How narrow is too narrow?

[mbsews]

I have degenerative disc disease at C4-5, 5-6 and 6-7 with acute onset of symptoms (excruciating pain right arm) in March 2004 that never completely resolved.  Recently I fell (also diagnosed with MS in September 2005) and took all my weight on my right arm which results in an acute exacerbation of my chronic right arm pain.  

An MRI showed only my usual mess and my symptoms are mostly back to baseline and tolerable (on 450 mg/day Lyrica with prn Vicodin for breaththrough pain)...except for buzzing in my right arm that can be provoked by moving "wrong" (mostly accidently extending my neck back/right).

But for the first time the radiologist measured the AP diameter of my spinal canal (6.2 mm).

My question is...How narrow is too narrow?
That seems awfully small.  My neurologist, who is a prominent MS specialist and kind of a hoot, just said that I should
1) Avoid going through windshields.
2) Not take up tackle football (I am a 51 yo woman!) and
3) Stay away from chiropracters.

I have resigned myself to only walking (rather than jogging) on my treadmill.  But I love to garden and am mostly still very strong so I tend to haul stuff around allot.  

What do you think?
Generally I do trust my neurologist implicitly.  But the fine motor coordination in my hands is much worse than it used to be.  I could put peripheral artery lines in 600 gm babies and did very fine handsewing that I now have difficulty with because my hands cramp and get numb.  Now I am constantly dropping stuff, spilling or knocking things over.

btw I will be having carpal tunnel surgery on my right hand in October and eventually on the left hand too.

I know that I have allot of confounders but I keep thinking how small 6.2 mm seems and I value my hand function more than my legs.

Thanks for your help.

[Paul J Slosar]

Sounds like you may have early signs of cervical myelopathy.  A spine surgeon could examine you for specific tests and confirm. The comments #1-3 trivialize the potential problems that you are experiencing.

I would encourage you to see an orthopaedic spine surgeon to confirm the above.

[mbsews]

Thanks.
I will do that.

I saw three neurosurgeons about more minor versions of these and other symptoms in the months before I finally figured out myself that I probably had MS which this neurologist confirmed.

He is generally very responsive....enough so that he switched me from Avonex to Tysabri after 18 months and  rounds of steroids.  My brain MRI was stable and has been fairly benign and many neurologists would not have offered me Tysabri "just" for symptoms in the setting of a stable MRI.  Tysabri has been enormously helpful in ameliorating my fatigue, pain and urinary symptoms and is worth the risks to me.  

But my neurologist thinks I worry too much so he tends to try to play down my concerns.  He didn't know me during the 47 healthy years of my life.  

It is reassuring that I have no signal changes in my spinal cord C1-T5 on MRI, either MS lesions or otherwise though my neurologist says that myelopathy is essentially a clinical diagnosis.  I do have positive Spurling and Hoffman's signs and am hyper-reflexic in all for extremities but have a negative Babinski.  My neuro exam is otherwise not terribly remarkable except that my 9 HPT times have been slowly increasing.

I think that it IS difficult to sort out all my issues but I would like to fix the things that can be fixed....or at least minimize further progression.

I see my neurologist again next week and if my 9HPT time is up again I will definitely push for further evaluation.  I have already tentatively arranged for an evaluation with an orthopedic surgeon from New England Baptist who has been involved in clinical trials for artificial cervical discs.  Fortunately I have individual health insurance that does not require referral in addition from my husband's HMO family plan.

But a year ago Dr. Banco's office said that he wasn't doing them outside of trials even after FDA approval because local insurers were not paying for them.  This may still be the case and I have been very reluctant to have a 5 level fusion or any other surgery even if anybody was willing to do it.  I fear that I will not be eligible for any trials because of my other medical problems.

I think I had my fill of surgery for awhile after having reduction mammoplasty in 2005 and a craniotomy for an asymptomatic but growing colloid cyst even though both surgeries were uncomplicated.  But I am finally getting carpal tunnel surgery this fall and I AM very fortunate to live in an area where excellent care is readily accessible.  

Thanks again for confirming that it is not unreasonable to pursue further evaluation for myelopathy.