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Old 08-28-2011, 01:05 PM   #1
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anything for severe spinal canal stenosis besides surgery??

I am a single 34 yr old mother of 4 children and was diagnosed 4 days ago w severe spinal canal and foraminal stenosis from C3-C7. I have been having a lot of neurological symptoms for 27 months and now i think we found the answer. My GP ordered an EMG when i went to see her because of a lot of muscles in my left arm that had been going crazy for approximately a month before seeing her. When I started to have severe cramping in my arm and thumb pulling in toward the palm of my hand while working I decided to go see my dr. I wasn't haviing much pain..just problems using my arm. She ordered the EMG which came back abnormal. She said the sensory part of the test was normal except delayed CMAP but the EMG itself was not so an MRI was necessary because of muscle damage in arm and a hidious claw hand I developed over the last 6 wks. I had the MRI about a week ago which showed the stenosis I mentioned above and because of recent loss of bowels and bladder she urgently got me in with a Neurosurgeon who will be preforming suregery on the 8th of next month because of lack of space in my spinal canal/cord...not sure which one or if theyre even the same. So, my question is..has anyone else had this and if so is there another approach rather than surgery? I don't really want the surgery, but my dr says this will progress without it. He said we could try conservative measures but highly doubts it's going to stop the progression in my arm..its pretty much useless as it is and i don't really care about that in comparison to the risks of paralysis if I don't get the surgery. I can do without my arm but NOT without the rest of my body!! Anything other than surgery would be preferred and it's not that I don't trust this dr but maybe he's rushing it? but I'm not a dr so i don't know...just hoping and praying there is an alternative to surgery...

Last edited by FrightenedMe; 08-28-2011 at 01:08 PM. Reason: typos

 
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Old 08-28-2011, 02:09 PM   #2
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Re: anything for severe spinal canal stenosis besides surgery??

I don't want to frighten you even more, but time is of the essence. Your problems have been let go too long.

I have had three cervical surgeries in 15 years, and I would go back tomorrow if I thought it were..as warranted. We are not in the Dark Ages any more.

My most recent surgery was a laminoplasty. From your description, it may be what you need. You can find out a lot about my thinking leading up to the surgery in the following link, which is to a now-closed thread:

http://www.healthboards.com/boards/showthread.php?t=853183

Given the severity of your symptoms I doubt that you are going to get a whole lot of help on this board with avoiding surgery. Personally, I can't remember reading a post from someone who seemed to need it more.

Anyway, it would greatly help me, and anyone else who wants to respond to know

1) exactly what surgery (ACDF, laminioplasty, etc) is your surgeon proposing, and at what levels?

2) what did yiour most recent radiologist's report say? Since you apparently have a four-level problem, your full transcription would help

Again, whatever you do, the time for waiting and stalling is over. Damaged nerves lose their ability to recover if they stay damaged for too long.

Last edited by WebDozer; 08-28-2011 at 02:18 PM.

 
Old 08-28-2011, 07:42 PM   #3
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Re: anything for severe spinal canal stenosis besides surgery??

again, i wont know the name of the surgery till i go in for my pre-surgery testing. the neuro may have said when he was telling me what my mri showed and what the surgery would consist of but may have forgotten as it was a lot to take in. i can give u the results of my mri...this will be a lot of tying but here goes...
loss of normal cervical lordosis.
c2-3 there is no central canal stenosis or neural foraminal narrowing identified.
c3-4there is a central disc extrusion which demonstrates superior migration along the posterior margin of the c3 vertebral body. this disc extrusion measures 4 mm x 6 mm x 9 mm in AP by transverse by craniocaudal dimension. there is severe spinal canal stenosis. no free disc fragment is identified. uncovertebral overgrowth moderately narrows the right neural foreman. no significant left neural foraminal narrowinf is present.
c4-5there is a broad central disc extrusion measuring 4 mm by AP dimension resulting in moderate to severe spinal canal stenosis. Moderate to left foraminal narrowing present. No significant right neural foraminal narrowing is present.
c5-6there is a broad 4 mm left paracentral disc extrusion which results in severe spinal canal stenosis. this extends into and severely narrows the left neural foramen. no significan right neural foraminal narrowing
is present.
c6-7there is a broad cental disc protrusion measuring 3 mm in AP dimension. there is resulting mild spinal canal stenosis. mild right neural foraminal narrowingis present.
c7-t1there is no central canal stenosis or neural foraminal narrowing identified.
there u go...not sure how someone would make a lot of sense of it bc i sure dont:P as soon as i find out about the exact name of the surgery my neuro wants to do, i will let u know sorry if there r any typos..my 3 yr old was climbing over me while typing..lol..and im too tired to read it to see if there r any.

