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Cervical - moderate, bilateral foraminal stenosis (multi levels)

MelWMMelW Posts: 426
edited 06/11/2012 - 9:02 AM in Spinal Stenosis
I am still waiting to get in with my neuro, so I am now just trying to educate myself before my appt. I posted a similar post in "Chronic Pain," but have not gotten a lot of response, and just now found this section on SH.

Anyhow, I have read a gazillion stories about cervical stenosis, but a lot of them leave out how severe, unless it is severe or congenital, then it is usually stated. So my question is, do surgeons normally wait until it is severe to do anything? Or does it also depend on your symptoms?

Also, as I have read may different stories (obsessively!!!!), I have noticed that many refer to their compression as "5mm," for example. My report says I have moderate, bilateral foraminal stenosis on multiple levels, but never refers to an actual measurement. I guess I should also mention that I have had prior cervical surgery, ACDF C5/6 in 2009. A little more background, I have been going to a pain management doc since March 2010, am on several pain meds to attempts to manage my pain, and I have tried more injections to see if they would successfully work before moving on to see my neurosurgeon, which they didn't help more than a day or so.

So, here I am still going nuts trying to figure out how my appt is going to go, when I do finally get an appt. I feel like it will go one of two way; 1) "wait and see how things progress" 2) surgery... At this point, I just want some relief! If he told me I could "possibly" get 20-30% relief from surgery, I would jump at the opportunity. I can't handle much more, I am absolutely miserable and very impatient for this appt to get here so I can get some answers. Two years of pain management and several injections later, and I a prepared to take the chance of going drastic in hopes of some relief.



  • Just read your post and am going through much of the same. ACF at C5/6 2009 and it went great - no issues, then boom - one day I wake up in level 8 pain with C6/7. Prednisone, ESI, narcotics...waiting on MRI. Scared that another surgery is in the future - and what do they do? Just another fusion, or a cage? It's tough waiting...I waited 2 years post diagnosis the first time, no way am I waiting that long this time! Hope your appt went wwell.
  • I posted a rating scale sometime back but am not sure where it went. However I have found that some radiologist do use and some don't and I think a lot depends wether they know the surgeon reads the films or not. Anyway for it to get on the rating scale it has to be at a 3mm, according to the AMA guidelines so maybe that tells you something.

    Now when they use things like moderate and severe, the problem is your moderate and my moderate might be a little off, your not sure what scale they are using. However their are the same guidelines for that as well. If I can find that scale I will post again, but you might need to remind me, ha ha sieve brain sometimes.

    Some surgeons may not operate till it is severe or causing neurologic issues. Which is why it is not only the films but his/her clinical exams that is taken into account. They have the standard test they do for each set of nerves looking for issues. He/she may also say lets do some more testing as they just aren't sure. Once you had surgery and the hardware is in place MRI's aren't as clean as they can be, unless of course you had dye.

    Now hopefully he gives you better odds on pain reduction like more 50-50. However even with surgery more than likely the pain issues you still have from the other levels won't go away, especially if you have nerve damage. Once a nerve is damaged it is damaged and won't heal itself. Keep in mind when we talk of damage it is different that just compressed. But then again maybe all along the pain you have been experiencing is coming from the other level.

    If he/she would suggest surgery, be sure you are prepared with questions. Things like your old hardware, being removed, using the same entry and so on. Those things are important, as you really don't want them adding on, for the main reason your cervical spine just isn't setup to handle it, with swallowing and so forth. But also on the same incision for purpose of scar tissue. Bi-lateral incisions create scar tissue on both sides and cause other issues. If for some reason you are using a different surgeon well they don't typically like to use someone else's incisions. Also be prepared to discuss if he/she says to wait and see, as in wait and see what? I think to many times, patients don't get the warning signs cleared with the surgeon as to what they are waiting and seeing. Then they are not sure if they are bothering them or they should call.

    Like I tell everyone only you can decide what is right for you and your individual circumstance. Your the one at the end of the day whom has to live with the outcomes good or bad.
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  • Thanks Tamtam! I am going to the same surgeon. He is awesome and very caring. I feel totally comfortable talking to him, which is not always the case for me. I tend to get intimidated with docs... when I tell them something and they either blow me off or challenge it, I just back down and get quiet. With him, it's not like that at all.

    Anyhow, why do/would they remove the old hardware? I have heard others talk about hardware removal, but never fully understood why, unless something is broken or loose.

    My surgeon will not operate unless my day to day activities are being interrupted, which they are. I have pretty intense arm pain, both arms (which with my first fusion it was just my right arm), can't sit or stand for long, dropping/running into things... If my pain is "ruling" my life, and he sees issues on my mri, then he gives the option of surgery.

    I did have dye, they did it without dye and then pulled me out and injected the dye and put me back in.

    When I had my injections, in January and March, a lot of my pain was gone right after the injection, but it returned as soon as all the numbing wore off. I assume that's a good sign as far as where my pain is coming from. He did the injections above and below my fusion. I assume that because it did initially drastically reduce my pain levels, that's good diagnostically?

