve the problem. I think they will suggest fusion, and there may be different implants used by different surgeons. Some use plates on the front, and some do not because the cage may have screws that go in on an angle from the front. My surgeon told me that it heals better with a bone disc instead of metal cages. My surgery was with a donor bone disc and no hardwrae. I stayed in a neck brace until fused which is 3 months. I don't think you will be offered that causeless you need multiple levels done. Some cages are titanium, some are PEEK which is a type on plastic that is supposed to be innert. I have problems with metals in my body, so avoiding hardware was good for me. Some surgeons go in from the front which is easier in healing, and some go in from the back which causes more pain because of going through muscle. The surgeon should explain what they do and why, and also tell yo what can go wrong. Do ask that, and ask what other procedures also could address your issues. Good luck!
@dlydailyhope
@julese
@jenniferhunter
All --
Your comments, experiences, and feedback are greatly appreciated! I saw the Neurosurgeon (one of the best in South Florida) on Thursday, April 10, 2025. After reviewing the MRIs from 2014 and 2025, he is suggesting conservative treatments before recommending surgery. See his notes below...
After clinical exam, and review of the radiographic findings, and history, I do believe that Doug is presenting with some intermittent right C6 and C7 nerve root symptoms. His MRI from 2014 appeared much worse and in fact had left-sided disc osteophyte complexes. On the 2025 MRI, this appears much improved. I do believe that his current symptoms are more of a sensory radiculopathy. He has excellent strength and no upper motor neuron findings.
I would trial a right C5-C6 and C6/C7 epidural steroid injection to see if this can provide him with even more relief. So far he has had an added benefit with PT, cervical traction, and at least the first injection. I think there is still room to continue with conservative treatments. Should his symptoms fail to improve or progress, I think he would make an excellent candidate for C5-C7 ACDF.
I reviewed the imaging findings with him. We discussed some the details of the surgery involved if needed down the road.
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