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  • sampath
    Post count: 1

    Dear Doctor,
    I am a 60 year old man. My MRI report shows:

    1)… moderate to severe canal stenosis at C5-6 disc level due to associated flaval ligament thickening at this level contributing to canal stenosis.

    2) Thickened ossified flaval ligaments at D10-11 bilaterally (left more than right) causing moderate degree thecal sac and cord compression.

    My problems: 1). Tingling in right thumb and index finger. 2). A feeling of tightness at right hand upper arm.

    3). Pinching/wound-like pain radiating from middle of the back upwards and downwards.

    4). Mild pain on left on top of left foot.

    5). Lower back pain–pins and needles piercing–can’t bear to sit in sofas or on chairs with uneven surface. OK to sit on flat surface with lower back support but not for long.

    My doctor suggests anterior cervical disectomy using PEEK spacer for fusion at C5-6. He does not want to touch t10-11 part stating that it may paralyse me. But my suffering is more in the back than in the neck. Moreover, I would like to travel a lot. Now, I am driving 50 to 60 miles but I want to go and see distant places. What do you suggest? .

    Donald Corenman, MD, DC
    Post count: 8459

    Significant canal stenosis at C5-6 does put you at some risk for a cord injury with a fall. Your symptoms; “1). Tingling in right thumb and index finger. 2). A feeling of tightness at right hand upper arm” are probably not associated with the cord compression but with foraminal stenosis which is not mentioned by the radiologist but is still probably present.

    The “pinching/wound-like pain radiating from middle of the back upwards and downwards’ could be related to the C5-6 level but this is not absolute. If you wanted to find out if the ACDF surgery at C5-6 would help relieve this pain, a low volume epidural injection (and keeping a pain diary-see website) would help to diagnose if this level contributed to the upper back pain.

    The ACDF might be very helpful to you but I am not a fan of PEEK cages in the neck as these cages are not biologically active (they are made of plastic). In my opinion, you need as much active surface area as possible in the small space of the cervical disc and PEEK cages reduce this biologically active surface area.

    The thoracic stenosis might or might not be causing symptoms but back pain is not a typical symptom of lower thoracic stenosis. Pain in the central spine in this narrowed thoracic area might be caused by degeneration of the discs or facets. If this narrowing for some reason is causing symptoms, a simple laminectomy (assuming this level is stable) is not a significantly dangerous surgery and should do the job to decompress the canal. If there is a degenerative kyphosis (Scheuermann’s disorder or degenerative kyphosis), the decompression by itself will not give you the relief you desire and might make the symptoms worse.

    Dr. Corenman

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