Spinal Stenosis

[2KNEE]

I recently had an MRI that shows congenitally narrowed spinal canal from level C3 - C6.  C3-C4 have diffuse disc bulge with spurs and moderate to severe narowing of the spinal canal to 5mm in AP diameter.  C4-C5 has disc desiccation with diffuse disc bulge and osteophyte with moderately narrowing of the spinal canal to 7mm in AP diameter.  C5-C6 there is disc desiccation with disc space narrowing and diffuse disc bulge with spurs, moderately to severely narrowing of the spinal canal to 6mm in AP diameter with compression of the spinal cord.  C6-C7 there is disc desiccation with mild annular bulge mildly narrowing the spinal canal to 10mm in AP diameter.  I also underwent an EMG test which showed no damage to the nerves or muscles but abnormalitits in the neck area (Which I assume is the reason for the pain, numb and tingling feeling running from my neck down into my shoulder, arm and hand).  I have been told that there is little that can be done except surgery.  Any additional information or help would be greatly appreciated.  

[philnoir]

Yes, an EMG can test for a damaged nerve. It measures the speed of nerve conduction. If nerve conduction is slowed, it indicates the myelin sheath around the nerve root or another A-fiber nerve may be damaged.

If the bulging disc or associated disease process is pressing on the nerve root, it can damage that myelin sheath.

Neuropathy can form from this situation, but there are other causes of neuropathy, one being spinal stenosis, that are related to disc disease. Only your doctor can make a diagnosis, and it requires a proper physical exam. The EMG just shows the nerve damage I spoke of.

Best wishes.

[Flossie37]

Thanks so much, that all does make sense, I did see a upper cervical Chiropracter for a year and it helped get me to the best point so far, but yes I have to take pain Meds. I'm not sure does the EMG show nueropathy? She said I had that and double carpal tunnel. And I do have bulging disk as well.

Thanks for your reply

[philnoir]

If no one has mentioned this, your condition is called cervical spinal stenosis. When the canal narrows, pressure is placed on many of the nerves within the cord and exiting the cord, causing pain.

The other pieces of your cervical spine disease involve the denegerative discs (DDD or degenerative disc disease). This includes inflammation of connective tissue, osteophytes, and bulging discs. Pain may be coming from an annular tear on one or more bulging disc (called discogenic pain).

Also with DDD comes changes in shape to the spine -- it can lose its normal lordosis or curve, pulling muscles and tendons out of shape, causing chronic muscle spasm -- this too causes pain.

Associated with DDD can be other pain syndromes like facet syndrome (or spondylosis), which puts pressure on peripheral nerve roots, and can generate arthritic pain from the facet joints.

If you have arthritic facet joints, there are interventional treatments that can help that piece of your neck pain -- nerve blocks and RF ablation of the medial branch nerve.

A good interventional pain doctor (which is a branch of anesthesiology -- advanced trained board certified experts in treating pain at the spinal nerve level) can make this diagnosis and treat.

Unfortunately, PCPs usually refer first to surgeons. Be very wary about surgery -- it can exacerbate pain. However, if the cord stenosis becomes worse, you will need decompression surgery to prevent injury to the cord or nerve roots.

It is fortunate that your EMG shows no damage.

Have you tried PT? Physical therapy can help increase/extend your range of motion and thus reduce pain in the normal range of motion.

Other treatments, like epidural spinal injection, can help, but have a low rate of success. Beware of injections of this type, or any doctor who insists on multiple injections (greater than 6) without measurable results.

NSAIDs can help reduce inflammation, but always take NSAIDs with food to protect sensitive stomach lining. Muscle relaxants may also help. Mild opiates can also be useful, but be careful with their use -- once you start, you may be on a painful road of increased use through tolerance, medically induced withdrawals, etc. Talk with your doctor about his/her philosophy about using opiate analgesics.

Ice is a great remedy, and sometimes just getting the weight of your head off your neck is a great relief. Learn to always support your neck when laying down with rolled up pillows or towels.

To learn more about cervical disease, see a site like spineuniverse or spine-health.

Best wishes.

[Flossie37]

Lesion on lower spine I can't remember the vertebra it right in the arch of my back, I can actually feel the severe pain and throbbing coming from the lesion spot. If I sleep on stomach it takes me a while to get turned over due to the pain.also lesion on brain. CSF protein 176. Has anyone had this and could possible help. All my labs were good besides C Reactive protein in the beginning of my sickness 2 years ago. It's normal now. I gained 30 pounds in 3 weeks with onset of sickness. From Feb.2013 to jan 2014 I lost from 180 to 125, Drs didn't seem to concerned.