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Old 10-17-2012, 02:37 PM   #16
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Re: Severe cervical spinal stenosis

Quote:
Originally Posted by xcobra View Post
Ladybud - Thank you for your reply! We appealed twice about the MRI with contrast; they would not back off their guidelines. With the CT showing some problems, maybe it will be different this time. I am going to ask the PM doc to refer me back to my NS for eval. Maybe there will be a chance Cigna will allow both MRIs if he orderd it (there seems to be some weasle wording about a specialist being able to do more than the original requestor. Of course, he is also a specialist, so who knows).
I have had my thyroid checked very recently, and the lab results indicated normal. Pain in neck and shoulders/biceps area is sometimes severe and wakes me up at night, but is not constant. Trying to find a comfortable position is difficult also. The pain is not as bad as it was prior to my original surgery in 05, but severity, duration, and frequency are all increasing. I have noticed increasing balance problems, no dizziness, just having to regain balance sometimes as I turn around or when I just close my eyes like when showering. I haven't noticed any real clumsiness in my hands, although there are times when my right hand/fingers "contract" or pull inwards together like a charley horse (?). Also some unconscious finger stiffening. So I don't know if this is a tempest in a teapot or if I really have a problem.

Hi, just wondering if you had more surgery & if so did it correct your issues with balance.

I had acdf surgery in Jan/11 at C5 & C6. Before surgery I was falling after losing my balance or tripping. My balance issue has gotten progressively worse & after numerous falls (avg 3x's month) I now have to use a walker inside & outside the house. I haven't found anyone else complaining of balance problems until reading your post. My last mri showed some arthritis in the discs above & below and the brain scan was normal. I have some pain in different areas of my neck & lwr spine but I can easily live with it. I'm just worried about ending up in a wheel chair or brain damaged from another fall.

Thanks in advance & good luck getting the help you need.

 
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Old 10-17-2012, 10:25 PM   #17
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Re: Severe cervical spinal stenosis

Hello bhills! I too have had an ACDF 5-6,7 (in 2005) and the C7-T1 foramenotomy in 2008. I had no choice on the ACDF since there was an osteophyte pressing against the sac and I was losing CSF. I had severe pains down left arm and the surgery sure helped that. My range of motion has been pretty good,but in the last 2 years I had to take some pain management procedures. Currently, I am having balance problems myself, tho not as bad as yours. Pains in biceps are getting worse as well as sciatica and tingling in feet. No surgery yet. I finally got an MRI the other day and awaiting doc to get back in town to tell me the results. Are you being followed by a doc for your problems? Surely they have done some testing to find out what is going on? Good luck and keep us inormed. I will publish my MRI report when I get it.

 
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Old 10-17-2012, 10:53 PM   #18
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Re: Severe cervical spinal stenosis

Well, Ichecked my mail after replying to bhills and my MRI report was there. Here is what it says:

"Exam: MR C-Spine w/o contrast

Findings: Sagittal and axial imagesof the c-spine were made. They demonstratenormal alignment with no compression deformityor subluxation. There is no pathologicmarrow signal. No paraspinous mass is noted.The cervical cord is normal in size and signal. There is no significant cerebellar tonsillar hernition.

C7-T1 has no significant abnormality.

C6-C7 has been fused. Anterior plates and screws do generate artifactbut the study is concerning for osteophytic encroachment on the left spinal canal and the left foramen.

C5-C6 has been fused and is partially obscured by artifact. Study suggests osteophytic encroachment on the left foramen.

C4-C5 has moderate disc bulging and osteophyte with moderate to moderately severe central stenosis and foraminal narrowing.

C3-C4 has marked narrowing and dessication of the disc with moderately severe disc bulging and compromise of the canal and foramina.

C2-C3 has no significant abnormality.

Impression: Postoperative and degenerative changes, including central and foraminal stenosis at C3-C4 through C6-C7."

So there it is. What do y'all think? Is C3-C4 something to worry about or "watch"?

