CERVICAL SPONDYLOTIC MYELOPATHY

[catwoman123]

CSM: The above is the result of my MRI scan at levels c5 area and l4 area, at these areas the spinal canal narrows sharply and bulges inwards. I went to GP with new symptoms of walking problems, stumbling, numbness of genitals, bottom, and feet when sitting, along with deterioration of hand, finger skills. (Had prev surgeries: anterior cervical discectomy c5-c6 with cage and metal plate 6yrs ago approx, and l5-s1 fusion and decompression for spondylolethesis 14yrs ago approx). Also have bilateral cervical ribs (extra set). Was left with bilateral arm pain and thoracic, neck pain which has plagued me for years after surgeries, no overhead activities for me! And on strong meds. My question is: I am now to see a neurologist following the MRI with maybe a CT scan/myelogram to follow. Does anyone know what may happen after the tests... surgery again... and if so of what type?? How do they decide what to do? I am grateful for any input THANKS IN ADVANCE. catwoman123

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am not able to see your report or images. However, I can provide information on herniated disc and canal stenosis.

The vertebrae (bones of the spine) have material between them to cushion and allow for mobility. This material may be squished out. This is called a herniated disc. It can be squished out centrally or laterally. In most people the pain associated with a herniated disc may resolve within 4-6 weeks. A minority of patients do not respond to medical/conservative management and require surgery.  Symptoms suggesting the need for urgent surgery include muscle weakness, loss of bowel or bladder control, loss of sensation, and progressive pain.

For canal stenosis, some people may note spontaneous improvement in symptoms with time. The initial treatment options are usually NSAIDs, physical therapy, and muscle relaxants. Adjustments to your posture (i.e., walking slightly stooped forward or using a cane) may relieve symptoms as well. If you fail these options, you may benefit from a consult to chronic pain for possible spinal nerve blocks. However, for those whose pain is intractable or people with neurological findings (e.g., muscle weakness, loss of bowel or bladder, loss of sensation esp in pelvis, or severe/progressive pain), a laminectomy (surgery on the bones of the back) is indicated.

If you have not already had one performed, you should obtain an EMG/NCS to assess the physiology of the nerves and muscles that they innervate. This test can be performed in most outpatient neurology offices.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[catwoman123]

Thanks very much for the reply Christopher, it is very useful information. I was only told it was CSM and stenosis of cervical and lumbar areas with no herniated discs (that was what I had previous ACDF for) and shown MRI scan of the narrowing at the aforementioned places. I will certainly ask for EMG/NCS studies when I see the neurologist and I will read up on laminectomies, many thanks Catwoman123