 
Old 08-28-2011, 08:56 PM   #4
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Re: anything for severe spinal canal stenosis besides surgery??

F - I appreciate your taking the time to type all that.

Think of it in two parts. The first is what's happening to the canal, and possibly the cord within the canal. The second is what's happening to the foramina and, by extension, what's happening to the roots of the peripheral nerves as they exit the spine and head out to your arms.

CANAL - The normal width for a man's mid-cervical (C3-5) spinal canal is 17-18mm (I suppose a little less for a woman, but I don't know), and 12-14mm for the lower cervical region (C5-7). Within the canal is the spinal cord, which may be around 9-10mm. Within the canal, and surrounding the cord, is the spinal fluid. If you see an MRI, the fluid will be light, and the cord dark. These are the normal dimensions, which allow for intrusions into the spinal canal to not affect the cord as long as they don't get very big. Let's say you have 2-4mm of leeway on each side of the cord.

However, a fair number of people don't have that leeway. They are born with overly narrow spinal canals (congenital canal stenosis). For these people, almost ANY intrusion into the canal is also an intrusion against the cord, and hence a problem. I am such a person.

There are several things that can intrude on the cord. (1) Disks (or disk material) can be forced out (backward) by pressure from the vertebrae. (2) Osteophytes (bone spurs) can grow from any of the different bony parts of the cage formed by the spine. (3) Ligaments can become swollen and/or ossified with time.

In your case, you have disk material at SEVERAL levels being moderately to severely displaced backward into the canal. I really don't know, but I would GUESS this has something to do with your loss of cervical lordosis. Lordosis means a "backward bend", and is the way a cervical spine should normally be structured. If you lose the lordosis, your spine becomes abnormally straight. If you visualize it, you can see how this would put abnormal pressure on the FRONT of the spine, thus forcing the disks out the back. That's my guess, although it may be something of a chicken/egg situation.

FORAMINA - Behind the vertebrae/disks is a cage containing the spinal canal. There are several bones, including the lamina and uncovertebral joint, and one hole on the front part of each side. This is the foramen. The peripheral nerves leave the spinal cord and pass through the foramina, in the case of the lower cervical spine (C4-C7), going out to the shoulders and arms.

Two general problems can occur with the foramina. Once is bone growth (osteophytes) intruding into the opening. The other is disk material being pushed so far out it interferes with the peripheral nerves. You seem to have both problems, although mostly the latter.

I'll go over the report one level at a time, and, for each, cover both the canal and the foraminal problems.

C3-4 - the disk between your C3 and C4 vertebrae has been forced backward into the spinal canal. It has gone UP the back side of the C3 vertebra. It appears to have been forced 9mm up (if my guess as to the meaning of "craniocaudal" in this contect is correct), and 4mm from front to back (AP or anteroposterior). This is pretty darn big. Fortunately, the disk hasn't fragmented, which makes it easier to remove.

A bone growth from the uncovertebral joint is moderately narrowing the right foramen. BTW, in radiologist-speak, there is minimal, mild, moderate, and severe... so moderate is just a little better than severe.

C4-5 - Another big disk extrusion (although this one, at least, isn't trying to escape upward like C3-4). "Moderate to severe" canal stenosis? What about the cord? You can have significant impingement on the canal without troubling the cord, and long as you have enough leeway. Something to ask the doc.

I'll assume he said "moderate to SEVERE" left foraminal narrowing. He did not say, though, whether it's due to osteophytes - as at C3-4 - or if it's the disk that's causing the problem. You will want to know that, I think, because you want to clearly understand anything he attaches the word "severe" to.

