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Neurology (Expert Forum)
Cervical Stenosis Surgery? when?
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Cervical Stenosis Surgery? when?
by bries, Aug 05, 2006 12:00AM
I'm new here, I'm dutch and I'm desparate.
I/m just diagnosed with cervical stenosis. mri scan indicates 10 mm at c3/4/5/6 level. multiple hernia's at these levels. Also Sacrum acutum. Military neck. I am a woman, 55 yrs.
Symptoms at the moment: both hands allways sleepy feeling,everything just falls out of my hands, I'm incontinent since 7 years, "nerv" pain in right arm, back of teh hand, from pink to index finger. I've a "back history", going back since I was 24 yrs. My ( really dutch) neurologist send my home saying: give the mRI -results to your physiotherapist, he will know what to do with it. Well in fact he did not.
I've got 3 questions:
1 What are the probable causes of this stenosis, I mean, I'm too young for this !? Could a sort of rheuma/ artritis cause this? My father had psoriatic atritis. I also got morning stiffness and pain in my achilles heels and psoriasis spots on my scull.
2 no matter what the causes could be..can this be operated, and if so..when...I.mean 10 mm at 55 yrs means 8 mm at ????? Whats too soon and whatts too late??
3 My rheumatologist says that I've defenitely have no rheuma, my neurolist says "all my nervous reactions are perfect" and the hernia;s are minor, my cardiologist says I can becom 100 yrs, my Interist says: youve got nothing...hell I have not seen so many different docters in my life! Who is the specialist on this topic??
Doctor's Answer
by CCF-Neuro-M.D.-SH, Aug 06, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe are concerning for cervical myelopathy, though other possibilities do exist. The cervical spinal canal is normally 12-15mm in diameter, with age related wear and tear, arthritis, injury etc., this canal can become smaller (stenosis). At 10mm and less, the spinal canal is considered at risk for compression/myelopathy (squeezed spinal cord) and at 7-8mm surgery is often initiated. However, depending on the patients symptoms and imaging findings, a patient may have surgery with larger canals.
Cervical stenosis symptoms generally start with neck pain, arm pain/numbness and then progress to decreased grip strength and arm weakness. As the stenosis worsens it can cause imbalance, clumbsiness (triping etc) and leg weakness. In the worse stages it can cause incontinence of bowel/bladder and paralysis. From the symptoms you describe, I am concerned that you have severe, symptomatic cervical myelopathy (neck/arm pain, arm tingling/numbness, decreased grip strength and incontinence), unless your sympotms are caused by alternative explanations. As for the cause, you will need additional tests, but it is likely that you have age related disc buldges with a congentially small canal to start with. Although no blood test is specific for psoriatic arthritis(PA), I would reccomend that you have an ESR (erythrocyte sedimentation rate) ANA with full subtype analysis, RF (rheumatoid factor-is usually negative in PA). Your rheumatologist will be able to discuss further options reguarding this possible condition.
I would recommend an SSEP, somatosensory evoked potential to assess whether the wires connecting your leg and brain are being damaged by your cervical stenosis. I would also recommend an EMG to evaluate for other causes of your symptoms, for example-carpal tunnel syndrome, radiculopathy (nerve root compression) etc. Most importantly I would recommend that you see a neurosurgeon for consultation on possible decompressive laminectomy (relieving the pressure on your spinal cord) as soon as possible. He may require further imaging such as a CT Myelogram (dye study of the spinal canal) to further assess your need for surgery. I hope this has been helpful.
The symptoms you describe are concerning for cervical myelopathy, though other possibilities do exist. The cervical spinal canal is normally 12-15mm in diameter, with age related wear and tear, arthritis, injury etc., this canal can become smaller (stenosis). At 10mm and less, the spinal canal is considered at risk for compression/myelopathy (squeezed spinal cord) and at 7-8mm surgery is often initiated. However, depending on the patients symptoms and imaging findings, a patient may have surgery with larger canals.
Cervical stenosis symptoms generally start with neck pain, arm pain/numbness and then progress to decreased grip strength and arm weakness. As the stenosis worsens it can cause imbalance, clumbsiness (triping etc) and leg weakness. In the worse stages it can cause incontinence of bowel/bladder and paralysis. From the symptoms you describe, I am concerned that you have severe, symptomatic cervical myelopathy (neck/arm pain, arm tingling/numbness, decreased grip strength and incontinence), unless your sympotms are caused by alternative explanations. As for the cause, you will need additional tests, but it is likely that you have age related disc buldges with a congentially small canal to start with. Although no blood test is specific for psoriatic arthritis(PA), I would reccomend that you have an ESR (erythrocyte sedimentation rate) ANA with full subtype analysis, RF (rheumatoid factor-is usually negative in PA). Your rheumatologist will be able to discuss further options reguarding this possible condition.
I would recommend an SSEP, somatosensory evoked potential to assess whether the wires connecting your leg and brain are being damaged by your cervical stenosis. I would also recommend an EMG to evaluate for other causes of your symptoms, for example-carpal tunnel syndrome, radiculopathy (nerve root compression) etc. Most importantly I would recommend that you see a neurosurgeon for consultation on possible decompressive laminectomy (relieving the pressure on your spinal cord) as soon as possible. He may require further imaging such as a CT Myelogram (dye study of the spinal canal) to further assess your need for surgery. I hope this has been helpful.
Member Comments (2)
by caregiver222, Aug 05, 2006 12:00AM
First of all, dismiss thoughts or surgery, at least for now. Often there is an injury and long after the injury heals there is inflammation that sends out signals for the body to repair itself by depositing more bone in the traumatized area. But to cut to the chase, these injuries often require treatment that is counter-intuitive. Normally, when you feel pain, you stop moving at the limit of pain, because you believe mother nature is telling you that to move through the pain will cause more damage. In your case, if you do this, your disability will grow year by year and eventually your arm will become paralyzed and you won't be able to pick up a pencil. Ouch! In many cases exercise through the limits of pain is the answer. This involves range of motion exercises with the skull rotated to the limit of possibility secveral times a day. Plus an anti-inflammatury (Motrin) and use of an axial traction harness for three otu four minutes three - five times a day. A cervical collar is contraindicated because it causes muscle atrophy and loss of tone. There are crystaline deposits in there that have to be broken off. Get off the bottled water, especially if it comes from a hot spring.