Severe spinal stenosis: Would you do surgery?

Posted by collierga @collierga, Jan 15, 2020

Hi there
I am new to this group. I am a 64 yr old female, in basically good health. Hip replacement 10/2018 with no complications.. Currently have no pain only bilateral finger numbness with minor lower left arm numbness. For the most part does not interfere with my daily living activities
Diagnosed with severe cervical stenosis via MRI in 8/2019,C-3-4 shows severe disc degeneration, moderate to severe bilateral formalin narrowing due to uncinate spurs/C4-5 same as 3-4 but with broad based disc bulge/5-7 C7-T-1 Degenerative anterolisthesisBroad based disc/osteophytic ridge causing severe central canal narrowing. i have gone to 2 different Neuro surgeons they both say complete opposite treatment plans. One says observe see him if symptoms get worse. The other doctor wants to do 2 surgeries, first through the front, #2 through the back to stabilize. I am leaning towards no surgery but am looking for someone to tell me they had this surgery and are happy t hey had it done. So far when i talk to people with back/neck issues they say they would never again go through surgery.
Thank you all in advance for you opinions..

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@wilcy

Just curious, how do you walk 15 minutes with spinal stenosis?

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@wilcy I think this is different for every patient and how advanced the stenosis is. I was able to walk with cervical stenosis, and I didn't have space left around my spinal cord. I had my decompression surgery before permanent damage began. I was getting muscle spasms that shifted my vertebrae around, and when that happened, I had an uneven gait, but I still could walk. When my physical therapist realigned my neck, I walked normally again. If the spinal cord compression gets severe, it can cause permament damage to the spinal cord, and that usually shows up on an MRI.

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@wilcy

Just curious, how do you walk 15 minutes with spinal stenosis?

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I have no pain only numbness in fingers and toes. Walking for the most part is not a problem. I try to exercise 3-4 times a week

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@jenniferhunter

@collierga I understand your concerns. You will get different opinions from different surgeons, but understand that there is a difference in the level of expertise in neurosurgery for the spine. To get great results, you need to seek care with the very best. It may be hard to figure that out as a patient, and I did my homework in choosing doctors by reading their research papers and learning about their area of interest, as well as any honors they have received from within their chosen field, and not from patient reviews. I am a Mayo cervical spine surgery patient and had great success with my surgery 3 years ago. I was loosing the ability to control my arms because of spinal cord compression, and none of the local surgeons recognized why I was getting pain all over my body. They assumed it should just be arm pain based on my imaging. I found medical literature with a case similar to mine because I looked up a term in a paper of Mayo neurosurgeon, Jeremy Fogelson, and I found what the other surgeons missed. None of them would offer to help, so I came to Mayo and it was the best decision I made. I wish I had come there first. If you can't come to Mayo, look at major interdisciplinary teaching hospitals with medical schools for better surgeons. I saw 5 surgeons over 2 years and just got worse and none would help. Having surgery at Mayo gave me my life back and the ability to use my arms, so the first thing I did when I was able was to paint a portrait of my surgeon. Dr. Fogelson is a spine deformity expert who teaches at Mayo and does both fusion and artificial disc replacements and is very kind and compassionate. I wish I had come to Mayo first, and if I were to have further spine issues, it is the only place I will go. The care was expert and compassionate and efficient. I didn't waste time waiting for tests and consults that drag out for months because Mayo does that efficiently and my testing was complete in 3 days and I had an offer for surgery. I watched a lot of online surgeon presentations and learned enough because I saw so many surgeons that I knew I was getting the right answers at Mayo.

In addition to severe central canal narrowing of the spinal cord, you also have severe foraminal stenosis or compression of the nerve roots. All of this can cause permanent nerve damage, and compression of the spinal cord can cause paralysis and other body issues including incontinence which also can become permanent. A common problem is gait abnormalities with walking. Collapsing discs can also cause the spine to start to fuse itself because the bone remodels from the uneven pressure on the endplates of the vertebrae. It may fuse in a poor alignment and would complicate a surgical repair or possibly make it un-operable. I can't answer that, only a surgeon can. Choosing a surgeon is a very important decision, and you want one who only does spine surgeries and who has a lot of experience. The facility is important too, and I didn't want to be in a for profit doctor owned surgical facility in case something went wrong. I wanted to have hospital surgery where they take time with the cases. I asked and was told that Dr. Fogelson would do 2 smaller surgeries (like mine one level C5/C6 in a surgery in an hour and a half) or one major surgery per day and that was done with neuromonitoring just to check for safety. In comparison, one of the other spine surgeons who saw me did a half hour surgery and did many patients in a day. I didn't want to be rushed through it or have the doctor thinking about time and the next patient when he was working on me.

