Cervical Stenosis

[eric44b]

I have been diagnosed with C3-C4 cervical stenosis by 2 neurosurgeons with different treatment opinions.  I originally complained of a burners syndrome when hitting my head causing axial load compression or when getting my head hit into extension during sports activities.  These symptoms would radiate to my shoulders and upper arms and resolve withing a week.  I would be asymptomatic otherwise as far as I know.  No other symptoms of spinal cord compression on exam in gait, reflexes, or upper motor neuron tests.  Both neurosurgeon's agree that on MRI I have spinal cord flattening with my stenosis measuring 5 mm on MRI and no spinal cord signal changes.  However, I have two drastically different opinions.  One neurosurgeon woud like to perform surgery now to protect against further neurologic deficit which might be irreversible.  The other neurosurgeon would like to send me back to full duty in the army without any risk modifications under the agreement that if I have any other increased symptoms I should return and need surgery.  He is under the belief that stastistics show that my risk is still very low to having a neurologic disaster but at the same time predicts that I will probably have symptoms later in life that will require surgery.  At that point he states my symptoms will be corrected by surgery.  I guess I don't know which way to turn.  Is surgery really required? Will my deficits be fixable if I wait for more symptoms?  Should I get a third opinion?

[texaspharmacist]

I would go first to a pain management doctor and see if you can be treated with some injections first.  If it can't be managed then the pain management physician will refer you to a surgeon if that is your last resort.  I discovered when I was 42 yrs old that I had no disc remaining in between my L5-S1 vertebrae.  I had no choice but to get a fusion.  My MRI results also showed spinal stenosis at the C3-C4 vertebrae.  My neurosurgeon recommended a fusion there as well waiting 3 months in between surgeries.  My surgeries (2002)  were both successful.  The neck surgery is a lot easier because at C3-4 they make a small incision in the skin (not muscle) from the front, move the striated muscle apart, do their work, and put the muscles back together and stitch it up.  My surgeries were performed by a neurosurgeon that also had experience with spinal reconstruction.   I found out when another doctor needed back or neck surgery... they went to this doctor.  I'm trying to say, know your doctor. Also, you have to weigh the pain you are in, the risk of damage occurring without surgery, and your limitations if you don't have surgery or if you have surgery.  For example, if you quit high risk activities (high impact sports) would you be able to avoid surgery?  I hope everything works out for you.

[MZ33]

I would wait as long as possible. In 2006 I had my first surgery for C3 & C4,it was from pain in my neck shoulder arm down in my hand.This was on my left side and I went for 3 opinions. They all said the same thing, only surgery will help.I had 5 epidurals and no relief.Drugs physical therapy and a chiropractor over 6 month of terrible pian,I gave in to surgery. Pain lingered after surgery but with meds I was able to do ok.Then in 2008,again pain ramps up again. This time same left side pain neck shoulder arm hand,but with my eye felt like I had an ice pick stuck in it.Called my neurosurgeon and had MRI CT Mylegram and next day had emergency surgery C5 C6 collapsed on spinal cord.When I awoke from this surgery the pain in my eye was gone.But I could not use my left arm and I still have terrible pain and no voice. 2010 still can't use left arm and pain management my life and no voice . 5 doctors later, they tell me I need to lower my expectation. So wait as long as you can and I wish you the best.

[Jenn724]

Third opinion sounds like the way to go. Although, going back to a regular job with no restrictions and back to active duty military without restrictions is a lil different. Sounds pretty risky to me, it's not like you're sitting at a desk somewhere, Seems like you would be at serious risk returning with no restrictions. Good luck though.

[Onoceobi]

What surgery are they wanting to do exactly? Often surgical intervention isn't the success we'd like it to be as it can create new problems we didn't already have. As a Reg Nurse I've seen enough to suggest that If you can avoid surgery on your spine then do so. It sounds like your symptoms are quite mild at present so I'd save it for when you absolutely have no doubt that you need it. While I'm not sure about not having any risk modifications, the second option still sounds best.