I was diagnosed with Moderate to Severe Central Canal Stenosis about 2 years ago and have not yet been able to see a specialist here in Canada. I adjusted my life considerably in order to cope and had been getting by until about three months ago, when my condition seemed to take a step function down, leaving me virtually disabled and unable to work. I cannot walk more than 20 metres, sit for more than a minute or two, or sleep for more than an hour. I am a 42 year old father of three young children.
I am seriously considering arranging to see a specialist regarding surgery in the US, but would like some insights into the viability of surgery as a remedy. For my family this would be very expensive (several thousand dollars for the visit, and perhaps $50k or more for the surgery).
My two year old MRI results read as follows:
When counting from the top of the vertebral column, the patient is seen to have a transitional lubosacral segment in that there is partial lumbarization of S1.
The vertebral bodies are in a good alignment. The visualized distal spinal cord and conus are normal.
L4-5 level demonstrates mild facet and ligamentum degenerative change.
The L4-S1 level demonstrates that there are congenitally short pedicles at this level. THis is resulting in a congenitally narrow AP canal diameter. There is a posterior disc protrusion. There is mild to moderate fac and ligamentum flavum degenerative change and hypertrophy. There is resulting moderate to severe central canal stenosis.
I am quite desparate to find a solution of sorts, but we are not wealthy and so cannot afford to seek professional advice from a number of sources, or advice to the effect that there is nothing that can be done.
Any insights that any of you might have would be very much appreciated.
Dear jrgillis, Welcome to the board. Reading your post Im wondering why you arent seeing a new spine specialist neurosurgeon/orthopedic surgeon in Canada, especially after your symptoms increased to being so severe that it leaves you unable to work & a lower level of functioning. Are you on a waiting list? In order to see what is currently happening I would want a new MRI especially before considering surgery. What does your current dr say & are you being treated at this time? Ive had four back surgeries & am unable to work also so I understand your situation from a pain & wanting to be a functioning person again standpoint. Im so sorry that you are hurting so bad & hope that you get better, find proper treatment, answers cetc. Ive found so many helpful people on this board.
Last edited by gmak; 01-02-2013 at 11:08 AM.
Your MRI and your issues look very similar to mine when I first started having sciatic pain.
It is difficult to offer any advice since the MRI is only one piece of the diagnostic puzzle. There may be other information that would be revealed in a physical exam and basic neurologic exam and also the spine specialist may see things on the MRI that were not mentioned by the reporting radiologist.
However, if your issues are pretty much contained to what is on the MRI, I would think that your stenosis could be resolved by a laminectomy and perhaps a discectomy if needed. I needed a one level fusion because in addition to the severe stenosis, I also had a spondylolisthesis at the L4-L5 level. But your vertebrae are all aligned, so you should be able to get by with a laminectomy and possibly a discectomy.
I understand the issues you are raising in your post since you are residing in Canada, but I wasn't clear on whether you are on a waiting list for surgery or if you were told you are not a candidate for surgery? A friend of mine came to the US from Denmark to get a hip replaced because the waiting period in Denmark was something like six years. I'm sure we'll be in the same boat as our new health care goes into effect next year...but for now, we can still get medical care pretty quickly.
One thing to be aware of is that lumbarized S! vertebra....it just means that you and about 15% of the population are born with an extra vertebra. It can be a whole vertebra or a situation where the last vertebra started to form into two but are not quite separated. It is only significant if you were to have surgery. The doctor needs to be aware that you have an extra vertebra so he doesn't inadvertently operate on the wrong area.
I can certainly relate to the amount of pain you are in. Before my surgery I got so that I couldn't stand long enough to chop an onion, and I was drivin g to my mailbox at the end of my driveway to get my mail. I too had the congenitally short pedicles and the smaller than normal diameter central canal. Unlike some other back issues that can heal without surgical intervention, there is nothing that can make that central canal enlarge other than surgery.