C5-6 - Another big disk extrusion. This time, the foraminal narrowing is caused by the disk.

C6-7 - Not quite as big a disk problem as at higher levels.

There are two general ways to fix these problems, both surgical. One is to come in from behind and perform a "laminoplasty", where the spine is propped open to increase the space in the canal, and allow the cord to migrate backward, away from the intruding disks.

The other is the very commonly done anterior cervical diskectomy and fusion (ACDF), where the surgeon comes in from the front, removes the offending disk(s) and puts in donor bone pieces in their place, then installs titanium clamps to hold it all together.

My GUESS is that you are in for a multi-level ACDF, partly because laminoplasties require some remaining cervical lordosis, and partly because it's your disks that are 90% of the problem, and ACDF's fix (remove) them, while laminoplasties do not.

(for the record, I have had one ACDF 15 years ago, and one laminoplasty three months ago)

Hopefully, you now have a better understanding, which you can take to your next appointment. Try to get the surgeon to spend 10 minutes with you (and let us know if you succeed, as that may be a record!). Have him show you the MRI, how the loss of lordosis affects you, and where the disks are protruding backward into the canal. See if the cord appears to be affected.

Also, you might want to ask to what extent your foraminal problems, which are extensive and serious, will be alleviated by whatever surgery is chosen.

Finally, I hope you can get a second opinion (at least). If you have a multi-level ACDF done, there will be times in your recovery when you'll be thinking there MUST have been a better way, and it will help a lot if you can remind yourself that multiple docs all suggested the same thing.

Keep in mind that I'm an AMATEUR, with no formal training in any of this. All I want is for you to be in a better position to converse with the surgeons, understand what they are saying, and get them to fill in any gaps in their explanations. THEY are the authorities, and YOU are the decision-maker.

Good luck. I'm really sorry that someone as young as you is so afflicted (although you certainly seem to be handling it well). If you have any other questions, before or after your next visit, please ask, and let us know how things are going.

Last edited by WebDozer; 08-28-2011 at 09:09 PM.

 
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Old 08-29-2011, 04:03 PM   #5
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Re: anything for severe spinal canal stenosis besides surgery??

wow! thank u so much for all of that!! it does make a little more sense now. does the report say the width of my canal? im definitely going to get the surgery!! i still dont understand why this is causing the problem with my arm. i know many people who have had bulging or herniated discs but not have any problems w their arms!! why is that? not really fair if u ask me:P is it because i have myelopathy? i think thats why my drs called it. they also said ive got upper limb spacticity. not quite sure what that is either but suppose it has to do w the muscles in my arm getting really tight whenever i use it. i could google this stuff but dont wanna scare myself anymore than i already am! i know people that do that and i think they scare themselves into thinking they have more than they actually do so i try to steer clear of that. i need to ask my drs all of this stuff but i always forget..lol! but i wanna thank u again for taking the time to explain all that to me

Last edited by FrightenedMe; 08-29-2011 at 04:05 PM.

 
Old 08-29-2011, 04:24 PM   #6
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Re: anything for severe spinal canal stenosis besides surgery??

i would also like to ask how u felt after the surgery? how long did it take to recuperate? did u immediately feel better or did it take some time? w a spinal fusion do the plates or rods or whatever they use cause any pain? thanks in advance)

 
Old 08-29-2011, 05:27 PM   #7
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Re: anything for severe spinal canal stenosis besides surgery??

There's no reason to worry about the myelopathy, because there's no way to treat it. You have to treat the conditions that CAUSE it, so concentrate on those conditions instead. You have quite significant disk bulges. They are the likely culprits, and they can be treated with ACDF's. You may not get better, or it may take a while, but right now you want to stop getting worse, and stop it as soon as possible.

As for the arm trouble, I had symptoms in one arm that were largely alleviated by my ACDF, so they must have been the result of the disk impinging on the nerve root, just as it is with you. The people you know with herniated disks who don't have arm trouble... well, their disks just aren't AS herniated as yours are. So you're one up on them, I guess....

