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Old 09-27-2011, 12:16 PM   #1
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Spinal stenosis-canal measures 5 mm and 6.6 mm

in two places where I have herniated discs. I also have advanced bilaterial foraminal narrowing. Disc 4-5 and 5-6 are affected. I have no change in the cord signal which is a good thing they say.

I've been referred to a pain specialist whose first question was had I seen a Neurosurgeon or an orthopedic surgeon. I am self pay for medical help outside of any system that doesn't take Colorado's Indigent Care Program so it's really hard to get in to see someone. Surgery would be paid for since it would be at the hospital and hopefully the surgeon accepts CICP for the hospital too. The ones in town do-it's just getting in for the consult and paying their fee which is quite expensive even if they discount for self pay.

He said that I would most likely need surgery but is going to try the ESI first. This way he can at least refer me to a specialist for surgery if needed.

I have noticed that my arms are getting a little more weak. I can't explain the sensations because they are hard to describe but the muscles seem to not want to work. When I cough sometimes I will get like an electrical impulse through my body. I also sweat a lot-I seem to be having problems regulating that.

I've had PT but it just made it worse. The last time I went one of the exercises actually made my collarbone hurt and it hasn't gone away-that was 3 weeks ago. All the pain meds they have prescribed do nothing-the last was morphine. All they do is make me constipated even if I take peri-colace like they say to and then I wind up vomiting because my bowels won't move. The same with neurontin.

This sucks and I wonder what others have chosen to do. How narrow has your spinal canal become before doing surgery and will mine get more narrow without surgery? Is it true that if the pain starts to get better it means the condition is getting worse? I wonder because that's what's happening and I'm hoping it is getting better but should I be concerned?

 
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Old 09-27-2011, 12:51 PM   #2
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

I have twice had my cord compressed down to 5mm, The first time - 15 years ago - required a single-level ACDF. The second time - a few months ago - was treated with a three-level laminoplasty.

I would say that if you are compressed that much, and in two places, you probably need surgery right away. It's not just that symptoms can get worse, but the ones you have are more likely, over time, to become permanent.

My amateur opinion (based on a lot of personal experience, however) is that you should not waste ANY more time with PT, or drugs, or anything but surgery. Find out what the docs think you need and get it done asap. If they make you jump through one last hoop (ESI), get it over with as quickly as you can and move on to surgery. Skip it, if possible, ESPECIALLY if it means you'll have to wait months for surgery. Those are months you do not want to lose.

If you want an informed-amateur opinion of your MRI please post the radiologist's report.

Last edited by WebDozer; 09-27-2011 at 12:55 PM.

 
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Old 09-27-2011, 01:08 PM   #3
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

Cervival spine MRI

C2-C3-Normal

C3-C4-Mild disc dessication and annular disc bulging without compromise of the spinal canal or neural foramina

C4-C5-Moderate disc narrowing with moderate broad-based annular disc bulge that effaces the ventral epidural space and narrows the AP diameter of the spinal cord to 6.6 mm. There is advanced bilaterial neural foraminal narrowing.

C5-C6-there is a prominent central disc protrusion with heterogeneous signal that narrows the AP demonstrate canal to 5 mm. There is no change in cord signal. There is mild bilaterial neural foraminal narrowing.

C6-C7 There is a subtle annular disc bulging without compromise of the spinal canal or neural foramina.

C7-T1-Normal

T1-T2-Normal

The radiologist impression just highlight the two sections where there is the canal stenosis.

 
Old 09-27-2011, 01:28 PM   #4
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

Thanks. It doesn't seem that the disks are BADLY herniated (although the exact meaning of "prominent", for this particular radiologist, is unknown). And he doesn't say that the cord is BADLY compressed, although he may just be letting the measurements say that for him. I suspect you may start out with a smaller-than-normal cord and an even smaller-than-normal canal, so it doesn't take much to squeeze them down pretty tight.

It's not unlikely that you'd benefit from a laminoplasty, but the surgery that the most docs do (important, I would think, given your financial constraints), and the one you won't have to convince anyone you need, would be a bi-level ACDF. Quite common and straightforward. Recovery from the surgery should be pretty quick, although how well you recover from your pre-surgery symptoms is another matter (still, you need the surgery to keep things from progressing in the wrong direction, which they very probably will).

Last edited by WebDozer; 09-27-2011 at 01:29 PM.

 
Old 09-27-2011, 01:32 PM   #5
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

One more thing.... whatever surgery you do, you need to address the foraminal narrowing as well as the compressed cord. It may very well be that the foraminal narrowing is also caused by the herniated disks, in which case an ACDF will do it. However, if it is caused by bone spurs (osteophytes), I'd ask any surgeon recommending an ACDF if he thinks he can get at those spurs by coming in from in front.

And, of course, keep in mind that I'm just an opinionated amateur...

Last edited by WebDozer; 09-27-2011 at 01:35 PM.

 
Old 09-27-2011, 01:54 PM   #6
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

This started on June 20; I woke up with a stiff neck. I've had the run around all this time because of my financial situation. The Community Health Center that I go to referred me to a PA at an orthopedic office who said there was nothing wrong with my MRI and it was my muscles that were causing me pain. He gave me an injection of baclofen and then manipulated my neck which made it worse. After reading up on the condition I see that was the worse thing he could have done.

I did see the MRI and the canal is really narrow at two spots. Another PA at another ortho's office went over it with me and showed me that it basically disappears at one spot what ever that means.

I really don't have any other choice but what I'm doing now. The neuro's want $250 same day payment for a consultation and I need to be referred to them before they will see me. The Ortho's and spine people want to review my case before they will even see me so even if I do have a referral it depends on their decision.

I don't know why he didn't put "badly" in the report and used prominent instead but I do know that the pain doc was very concerned when he read the MRI report. Like I said, his first words were "Have you seen a neurosurgeon or an orthopedic surgeon" and "you will probably need surgery".

 
Old 09-27-2011, 01:59 PM   #7
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

That first PA is someone you might want to avoid.... good luck!

 
Old 09-27-2011, 02:08 PM   #8
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

Quote:
Originally Posted by WebDozer View Post
One more thing.... whatever surgery you do, you need to address the foraminal narrowing as well as the compressed cord. It may very well be that the foraminal narrowing is also caused by the herniated disks, in which case an ACDF will do it. However, if it is caused by bone spurs (osteophytes), I'd ask any surgeon recommending an ACDF if he thinks he can get at those spurs by coming in from in front.

And, of course, keep in mind that I'm just an opinionated amateur...

Yeah, I have a bone spur too. The PA at the second ortho's office showed me that too.

 
Old 09-27-2011, 02:12 PM   #9
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Re: Spinal stenosis-canal measures 5 mm and 6.6 mm

Quote:
Originally Posted by WebDozer View Post
That first PA is someone you might want to avoid.... good luck!
Oh, I never went back to him. After his "treatment" I felt worse. The second one told me he doesn't believe in manipulation which made me feel better. Most of the people I've seen have been great.

Thanks-I'm hoping that it just doesn't get any worse right now.

 
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