The surgery itself isn't terribly complicated as spine surgeries go. If everything goes according to plan, I would think after you recovered you would be able to return to work. The surgery may not get rid of 100% of your pain as you may have developed some permanent nerve damage while the nerve or nerves have been badly compressed, but you should be much better.
Thanks to you both for responding. Thus far, I haven't even been able to secure an appointment with a specialist, and so I don't even know if I am candidate for surgery per se. My GP seems to think that I am, but he says that it can be next to impossible to rise to the top of the list, as emergencies take precedence.
I talked it over with my wife and we agreed that I should schedule an appointment with a specialist in the US. The Cleveland Clinic has an office in Toronto, where I live, and is quite reputable, so we thought that it would make sense to arrange a consultation there.
[QUOTE=jr7723;5111920]Thanks to you both for responding. Thus far, I haven't even been able to secure an appointment with a specialist, and so I don't even know if I am candidate for surgery per se. My GP seems to think that I am, but he says that it can be next to impossible to rise to the top of the list, as emergencies take precedence.
I talked it over with my wife and we agreed that I should schedule an appointment with a specialist in the US. The Cleveland Clinic has an office in Toronto, where I live, and is quite reputable, so we thought that it would make sense to arrange a consultation there.[/QUOTE]
Dear jrgillis, I was thinking about your situation last night, it is daunting for me to think that a man cant work anymore & its not considered urgent!! Cleveland clinic has a great reputation as far as I know. I hope for you that if a spine specialist does recommend surgery that you can use his recommendation to get into a dr & hospital that would be covered on your medical plan. I prayed for your family & will continue, i can imagine too well your circumstances and in my opinion you could use a break!
Last edited by gmak; 01-03-2013 at 01:34 PM.
That is interesting the Cleveland Clinic has an office in Toronto. Do they also do surgery there or do you have to go to Ohio if surgery is necessary?
If you can possibly manage it financially, I would encourage you to see a spine specialist. You are too young to have to give everything up when your issues may have a fairly easy solution (I shouldn't use the word "easy" as anything connected to the spine is complex...but as spine surgeries go, yours should be relatively easy unless it is necessary to do a fusion....but even then, chances are good it would return you to a more normal life.)
On another topic, I was looking at spine surgeons in Buffalo, thinking that might be the closest US city to Toronto...and the funny thing was that everyone I looked up had been educated and done their fellowships in Canada! I guess they became frustrated with the Canadian health system and moved across the border.
Thanks for the message. Yes, I'd bet that the health care sector in Buffalo does a brisk Canadian business ; ))
I find it strange that our Canadian system is often held up as a model of state run health care for America. To be sure, it isn't all bad. If you have a life threatening problem, then you will get the care you need. It is when there is any kind of discretion involved that the problems show up.
In effect, our system is badly supply constrained. To make matters worse, even if you are willing to pay for a procedure, you can't get it here at home, as this would be a clear admission that our system is failing.
The irony of your discovery in Buffalo is clear, and perfectly foreshadowed my own situation. The surgeon whom I have selected at the Cleveland Clinic was trained at the top university here in Canada. He obviously wants to use his considerable skills to provide the most and best care, and clearly I want and need to receive treatment, but we both have to travel to America to match skills with needs. What a shame....
On the plus side, I should be able to arrange my first consultation in the next two weeks or so. Compared to what I'm used to, this is like warp speed ; - )
So you can have a consultation with a doctor who works for Cleveland Clinic in an office in Toronto, but you have to go to Ohio for treatment or is it just for treatment??
I find the topic very ironic too as I've been on the board a number of years and clearly remember Canadians who wait a long time to get a MRI and then wait some more to have it read. Here if one has an "issue" with the spine and the MRI is older than six months, you have to get a new one because the MRI is considered too old to be accurate. Many people in the US gripe about our healthcare because they don't realize how it works in some other countries...and point to people who are uninsured...but those people are not turned away at the doors of an emergency room....so, we'll see how things turn out here in a couple more years!!
I am glad you have an appointment. It will be helpful to at least know what can be done for your issues.