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#5141

Dear Dr. Corenman,

A friend of mine recently shared his dad had spinal surgery due to spinal stenosis. His dad who is probably in his 60s was very active in the martial arts all his life. The spinal stenosis apparently led to difficulty walking and needed to have spinal surgery.

I’ve been reviewing your videos all day and I’m freaked out because I too have cervical stenosis. Its mild to moderate at the C5-C6 level and mild and the C6-C7 level. The stenosis are due to disc herniations at those levels.

Over time will the stenosis get worse? If I happen to fall during skiing, snow boarding, or ice skating will I do more harm. I’m not an avid skier or snow boarder nor ice skater. But during the winter I may enjoy those activities and I’m very careful and stick to the “bunny slopes” or beginner hills. The same with ice skating I’m very slow. Please note I’ve only snowboarded once and never skied.

The pins and needles I felt in the beginning July (car accident in May 2011) have calmed down significantly. My neck is a bit stiff at times. The stiffness is more mild. My arms are not as weak. However, I’m dealing with right arm weakness due to a partial supraspinatus tear. And the MRI was only recently done because the pins and needles were essentially gone but my right arm was still very weak.

The right side of my neck is constantly sore and I have a mild headache. I have these symptoms despite the Relafen 1000 mg daily.

But could the neck pain and headache be due to the partial tear in the shoulder?

Cervical ESI was recommended in September but I declined due to fear. However, I recently did the lumbar ESI and survived it. I’m 5 days post procedure.

Should I consider ESI in the C-spine, even though I no longer have pins and needles and the weakness has diminished associated to the disk herniations?

The spine specialists was upfront and stated the ESI would only be therapeutic and would not “heal” or “fix” the problem.

I look forward to your feedback and recommendation.

[Donald Corenman, MD, DC]

#5147

I assume that your friend’s father had cervical stenosis and not lumbar stenosis. Both can make walking difficult but cervical stenosis can lead to myelopathy (see website for description of that disorder)- compression and dysfunction of the spinal cord.

When a radiologist uses the term “mild” or “mild to moderate”, compression is in the eye of the beholder. It is difficult to know how much compression is present as every radiologist has a different set of criteria for those terms.

It is important to know if there is at least some cerebral spinal fluid (CSF) around the cord at the level of constriction. CSF is the cushioning around the cord and the more the better.

Two problems to be concerned with in the case of cervical stenosis. One is myelopathy and the other is central cord syndrome (see website for description). Normally myelopathy is a slowly developing problem with warning signs associated and can be carefully watched for occurrence of those signs.

The problem with central cord syndrome is that it occurs immediately in the face of a specific blow to the head. The spinal canal changes in volume with flexion and extension. Flexion widens the canal and extension narrows it. A fall onto the face or forehead that forces the neck to bend backwards can pinch the cord causing this cord injury.

Central cord syndrome is more prevalent in an active population. Activities such as snow skiing or boarding, mountain biking, horseback riding and even wrestling can cause this injury in a person with cervical stenosis. I see about 10-20 central cord syndromes a year in the active population and about 1-2 in the non-active population. You can see that your risk drops substantially if you have cervical stenosis and drop at risk activities.

I agree that an epidural steroid does not fix any mechanical problems and your stenosis is a mechanical problem. If however, you have symptoms from the other problems in your neck (disc tear and bulge or nerve root irritation), the epidural should yield relief.

Will the stenosis become worse? I cannot answer that question. Most patients with stenosis from a disc bulge will have further degeneration in those discs and most likely, advancement of the bulge or spur. This could make the stenosis worse. I have also seen patients who get no worse after following them for 20 years.

Shoulder dysfunction can cause neck pain but the normal pattern is pain that starts in the shoulder and radiates to the neck. I have seen a handful of patients with unilateral neck pain that originated from the shoulder.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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