Just saw your other question... it was 15 years ago that I had my ACDF, and I frankly don't remember how I felt. If you think about all they're doing, you'll probably expect worse than what actually happens. Anyway, there is a lot of writing about multi-level ACDF's on this board, and others can tell you more than I.

Last edited by WebDozer; 08-29-2011 at 05:30 PM.

 
Old 08-30-2011, 07:26 AM   #8
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Re: anything for severe spinal canal stenosis besides surgery??

frighten, I have bulging disks and no arm pain. The only pain is pain in the neck.
It is literally pain in the neck. THe pain is pushins up not down.
So you are right. But still, it is causing unbearable pain.
Always get second and third opinion before any surgery.

 
Old 08-30-2011, 04:54 PM   #9
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Re: anything for severe spinal canal stenosis besides surgery??

Great job Webdozer...I'm finally back on-line after Irene. Hope I can help.

FrightenedMe...my condition was somewhat similar to yours and I had a laminoplasty where they re-build the back of the neck and then later, had 6 vertebrae fused also from the back.

Here is my question....did your surgeon say he was operating from the back or the front of your neck? Do you remember...that will tell us what is being done. If not, please ask someone to write it down when you go for your pre-op. That will help us tell you what to expect and what you need afterward.

I had arm problems...pain for quite a while followed by the same type of cramping and I dropped a ton of stuff. I had a subtle loss of feeling that I found out when I tested my fingertips for blood sugar(type 2 diabetic). It is caused by compression of the nerves coming out of the spinal cord. Different nerves at different levels go to different areas of the shoulders and arms and that is why some don't have arm problems....may not be that nerve.

What so many don't realize is that with spine problems, you start with pain and as it eases, you are actually getting worse. The loss of pain and the development of muscle problems(weakness, cramping) along with sensory problems like numbness and tingling are signs you are starting the slow descent to paralysis. Like me, you are getting there.

The problem with spines is that there is no non-surgical way to alleviate the problem. You have nerves between bone and hard discs...the proverbial "between the rock and the hard place". And the only way to fix it is removing one or the other. I do know people who have been so afraid of surgery they have opted for paralysis and are in wheelchairs..strange choice to me.

So you really have no choice if you want to keep walking and moving your arms. It isn't just arms...it's legs too when the neck is involved like yours, mine and Webdozers.

Wish you had known earlier and we might have been able to give you more advice but since you are scheduled already, time to start getting ready. Check out the thread at the top of the page and what you need after an ACDF.....good advice from those who have had it.

Any questions, we are here.

hugs............Jenny(fused C3 to T1)

 
Old 08-31-2011, 11:16 AM   #10
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Re: anything for severe spinal canal stenosis besides surgery??

I do know a few people who have had this done....and I am glad to report that they had complete success...good luck to you
I am 16 days post op from spinal fusion...it was the best decision I ever made...but yes, I know it is ver scary!!

 
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Old 08-31-2011, 11:36 AM   #11
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Re: anything for severe spinal canal stenosis besides surgery??

Quote:
Originally Posted by FrightenedMe View Post
I am a single 34 yr old mother of 4 children and was diagnosed 4 days ago w severe spinal canal and foraminal stenosis from C3-C7. I have been having a lot of neurological symptoms for 27 months and now i think we found the answer. My GP ordered an EMG when i went to see her because of a lot of muscles in my left arm that had been going crazy for approximately a month before seeing her. When I started to have severe cramping in my arm and thumb pulling in toward the palm of my hand while working I decided to go see my dr. I wasn't haviing much pain..just problems using my arm. She ordered the EMG which came back abnormal. She said the sensory part of the test was normal except delayed CMAP but the EMG itself was not so an MRI was necessary because of muscle damage in arm and a hidious claw hand I developed over the last 6 wks. I had the MRI about a week ago which showed the stenosis I mentioned above and because of recent loss of bowels and bladder she urgently got me in with a Neurosurgeon who will be preforming suregery on the 8th of next month because of lack of space in my spinal canal/cord...not sure which one or if theyre even the same. So, my question is..has anyone else had this and if so is there another approach rather than surgery? I don't really want the surgery, but my dr says this will progress without it. He said we could try conservative measures but highly doubts it's going to stop the progression in my arm..its pretty much useless as it is and i don't really care about that in comparison to the risks of paralysis if I don't get the surgery. I can do without my arm but NOT without the rest of my body!! Anything other than surgery would be preferred and it's not that I don't trust this dr but maybe he's rushing it? but I'm not a dr so i don't know...just hoping and praying there is an alternative to surgery...
hi, i have spinal stenosis in my lower back l1 down 2 s1 with bone spurs the dr. stated surgery was one of the options but i also developed rsd so they r wanting to try a spinal stimulator. that was one of the optons 4 spinal stenosis from the orthropidic dr i was seeing i maybe something that might work 4 u