 
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Old 10-18-2012, 11:42 AM   #19
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Re: Severe cervical spinal stenosis

Hi Xcobra, Thanks for responding & sorry to hear you are still having problems...too bad they couldn't just come up with a total spinal re-construction/transplant for people like us. I am being followed by a physiatrist (re-hab doc) in London, ON. So far rehab is not helping & since my last fall causing a huge goose egg on my head I asked emergency doc for script to get a protective helmet. During my recent in-patient rehab they took another mri of my head & neck & noticed arthritis in disc above & below fusion. Doc said that may be pressing on a nerve & I'm to see N/S next month. Don't know about you but I'm not crazy about the thought of more surgery but what can you do? Take care & good luck to you.

 
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Old 10-18-2012, 11:48 AM   #20
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Re: Severe cervical spinal stenosis

Xcobra - Your C3-4 looks like something to watch, depending on symptoms. Do you have any symptoms that you might attribute to that level?

Actually, everything from C3 to C7 would bear watching. Unfortunately, the radiologist has not been very articulate in his descriptions, so little help there...

 
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Old 10-18-2012, 01:18 PM   #21
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Re: Severe cervical spinal stenosis

WebDozer - You're right, the radiologist could have been much more helpful in his interpretation of the MRI.
I have noted worsening neck pain, even when not moving. It really lets me know when I do the neck stretching exercises I have done since my original surgery in 2005, especially to the left side. Normally the pain is dull or aching and is somewhat constant, but can be sharp. I find I can block it out some of the time by concentrating on some task I am doing. Other times, it hurts enough that I have to stop what I am doing until the pain passes. Sometimes, the pain extends down into the shoulder blades or across into my shoulders. I really have pain in my biceps, left primarily, though the right also hurts upon occasion. The pain in my left biceps was like a band across the biceps and was achy and diffuse in nature (if that makes any sense). Recently the orientation and severity changed so that the pain is parallel to the biceps, just off the midline (away from the body). Pain is now sharper and seems more focussed. This pain is even evident when I lay down at night to sleep and often wakes me up; can't seem to find a comfortable position to put it. I also still have the sharp pain into my left ring finger. I do have occasional sharp headaches usually centered over one eye or the other or it feels like a sharp needle-like pain deep inside my head. I am having some balance problems when walking, occasionally when simply standing. No dizziness at any time. I don't know if I would call it clumsy hands or not, but I seem to be losing my grip at times, letting things fall to the floor without realizing I have relaxed my grip. No incontinence , just increased constipation . Oh and increased difficulty in swallowing. Since neither the recent CT or the MRI noted any of my fusion instrumentation or an osteophyte pressing against my esophagus, I guess there is another reason.
I just talked to the pain management staff to get the doc's take on this. He agrees there's a lot of wear and tear, but isn't ready to send me back to the NS yet. Not that I am advocating surgery, I just want to know if the situation just bears waiting or what. And when do I know that I have to get something done?

 
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Old 10-18-2012, 01:29 PM   #22
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Re: Severe cervical spinal stenosis

Reading report again, it looks even worse. he doesn't even say WHICH SIDE has the foraminal problems. It is exceedingly unlikely that both sides are the same.

As for the PM doc, I don't want to question his honesty, but he has a built-in advantage to keeping you coming back.

Can't you see someone in between PM and surgery, like an orthopedist? And get that MRI read by a different radiologist? If you want a name, I will give you one.

 
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Old 10-18-2012, 02:18 PM   #23
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Re: Severe cervical spinal stenosis

