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  • Cervical Stenosis with myleopathy

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    Old 01-19-2015, 09:16 AM   #1
    medlinfla
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    Cervical Stenosis with myleopathy

    Need help
    Received above dx from several docs, Neurosurgeons, some want to operate, some not so much. My Neurologist and the Neurosurgeon who wants to operate has warned me that if I do not have surgery I will become parallized
    C5-6. My dilemma is caused by the fact that I do not have any pain.
    Have some tingling in fingers and crackling in my neck when I turn it.
    They said the narrowing is down to 4mm wide in that area.
    How can that be without pain.
    I played a lot of sports and now I am told not to even move my neck quickly.

    Also not sure whether a Neurosurgeon or Orthopedic Spine Surgeon is best for this problem.
    Terrified of surgery as I had a stroke a few months ago and have COPD.
    Live in Florida, any recommendations of Docs
    Thanks
    Terry

     
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    Old 01-19-2015, 12:50 PM   #2
    Lionor
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    Re: Cervical Stenosis with myleopathy

    Hi,

    I'm sorry to hear about your diagnosis and situation. I know first hand how different surgeons can give wildly different action plans. It depends on how conservative they are, what procedures they have more of a predilection to and lastly by their age. I have noticed the younger surgeons seem to be more pro-active and more willing to think outside of the box. (Not trying to be ageist)

    Anyway, to the issue at hand - 4mm is very tight indeed. It's just at one level. Does your spine state effacing? Abnormal signal? And without knowing what the cause is (disc, bone, anterior, posterior) it's hard to give any specific advice. Also your age would help along with any other issues like bone density, arthritis etc... Do you stumble, drop things, have trouble walking in a straight line?

    But like I said 4mm is very tight, I don't see a reason why they wouldn't want to take the pressure off the cord with an ACDF. If it's just at one level it should resolve the issue. Heck at one level they could replace the disc and preserve motion (FDA approved).

    You may not have any foraminal stenosis, or radicular symptoms. You don't have to have pain to have myelopathy and vice versa.

    Can you post your MRI here? or give us a little more information.

    I'm contemplating a laminoplasty and I understand your fears, esp since you had a stroke and have breathing issues.

    Neurosurgeons and Orthopedic surgeons are basically one and the same as long as they are both spine specialists. Look for ones that have residency, internship and fellowship training.
    Iím sure that didnít help much, with more information on your stenosis/compression we may be able to give more guidance.

     
    Old 01-19-2015, 07:43 PM   #3
    ChuckStr
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    Re: Cervical Stenosis with myleopathy

    At 4mm you certainly have compression of your spinal cord. At C5/C6 your spinal cord would be at least 7mm normally. That much compression is probably dangerous on its own but, as you've experienced, you'll often get different opinions on this depending on who you talk to.

    As far as ortho or neuro spine surgeons it probably doesn't matter as much as them being spine specialists. Spine specialists have received specialized training in diseases of the spine that a "regular" neuro or ortho surgeon wouldn't have. They also limit their practices to spine issues. I personally, think there are some differences, however, and it is often useful to get opinions from both. In my experience, ortho spine specialists tend to be a little more conservative and also more willing to think outside the box in terms of treatment. As Lionor suggests, ADR (disk replacement) may be a possibility in your case since you have only the one spinal level. That is something you'd want to explore with the surgeons you get opinions from.

    It is relatively common to have cervical cord compression/myelopathy without significant pain if you don't also have neuroforaminal stenosis causing nerve root compression. The other problem with myelopathy is that it is impossible to predict the course. In general 75% of sufferers have stepwise symptom increase followed by some amount of stability and/or alleviation of symptoms. 20% have consistent slow degradation and 5% have fast progression. Symptoms to watch for are hand clumsiness, gait disturbance, foot drop, and bowel/bladder issues.

    I don't have specific recommendations for Drs in Florida (living on the other side of the country), but in general, university hospitals will often have spine centers with excellent spine surgeons.

    Good luck and let us know how it goes....

     
    Old 01-21-2015, 11:44 AM   #4
    jmh94
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    Re: Cervical Stenosis with myleopathy

    medlinfla

    I have been in this very situation. The reason I got it all checked out was because at first my pain was unbearable and with weakness in the tricep, forearm and lats. The pain subsided after a few months and I mentioned this to my surgeon. He said that even though the pain had diminished, the pressing issue is the neurological problems.

    As you say you used to play a lot of sport and my surgeon also refused to let me even lift heavy bags before the surgery. I can only advise you with what I have been through. I am now post op 3 months, did not once see a neck brace and already muscle memory is kicking in, less numbness and full range of movement from a single fusion in my neck.

    Honestly never looked back after this surgery and no longer have to worry about spinal cord deterioration.

     
    Old 01-21-2015, 12:56 PM   #5
    medlinfla
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    Re: Cervical Stenosis with myleopathy

    Thanks so much for taking your time to answer me. I am 73, but very active. No pain, Cspine filled with Arthritis, I think they call it spondylosis. Do not stumble, drop things a little trouble walking a straight line but that could be because 6 months ago I broke 4 bones in my ankle, Very high, non-supportive shoes. I have osteopina. My neck cracks when I move it, makes funny noises.

     
    Old 01-21-2015, 04:59 PM   #6
    ChuckStr
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    Re: Cervical Stenosis with myleopathy

    Unfortunately severe osteoarthritis of the spine is fairly common in people your age. Dropping things and gait disturbance are symptoms of myelopathy which is basically spinal cord damage which could be due to severe compression of your spinal cord. Yes, it is possible the trouble walking is due to something else, but I think it is definitely worth getting checked out by a spine specialist. The cracking of your neck when you move it (known as crepitus) is probably indicative of the arthritis there.

     
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