Newbie with cervical spine issues

[Ben]

Hi all,

After experiencing paresthesia in my left arm a few months ago, I had an MRI with the following results:

C4/5: mild central and mild bilateral foraminal stenosis
C5/6: mild central, severe right and mild left foraminal stenosis
C6/7: mild central, severe left foraminal stenosis
Straightening of normal mid cervical lordosis.

My neuro wants to take a wait-and-see approach, he's very conservative. I had a course of oral steroids which didn't help, but then had an ESI in November which seemed to help for a while. I'm in a reasonable amount of pain; need to take opiates to sleep but avoid them during the day. NSAIDs have wreaked havoc on my stomach so I'm too scared to take them anymore. My symptoms have been up and down - sometimes I feel almost normal, other times like hell. I have pain in my left arm, numbness in hand/fingers, and right arm as well but not as bad. I've also been recently experiencing weird leg and toe sensations as well, and a burning behind my right hip, so I probably have lumbar issues as well (or myelopathy).

Anyway was just wondering if any thoughts about what I should do before resorting to surgery? I'm interested in anything that can help - pillows, zero gravity chairs, collars, exercises, traction etc.

[mmglobal]

It's nice to read all the mild this and mild that, but you've got severe foraminal stenosis noted at 2 levels and (lucky you) on both sides.

It's also nice that you are dealing with a surgeon who does not want to just jump in and start cutting. With the severe stenosis and (I assume) symptoms that map out to the pathology noted, it's hard to imagine that you'll be able to avoid surgery... but you never know, and with spine surgery, less is better.

Do you have lumbar and thoracic MRI?

You've not noted anything more than mild central canal stenosis. As I understand it, myelopathy does not manifest itself as weird sensations and burning pain.... I'd be more concerned if you were taking about missing reflexes, significant strength loss, gait disturbance; bowel, bladder or sexual dysfunction, etc... (I hope the doctors will still want to rule out other spine problems that may be affecting your hips and legs.)

With the main problem being foraminal stenosis (?) and if the related symptoms are of primary concern, you might ask if you are a candidate for a foraminotomy (or other decompression surgery) instead of jumping straight to fusion or ADR. If you do something like that, I'd suggest that you do it with an experienced ADR surgeon so he/she will have an eye towards that possibility. You don't want to burn the ADR bridge with too aggressive a decompression surgery.

Obviously, all this comes with the usual, "I'm not a doctor" qualifiers... this is just to provide some ideas for discussion.

Mark

[Ben]

Thanks for your response and sorry for the delay. I was waiting for a complete brain/spine MRI and finally have the results. Turns out I have disc protrusions between T5 and T9, the biggest at T8-9 which is causing "mild" compression to the cord. T6-7 and T7-8 there is mild impinging on the cord by discs. Also have mild cord impingement at C5-C6, and the foraminal stenosis at C4-C7 mentioned before. What a mess. (Lumbar is fine, go figure).

So the worst issue looks to be the compression at T8-T9 which might be causing my transient numbness in legs/toes and cold/burning around the chest. The neuro still does not want to operate. He says that thoracic surgery is extremely complex/risky and since I don't have any problems with reflexes, walking, or bowel/bladder/sexual function, that it should be managed conservatively for now. He also says it's not guaranteed that the numbness is caused by that compression. I also don't have much loss of sensation (by "numbness" I mean a cold sensation, not a loss of sensation).

I'm not in a lot of pain; maybe a 2-3. Not taking any painkillers. Arm/hand pain has improved. The leg numbness and chest burning is freaking me out though - I'm not in a good place emotionally. I've read that symptomatic thoracic disc issues are extremely rare, 1 in a million per year. That means if I do need surgery, the surgeon won't have seen many of these, which increases the risk even more. I just don't understand how I went from no back problems whatsoever to all this happening at once. Not sure what to do next...

[mmglobal]

If you have to have surgery, please know that there is a HUGE difference in thoracic spine surgery from one surgeon to the next. I may be looking at a 1-level thoracic fusion. I had lunch with Dr. John Regan, one of the top thoracic spine surgeons and developer of several minimally invasive techniques. We talked about XLIF (extreme lateral interbody fusion). He says my surgery can be done in a surgery center, maybe even on an outpatient basis. I've seen films from one of the developers, Luiz Pimenta of Brazil... 4 level (or more??? memory not what it used to be) XLIF thoracic fusion in a woman in her 70's... walking around the next day like nothing happened... prior to surgery, she was VERY impaired.

I've been chasing my thoracic spine pain for 4 years now, getting ambiguous results from multiple each facet injections, costo-vertebral joint injections and ablations, intercostal nerve blocks. The most recent adventure has been 2 thoracic epidurals with some pretty amazing results.

Contact me off the forum if you want to talk. (private message or via ispine or GPN website contact forms.)

All the best,

Mark

[mmglobal]

Just to fill in and restate what you've already mentioned above, if you have plenty of room in your spinal canal, you can tolerate substantial impingements... even though the shape of the cord may be changed by a disc protrusion or osteophyte, if there is plenty of room behind the cord, it is not compressed as it would be in a small or highly stenotic canal.

My problem has been that my bad thoracic discs LOOKS like it should be asymptomatic. That may be great for most people, but apparently, in me, it's highly symptomatic. Just because it's doesn't look bad does not mean that I don't have chemical irritation of the nerve root or some other issue causing my radiating pain.

The successful thoracic epidurals have been great, but I don't have any illusions about the odds of long term relief. If they'll do the trick and I can remain this functional (even though I'm still taking pain meds), I'll just enjoy being a person again. If they cannot reasonably do the trick for the long term and I get anywhere near as bad as I was... an XLIF is likely in my future.

Mark