 
Old 08-31-2011, 02:16 PM   #12
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Re: anything for severe spinal canal stenosis besides surgery??

Sorry to say Sears, that stenosis in the lumbar is different from stenosis in the cervical. The only nerves you are affecting in the lumbar are those that control the legs, bowel and bladder, but in the neck, that same stenosis can cause you to become paralyzed from the chin down and stop your breathing....it's potentially deadly.

And the lumbar vertebrae have twice the needed room for the nerves whereas in the neck, the foramina is very small in comparison. You can't wait.

Trust me, we all wish we had more options.

Jenny(fused C3 to T1)

 
Old 08-31-2011, 02:32 PM   #13
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Re: anything for severe spinal canal stenosis besides surgery??

Jenny,

the neuro is going to be going in the front. my dr told me last wk that if i had any numbness in my "saddle" area then to go straight to the ER. i woke up this morn to get ready for work and both my arms, from my shoulder blades all the way to my fingertips, were numb! i cld still use them, they just felt really heavy and like someone had frogged me in every muscle i had. so, i went to the restroom and realized my innder thighs were also numb. i decided to go ahead and go to the ER and they said theyre a little concerned that im getting something (dont remember the name of it) but until i can not pass any urine at all then i can come home. they also said that there is significant weakness in my right leg when compared to my left. he said that either my neck is causing this or im having a problem w L3 and the nerve roots r being compromised there also! grrrrrr!! i dont understand what happened to me. my hand is a mess. im falling apart at 34 yrs old my whole body aches. i dont have much pain in my neck or arm. i do, however, have a lot of aching/cramping, and have had for about 3-4 months in my lower abdomen, back or hips. i cant tell which. it seems ti be all the way around..i dont know how to describe it. almost like someone is squeezing my around my hips. but its very achy and crampy. well thank u so much for the post..i do have to go bc my 5 yr old is wanting my attention. oh, i wanted to ask..do u feel better after the fusion?

 
Old 08-31-2011, 02:48 PM   #14
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Re: anything for severe spinal canal stenosis besides surgery??

Quote:
Originally Posted by sears View Post
hi, i have spinal stenosis in my lower back l1 down 2 s1 with bone spurs the dr. stated surgery was one of the options but i also developed rsd so they r wanting to try a spinal stimulator. that was one of the optons 4 spinal stenosis from the orthropidic dr i was seeing i maybe something that might work 4 u
what is rsd? and and ive never heard of a spinal stimulator...my neuro never mentioned that. what does it do exactly? its an alternative to surgery??

 
Old 08-31-2011, 04:07 PM   #15
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Re: anything for severe spinal canal stenosis besides surgery??

RSD is reflex sympathetic dystrophy, a pain syndrome not connected to spine issues. A spinal cord stimulator is used to ease pain in the spine when surgery does not help. A certain number of people will always have pain even if surgery is done and no one seems to know why. But it is not used "instead" of surgery where surgery may fix the problem but to help control chronic pain when pain meds and other pain management treatments don't work. And for some people, no one can find the problem causing the pain and it may be used then or for people who can't undergo surgery due to other illnesses. But then you have an implanted metal device and you no longer have an MRI and they can easily get infected so you have a whole new set of problems.

Spine problems are tough.

Jenny

 
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