WebDozer -
I guess I assumed that with what is occurring at C5-6 and C6-7 foramina (left side) that it would also be that way at C3-4 and C4-5.
As far as the PM guy, at my last procedure, he said something a little odd to me before I went lights out. He said that there was a level of risk associated with these epidural/facet joint procedures and wanted to be sure I was still ok with having them done. I'm like - "Holy smokes, is my number coming up?" - because I have had several procedures over the last 2-3 years. So, I was left wondering if he thought I should stop taking them. His PA told me to relax, he was just making sure that they were doing the best for me. I have no reason to doubt these folks. And they are in the same building as my NS. neurologist, and PT people. One big happy family and all connected to the Huntsville hospital computer database.
There is an Orthopedic association connected to the hospital also. My problem is that my NS (who referred me to the PM doc) has operated on me twice and held if not my life, then my ability to use my arms and legs, etc in his hands both times. I have absolute confidence in his ability, but would not want to jeopardize a good relationship by going directly to him around my PM guy. In fact, I believe the NS practice requires a referral. Any suggestions? Maybe show the report to my family doc and ask for a referral that way?

 
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Old 10-18-2012, 02:21 PM   #24
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Re: Severe cervical spinal stenosis

Doesn't seem like there's much you can do, if you are stuck within that system. If it's just a matter of going to another city, you might consider it. As for showing the report to your GP, you need a better report, first....

Last edited by WebDozer; 10-18-2012 at 02:24 PM.

 
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Old 10-18-2012, 02:43 PM   #25
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Re: Severe cervical spinal stenosis

WebDozer - By the way, you have had significant work done to you neck. What kind of ROM do you have?

 
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Old 10-18-2012, 02:46 PM   #26
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Re: Severe cervical spinal stenosis

My ROM is good. Keep in mind that I've only had one single-level ACDF, and that was on one of the less important disks (C3-4). The second operation was a foraminotomy, which has no effect on ROM, and the third was a laminoplasty, which is designed to preserve ROM...

 
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Old 11-13-2012, 11:53 PM   #27
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Re: Severe cervical spinal stenosis

I had my latest pain management procedure on 11/13/12. Before going under, I talked to the doc, explaining my concern about the not more than 8mm width of the canal at C3-4 and C3-5 (from the CT) and the impingement on the canal in that area (from the MRI). He agreed that I should be concerned but said if I were to have another fusion, I would probobaly need another in 5 years. I told him I was not advocating surgery, but again expressed my concern about the impingement. Then he asked if I had talked to my NS yet. I told him he requires a referral so he said he would put a note in my chart. Hopefully, I guess that means I will see the NS soon.

 
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Old 12-04-2012, 10:58 PM   #28
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Re: Severe cervical spinal stenosis

Saw my NS today (12/4/12) and he said we needed to fix the problems, or at least some of them. On 17 Dec, I have an ACDF of C3-4 and C4-5, removal of some of the osteophytes I have causing some of the compromise to the canal, plus removal of the old hardware from my earlier C5-6,7 ACDF. Spacers will be put in place with a mix of ground up bone from my spinous process and BMP, then some rods and screws to hold it all together. The deal should take abou 2 hours and I may or may not have to stay overnight. Las time I did this, the bone spurs had put a hole in the sheath surrounding the cord causing leak of CSF, and the doc had to glue it shut. Anyway, I had to lay flat of my back for hours and they kept me overnight. Hopefully, this time will be better.

 
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Old 12-05-2012, 06:34 AM   #29
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Re: Severe cervical spinal stenosis

Good luck with all that. I think it's remarkable that they'd even consider making something so extensive an outpatient procedure. Please keep us updated on the hospital stay and the recovery...

 
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Old 12-21-2012, 04:20 PM   #30
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Re: Severe cervical spinal stenosis

I had my surgery on 12/17/12 - ACDF C3-4, 4-5, removal of several bone spurs, and removal of the hardware from my ACDF 5-6,7 from 2005. Surgery went well, very little pain post op on Monday. Was encouraged to walk around the hall as much as I desired. Later that night, though, I started leaking what turned out to be CSF from my incision. The next morning the neurosurgeon put in some more sutures and staples and put me flat on my back for 24 hours to seal the leak. He told me that several of the bone spurs didn't just puncture the dura, they were growing into it. So, he had to disect them out and put an artificial sheath around the dura to repair the damage. It will absorb into the natural dura over time. I came home Wednesday morning and am doing pretty well.

 
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