Excruciating pain from cervical (C7/T1) radiculopathy

Posted by mlerin @mlerin, Nov 4, 2019

I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. Had a cervical epidural injection last Thursday and so far no relief. Is prolotherapy or PRP a good option? Any other non-surgical treatments out there that actually work?

@mlerin With stenosis, when it is bad enough and causing nerve compression, epidurals may not have an effect. An epidural works by reducing inflammation which takes a little bit of pressure off, but if it is too far advanced, the pressure will be caused by arthritic changes, abnormal bone growth or a ruptured disc. If there is any instability or a collapsed disc, it can put extra pressure on the compressed nerves. I had one epidural injection and it only stopped all the pain for 5 days, and then it slowly returned over the next few weeks. I can tell you that cervical spine surgery is not that bad at least in my experience. I had an ACDF or anterior procedure which is an easier recovery that a posterior approach that goes through muscle layers. If your issues are just in the foramen where the nerve roots exit, there are some procedures that just clean out the compression without removing a disc. If you have stenosis in the central canal, they access it by removing a disc. I had spinal cord compression in the central canal from a collapsed disc and bone spurs at C5/C6, and had a fusion. I had a great recovery and had a fusion without hardware, and only a bone graft. I stayed in a cervical collar until it fused. I took it easy during my recovery. You may want to get other surgical opinions before deciding. Ask your doctor about prolotherapy. I have heard about it, and it relies on an injection that causes some inflammation which is a step toward healing, but it will not fix any stenosis that exists. If you have muscle spasms causing mal-alignment, physical therapy may help realign your spine and could help if alignment or instability is adding to the problem. It will not fix stenosis either, but could buy some time.

Generally, fixing this by decompressing the stenosis is best done before permanent nerve damage happens. Ask your surgeon's opinion on that and about how soon they think that should be done, and ask what will happen if you don't have surgery or wait too long. I had to make that choice too, and I didn't want to become disabled because of my spinal cord compression. I was also loosing the ability to use my arms and coordinate my movement. I lost about half my muscle in my arms and shoulders to atrophy. I tried to find surgical help for 2 years and was turned down by 5 surgeons, so I came to Mayo and had a wonderful gifted surgeon who gave me back my ability to do my artwork. I wish I had come there first and not wasted time with doctors who didn't want to help me. Epidural injections can also take a couple days to work, so time will tell. When I woke up from surgery, all of my pre-existing pain was gone, and I only had pain from the incision and surgical path. I also had a great physical therapist who did myofascial release before and after surgery. You need to trust your surgeon completely, so ask lots of questions and get as many opinions as you need. I'm glad that the others didn't want to help me because I had a better choice of fusion without hardware and probably would not have had that choice if one of the others had operated. I understand the anxiety, and I had a lot of that, but I learned to understand and control my fear and was able to be calm on my surgery day. I expected spine surgery to really hurt a lot, and it did not. Other patients who waited too long and have permanent damage talk about having pain that is not resolved by surgery. Doctors can't promise the surgery will take away pain, and they tell you it will keep it from getting worse. My surgery resolved all my pain and my range of motion is normal. Do your homework and research so you'll be able to make an informed decision. Here is my story on Sharing Mayo Clinic. https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

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@jenniferhunter

@mlerin With stenosis, when it is bad enough and causing nerve compression, epidurals may not have an effect. An epidural works by reducing inflammation which takes a little bit of pressure off, but if it is too far advanced, the pressure will be caused by arthritic changes, abnormal bone growth or a ruptured disc. If there is any instability or a collapsed disc, it can put extra pressure on the compressed nerves. I had one epidural injection and it only stopped all the pain for 5 days, and then it slowly returned over the next few weeks. I can tell you that cervical spine surgery is not that bad at least in my experience. I had an ACDF or anterior procedure which is an easier recovery that a posterior approach that goes through muscle layers. If your issues are just in the foramen where the nerve roots exit, there are some procedures that just clean out the compression without removing a disc. If you have stenosis in the central canal, they access it by removing a disc. I had spinal cord compression in the central canal from a collapsed disc and bone spurs at C5/C6, and had a fusion. I had a great recovery and had a fusion without hardware, and only a bone graft. I stayed in a cervical collar until it fused. I took it easy during my recovery. You may want to get other surgical opinions before deciding. Ask your doctor about prolotherapy. I have heard about it, and it relies on an injection that causes some inflammation which is a step toward healing, but it will not fix any stenosis that exists. If you have muscle spasms causing mal-alignment, physical therapy may help realign your spine and could help if alignment or instability is adding to the problem. It will not fix stenosis either, but could buy some time.

Generally, fixing this by decompressing the stenosis is best done before permanent nerve damage happens. Ask your surgeon's opinion on that and about how soon they think that should be done, and ask what will happen if you don't have surgery or wait too long. I had to make that choice too, and I didn't want to become disabled because of my spinal cord compression. I was also loosing the ability to use my arms and coordinate my movement. I lost about half my muscle in my arms and shoulders to atrophy. I tried to find surgical help for 2 years and was turned down by 5 surgeons, so I came to Mayo and had a wonderful gifted surgeon who gave me back my ability to do my artwork. I wish I had come there first and not wasted time with doctors who didn't want to help me. Epidural injections can also take a couple days to work, so time will tell. When I woke up from surgery, all of my pre-existing pain was gone, and I only had pain from the incision and surgical path. I also had a great physical therapist who did myofascial release before and after surgery. You need to trust your surgeon completely, so ask lots of questions and get as many opinions as you need. I'm glad that the others didn't want to help me because I had a better choice of fusion without hardware and probably would not have had that choice if one of the others had operated. I understand the anxiety, and I had a lot of that, but I learned to understand and control my fear and was able to be calm on my surgery day. I expected spine surgery to really hurt a lot, and it did not. Other patients who waited too long and have permanent damage talk about having pain that is not resolved by surgery. Doctors can't promise the surgery will take away pain, and they tell you it will keep it from getting worse. My surgery resolved all my pain and my range of motion is normal. Do your homework and research so you'll be able to make an informed decision. Here is my story on Sharing Mayo Clinic. https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