I had a great recovery and have no pain. I lost some muscle in my arms and shoulders because of spinal cord compression, but that is coming back. It takes a long time, but having surgery at Mayo changed my life. I read a and learned a lot and knew I was choosing a great surgeon. I highly recommend him if you can come to Mayo. Here is my story. Let me know if I can answer any more questions. https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624

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I had neck surgery for cervical stenosis. At the time they told me it was so bad that is I fell I could be paralyzed. So they rushed me into surgery. I have had nothing but pain ever since. I wish I had looked into other options 1st. Then almost 2 yrs ago I had a lumbar burst fracture of my L4 they wanted to rush me into surgery right away. I said no I want to treat it with p t first. Wish I could have gotten into mayo for another opion. But even though I have a mayo number they would not see me.

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@suerc

I had neck surgery for cervical stenosis. At the time they told me it was so bad that is I fell I could be paralyzed. So they rushed me into surgery. I have had nothing but pain ever since. I wish I had looked into other options 1st. Then almost 2 yrs ago I had a lumbar burst fracture of my L4 they wanted to rush me into surgery right away. I said no I want to treat it with p t first. Wish I could have gotten into mayo for another opion. But even though I have a mayo number they would not see me.

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@suerc That must be frustrating. I don't know what is involved in accepting patients to Mayo. I had been turned down by 5 local surgeons over 2 years time, and that may have helped me get accepted to Mayo. I had learned a lot by seeing the spine surgeons who didn't want me as their patient, and I know that surgeons are not equal. Some are very good; others not. Some are high pressure, and I experienced that too, but I didn't trust that surgeon. My PCP told me to get several opinions before choosing. I researched everything I could find before I was their patient. Have you tried physical therapy? What has helped me a lot before and after spine surgery to have a great recovery is myofascial release. Surgical scar tissue causes restrictions in the fascia, and that can be treated. Here is our discussion. There is a provider search on the MFR website.
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

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I had cervical spine surgery at the Mayo Clinic 11 months ago and I do not regret it. I had numbness and tingling in my left hand, shoulder pain, and was losing strength in my left hand. Most of my symptoms have resolved. PLEASE NOTE: many orthopedic surgeons operate on the spine not just neurosurgeons. My surgeon was Dr. Ahmad Nassr whose research focuses on the spine. Please do not limit yourself to neurosurgepns only.

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@collierga

I have no pain only numbness in fingers and toes. Walking for the most part is not a problem. I try to exercise 3-4 times a week

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What kind of exercise?

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@suerc

I had neck surgery for cervical stenosis. At the time they told me it was so bad that is I fell I could be paralyzed. So they rushed me into surgery. I have had nothing but pain ever since. I wish I had looked into other options 1st. Then almost 2 yrs ago I had a lumbar burst fracture of my L4 they wanted to rush me into surgery right away. I said no I want to treat it with p t first. Wish I could have gotten into mayo for another opion. But even though I have a mayo number they would not see me.

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So very sorry to hear about your pain. it seems everyone has a different story
Sending prayers for healing and that your pain will subside

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@wilcy

What kind of exercise?

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Alternate between walking, elliptical/weights/core work and swimming once a week

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@baltopat86

I've been dealing with advancing spinal stenosis for 4o+ years now. Considered to be late-final stage, I'm now experiencing difficulty maintaining visual focus. Wondering if this is to be part of the disease process….. I haven't found much literature concerning this particular issue.

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hello Baltopat86, i was looking up spinal stenosis symptoms and all, i am not familiar but i do have lots pain in the back all the way down to legs and feet, finally i got an appointment with a neurologist oct.27 i still have a long wait and i am in pain, i just wish you all the best, take care

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I've been dealing with advancing spinal stenosis for 4o+ years now. Considered to be late-final stage, I'm now experiencing difficulty maintaining visual focus. Wondering if this is to be part of the disease process….. I haven't found much literature concerning this particular issue.

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