Hi Allen, I've been through the same run around with surgery, to have or not to have. basically an impinged thecal sac is just a physical abnormality,or structural defect, the pain may or may not be from the impinged sac,It may be entirely disco geneic an the you have to find a doc willing to fuse you to relive pressure on a ruptured discs. A disco gram would determine the extent of the damag e to the disc, or a mylogram CT in which you flex and extend. But the fact they can see the a sac impingement dosn't mean that surgery would relieve your pain.
The criteria to have surgery has more to do with damage being done by not correcting it. I have had several surgeons tell me that nobody ever died from pain, personally I don't agree but that's anothr topic. The types of things that determine the need for surgery is first, a clear mechanincal problem that can be coralated to the symptoms you have, again, pain isn't one of the symptoms they look for or give much creadence too. It's more of a guide to where the problem is. They aren't fixing pain, they need to fix the generator. They look for neurologic impairment like loss of reflexess, loss of strength, loss of coridiantion, loss of bowel and bladder control, muscle atrophy and other visable and measurable neurological symptoms that continue to get worse.
If you have back surgery or neck surgery solely because you have back or neck pain without the neuro problems like loss of strength, muscle and reflexes, surgery on your spine to reduce spine pain is rarely succesful and more often creates more pain. Docs don't want to perform a surgery that isn't going to be succesful by the standards and meaures they use.
They measure success by a differnt standard. If you had an EMG that was totallly wacky from a nerve compression in your neck, had muscle atrophy in your arm and loss of strength and coordination, those are the things they look to correct with surgery. If you had a fusion and those things were corected but you were left with more neck pain that you ever had before, your surgery would still be considered a success and the pain just a consequence from needed surgery to prevent further neuro damage. If the muscle grows and your hand strengthens and your reflexes return, than the surgery is a succes despite any compliant of debilitating neck or back pain.
The goal of surgery was to correct neuro defects. Pain isn't a visable defect they can pinpoint and isn't used for sole critieria for surgery.
It's certainly not all in your head, He just doesn't see the benefit or value in taking a risk at worsening your pain if your goal is to reduce your pain.If you have surgery and end up in more pain, there isn't a pain relieving surgery. You might be a better candidate for nerve blocks, ESI, RFA or nerve destruction to ease the pain through interventional therapies, but open spine surgery rarely decreases pain if that's your chief complaint.
I've been through this with every surgery an it wasn't untill I lost reflexes, couldn't lift my toes, had hardware snap and impinge nerves that caused bowel and bladder problems before anyone would even consider surgery. Pain reduction is a secondary goal of surgery and relieving pain alone isn't worth the risk of making things worse.
Sorry Allen, I wish I had a beter answer, but you really don't want to have surgery unless the poblem is clear cut "mechanical defect" and the benefit is clear cut and the surgeon knows that by relieving an impinged nerve it will likely restore neurologic function. An Impinged thecal sac really doesn't have a dermatome to folllow or have a direct coralation to any specific area or problem.
Untill an impinged sac progresses to an impinged cord and major stenosis that causes you to wake up or rapidly develop a cord compression and you have a mirad of neurological symptoms and possible paralysis. I don't think an impinged thecal sac has been directly limnked to pain generation, It may predict future risk but It's really a roll of the dice if that's even what's causing pain and surgery to fix, is extremely invasive in your cervicle spine.
Instability is anther reason for surgery, If you have spondylothesis grade 1,2,3 or 4 the hhigher number being the greater degree of slippage. This is where the vertabrea shift upon flexion and extension an that cause a thecal sac compression which could lead to cord compression and wose case sveering to a degree is another reason to operate, but pain itself is very iffy? Without the major neuro problems, altered sensation is a problem but at what risk is altered senasation put you at Vs surgery.
By alterered sensation that caould be anything from pain, to feeling likje it on fire to nuumbness or feeling it's in a bucket of Ice, The nerves can be prettyt creative.
You may have to wait untill you have a clear cut need that they see and believe can be corrected or an impinged nerve from a disc would be something obvious that can relieve radiculopothy/ when severe enough causes all those major symptoms.
THere are also docs that will cut on anyone desperate enough to have it done, That may not be the best way to go and the advice to keep getting opinions untill your convinced this should or can't be fixed and th odds are in your favor. It may be a good thing when someone first apt with a surgeon says wait and follow the standards of care, anti inflamatories, PT, and pain relief. Already being a CP atient may be what's stopping trying PT ito see if it can help? There are more than one kind of PT's. Some were great at masssage and and hands on, there is scarr management, myofacial release and trigger point pressure, the Mcekenzie method, core stabilization and excercisse to correct posture and strength.
Have you tried anything lately like that or the way they would treat an acute injury in a non CP patient? I would love to get back into PT, but they have to be able show functional and measurable improvement and I keep hitting the same wall as far as endurance or standing and sitting, I do a lot of posture and core strengthening at home which helps but a massage sure would be nice.
Good luck and keep us posted. I would definitely get other opinions though, It's not insulting, When you have een everyone in a particluar loop of docs that don't like to disagree and sometimes you have to get an Indepenent medical eval, with a nurosurgeon that starts fresh and isn't influenced by their buddies opinion. Sometimes leaving the area is a must and a med school dept of NS or ortho would be the place to go.
Hang in there, Dave
I don't know if this was helpful to the original poster, but it sure was to me.