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Thanks for the nicely detailed message. My main issue is foraminal narrowing which is most significant at C5-C6 on the left and at c7-T1, right. Interestingly enough, both areas have narrowing but my pain and all symptoms are on the right only, seem to be stemming from c7-t1. I’m 4 days out of an epidural injection and it’s not working making me think it didn’t take. I heard a lot about prolotherapy and PRP and prolo seems to be the next step I’ll pursue before considering surgery. I’m so glad you had such a positive outcome with surgery. I live in northern CA but am willing to go to Mayo Clinic to consult with good physicians. Do you mind sharing the name of your spine surgeon? Thanks again for the wealth of info. We should all live a life free of chronic pain.

Liked by Jennifer Hunter

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Might I relate to you an experience I had while living in Oklahoma City… 1. I had an accident where I had to have a spinal fusion on the lowest Vertebrae ..L4, L5, etc… the Spine surgeon cleaned up around the fusion and I have little problem now 25 yrs later… BUT. a couple years after that fusion I was having Pains in the neck, down my arm etc… so I went back to that surgeon..great doctor … He gave me the epidural injections.. and arranged for me to return to his office in several days… The Epidurals had NO effect… Did Not help the Pain in any way.. I was an architect.. and did a lot of drawing… drafting too.. So my back surgeon said, "You have Cubital Tunnel Syndrome"… that in essence is your "crazy bone" is giving you problems when you bend your elbow… stretching that Nerve…. But he said … I don't do arms….. so I went to an Arm and digital surgeon… who ran some tests and pronounced that I had "Cubital Tunnel Syndrome" ….. Surgery was done… they cut my arm and moved the nerve… so stretching my arm no longer irritated the nerve…and my neck etc… So the moral to the story is ….sometimes… if the epidural does not help…. you may have a different problem than you or your doctor first thought…. Good Luck.. That arm fix has worked wonders for 20 yrs now… Ken

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@mlerin

Thanks for the nicely detailed message. My main issue is foraminal narrowing which is most significant at C5-C6 on the left and at c7-T1, right. Interestingly enough, both areas have narrowing but my pain and all symptoms are on the right only, seem to be stemming from c7-t1. I’m 4 days out of an epidural injection and it’s not working making me think it didn’t take. I heard a lot about prolotherapy and PRP and prolo seems to be the next step I’ll pursue before considering surgery. I’m so glad you had such a positive outcome with surgery. I live in northern CA but am willing to go to Mayo Clinic to consult with good physicians. Do you mind sharing the name of your spine surgeon? Thanks again for the wealth of info. We should all live a life free of chronic pain.

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@mlerin You are most welcome. I'm glad to help. @ken82 also makes a good point in that you can have pain caused in a peripheral area of the nerves. Pain can be generated from anywhere along the path of the nerve or in multiple places and it feels the same as pain generated from compression at the spinal nerve roots in the foramen. This is what the neurologists test for to try to figure out the point of compression based on how fast the nerves conduct electricity, and how well a muscle responds when it receives that electrical impulse or not. For me, thoracic outlet syndrome generates pain where the nerve bundle passes through the areas of the scalene muscles on the side of the neck, in between the collar bone and rib cage, and under the pectoralis minor muscle where it attaches to the arm pit. Spine surgery doesn't fix those compression points, and I work on those in physical therapy. Those areas became more painful after spine surgery for a bit because everything tightened up with the scar tissue and healing. I had to wait for the fusion process to begin before I could do any stretching and PT in those areas of my neck. The surgical incision is very close to the areas with the TOS issues, and after I could rehab and strengthen my neck (gets weak in a neck brace after 3 months), I am making progress again with myofascial release of the tight areas. I had spine surgery without hardware, and only have a bone graft, so I had to be careful not to do anything that could dislodge it and lived in my neck brace. My surgical notes say that the surgeon tested it in the OR and it didn't move when he tugged on it. The surgical incision was closed in layers with dissolving sutures very neatly by the neurosurgical assistants and the scar is hardly visible in the crease in my neck.

Here are a lot of links to information about my Mayo neurosurgeon, Dr. Jeremy Fogelson in Rochester. He is a gifted surgeon and a very kind and compassionate man and who loves his job. It would be worth the trip to get an opinion at Mayo. I tried for 2 years to get help and was refused by 5 local spine surgeons where I live likely because my symptoms were unusual, and the care and efficiency that I experienced at Mayo was far superior to anything else. I didn't know medicine could be that efficient and that I would have expert care and have all the testing done in 2 days, and that I would have an answer at my first appointment with the surgeon, and that surgeon would be a very nice guy. When you are the patient who is worried, compassion and understanding from your surgeon helps a lot. Those 2 years before I came to Mayo were always a wait for appointments and testing, and waiting again to follow up and it drug on as my symptoms got worse. I had documented the changes as it progressed, and I was loosing my shoulder and arm muscles to atrophy from my spine problem, and even when I brought that up, I was told it didn't look bad, but that local surgeon didn't know what was normal for me, and didn't listen.

Good luck in your quest. For me, this was life changing and coming to Mayo gave me back the ability to reclaim my talent and do my artwork. Let me know if I can answer any questions.
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
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@

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