    I am counting down! 24 more days till I see the neuro!!
  • I forgot to mention weakness too. That is getting pretty bad. Just lifting a shirt on a hanger and putting it on the clothes rack makes me feel like I have lifted 100 lbs. If I raise my arm in front of me, about shoulder level, my arm shakes because it feels like I am holding something heavy straight out in front of me. It is hard to explain... I had weakness prior to my first surgery, but it wasn't this bad. I feel stupid trying to explain it. It is like I went to the gym and worked my arms out. You know that feeling like your arms feel like jello after you work out, like if you were to pick up anything afterwards you would drop it? That's what it feels like.
  • Hi,

    Can you pls guide me on this: My father left hand movement has got restricted. He is not able to move his hand but there is no reduction in strength . He is able to do every thing by himself. So we consulted neurologist on this and he came up with following diagnosis: Neurogenic changes in R C5,C6,C7 and L C5,C6 segment in the form of reinnervation without ongoing denervation with possible site of localization being PREGANGLIONIC.

    He referred us to neurosurgeon and neurosurgeon suggested us following : Foraminotomy bilaterally at the effected level .And he said if we don't go for this operation right now other hand and legs will also get affected and he might suffer from paralysis

    I want to know : Is it advisable to go for Foraminotomy at the age of 63?

    how much time will it take to heal after operation?

    What are the other thing we try ?
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  • Shaz,

    The doctor is the only one that can determine if he is fit for surgery. They take into account age, health, etc. If the risks of not doing the surgery out weigh the risks of doing it, then that is your fathers call along with what the doctor has told you.

    I would make a new post with your concerns, under your own topic. You will get better responses in doing that.

    Is he scheduled for the surgery already?

    Take care.
  • MelW said:

    The doctor is the only one that can determine if he is fit for surgery. They take into account age, health, etc. If the risks of not doing the surgery out weigh the risks of doing it, then that is your fathers call along with what the doctor has told you.

    I would make a new post with your concerns, under your own topic. You will get better responses in doing that.

    Is he scheduled for the surgery already?

    Take care.

    Thanks for your reply ...

    My father got operated but after operation some major complication arises .There is weakness in all four limb and due to this he hands and leg movement stopped but he is now recovering from that . The worst part is that he sat on operation theater himself and came out of hospital on wheelchair In his right hand he complain about heaviness always and also in left leg and his left hand is moving very little .
    I am giving him regular physiotherapy (3 times day each 2 hrs )

    Can you please tell me after operation there won't we need of any surgery to remove the spinal cord pressure (as laminoplasty is done c3-c7)

    How much time will take to go the heaviness of his hand and fully recover him

    Can you please guide me post operation..

    Thanks in advance
  • RickilalasRRickilalas Posts: 558
    edited 08/16/2012 - 10:14 PM
    Some quick notes on cervicle compression. I had very few issues that could be caused by cervical compression.
    I went to the surgeon to get a second opinion on my Lower back He saw something was wrong with my neck just looking at me that no one else did including the GP and first surgeon. He did exrays and said my neck was straight and that it wasn't right. He agreed that I needed the lumbar fusion but want MRI of of all three areasa of my spine
    He calls me back in about two weeks later and said I needed to come in. When I got there I thought I was getting lumbar surgery but was told I had a severe compression of my cord at C5 C6 andC7 and it had to be done quick. I was I'n disbelief on this so he took me to radiology and showed me the scans and they were not good.
    I learned from him that the compression depends on if there is still spinal fluid all the way around the cord. It shows white on the MRI. When you have a compression of any size with no fluid its time for surgery
    Problem with compression is its hard to tell what will be hurt some people are lucky and have surgery with no more problems. Then comes me I was set for a 2 hour fushion from the front, they get in there and my compression was worse then MRI showed. Surgery took 6 hours and went well. But when pressure was taken off of cord I then had a host of issues caused by cervical nerves and they found that I had been compressed for a very long time and it was wearing into the cord doing major cord damage The next several hours would let them know what damage was done.
    Things worked out for me that day they were worried that I would be catastrofic ( there word for quad)
    I had a good recovery and got lucky. I did have, many more problems but months later MRI showed cord still did not have room so another surgery was done Lamimectmys of the same cervicl area and it helped a lot.
    So a couple of points to make if I waited just a week the doc said t would have been a quad and I had very mild issues with a pinky finger, a small numb spot on my arm and a stiff neck.
    My advice would ask the doctor how bad the compression is, is there spinal fluid all around the cord.
    Does he think you need surgery now or can it be watched, do you have pain now.
    From my experience I would do surgery as early as needed and possible to stop further damage. I don't care if its a nuro or a or tho as long as ALL he/she does is spines and has a good record. I like the teaching hospitals for this
    My surgeon is Even posted on this site If I had gotten to these better doctors years ago more could have been done for me OK night meds are kickin in and its hard to type talk to you lator

  • backstagepassbbackstagepass Posts: 2
    edited 09/13/2012 - 12:04 PM
    Im right in there w/ ya guys and girls. this cervical stuff is tricky. I had a fusion c4/c5 5 years ago june. my neuro said its very common that other areas will be affected after the fusion. theyre taking the weight or stress. my newest MRI shows more cervical damage, the ones above and the ones below. everybody has to weigh the pain aspect, it just comes w/ the disease. how well you can move and your present dexterity are good points to measure from. if your pain is getting worse, then you have a more complex problem. my balance is off a little but dexterity is still good. Im lazy as heck so I dont want to preach but I do try to walk a little and stretch when I can. mornings can be tricky. what kind of pillow and mattress do you have ? maybe you could change one or both, might help. no one wants to have surgery, me included. Im sure they would like to slice me open for a laminectomy, but Im holding out and seeing how it progresses. acupunture, tai chi, yoga, massage, give em all a try. one might just work. best of luck to all.
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