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  • Jellyhall
    Participant
    Post count: 90

    I have cervical spondylosis throughout my neck, with my cord being pushed backwards and compressed at C3/4 and C4/5. There is no Spinal fluid visible either side of my cord. I don’t have high signal on the MRI. There is loss of lordosis of my neck. I have various stabbing and shocking pains, aching and burning, tingling and numbness in my hands,wrists,arms, legs and feet and neck and shoulder pain with headaches. Most of the pains don’t last long, but the headaches can last for days. Sometimes the numbness (in the ring and little finger of my left hand, and the thumb, first and second fingers on my right hand) lasts for several hours.

    I have hyper reflexes in both legs. I get stiffening spasms in my legs and inturning right foot in the morning as I start to move as I wake up. Strangely, I particularly notice this as my husband gets up out of bed and makes the bed move. Sometimes this extends to my adbomen causing my back to arch right up off the bed. I also get this stiffening if I get up after sitting for a long time. My muscle strength is pretty good but I am getting slightly clumsy hands and sometimes my legs feel rather jerky when I walk. This is not always apparent and sometimes they feel ok.

    I had a decompression and fusion of L4/5 2 years ago for grade 2 spondylolisthesis. I also have 2 dics mildly compressing the cord in my thoracic spine, which cause tightening around my chest and spasms, particularly when I try to twist. I think that this makes it hard to know which levels are causing which symptoms.

    How do you know when it is time for surgery? It has been suggested that I have a 2 level ACDF. Weighing up the risks of surgery with the risks of not having surgery, it is so hard to decide. Are there any particular symptoms that would indicate that surgery can’t wait any longer? (I am aware that bowel and bladder incontinence would mean this.)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    You have cervical stenosis at C3-5 (see website for further details). The loss of lordosis could be from the degenerative disc disease that always accompanies the bony spurs that compress the spinal cord or from antalgic positioning (neck flexion opens the canal to protect the cord).

    The intermittant symptoms in your arms and legs could be from cord compression. Headaches can be created from cord compression but also from degenerative discs and facets.

    Hyperreflexia (increased deep tendon reflexes) goes hand and hand with myelopathy from spinal cord compression (see website for myelopathy). Muscle spasms like you are experiencing is also associated with myelopathy. “Clumsy hands” and a feeling of “jerkiness” when walking are hallmarks of myelopathy.

    In general, if you have the symptoms described above and you have cord compression in the neck causing myelopathy, you need surgery. Compression of the cord is unforgiving and if there is damage, the cord may not heal after surgery. See your surgeon soon.

    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.
    Jellyhall
    Participant
    Post count: 90

    Thank you for your reply and expert opinion, which I value.

    Is there any way to determine which level is causing my symptoms? I have been told that the tightening and spasms I get around my chest are probably being caused by the 2 thoracic discs which are compressing my spinal cord and nerve roots, particularly to the left, where I get the most pain.

    How can we tell if it is my neck or thoracic spine that is causing the symptoms below my chest, particularly the pains and stiffening spasms in my legs?

    I am in the UK where things seem to be left longer than in the USA.
    I am an otherwise healthy 56 year old woman. (I do take prescribed Vitamin D and Calcium, after my levels were found to be low.)

    I have seen 4 neurosurgeons, 2 of which have said that I should have surgery. The other two say not yet, but that we should ‘wait and watch’, (every 6 months) but no real explanation has been given as to what they are waiting for. I suppose that there is some symptom that I don’t have yet.

    I don’t want to be in a situation where I have permanent nerve, or worse still, cord damage from waiting too long.

    I now have the option of having surgery with one of these neurosurgeons, but do wonder what the reason is for this other surgeon saying that we should wait.

    It is so hard to make this decision without fully understanding what is going on.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    If you have symptoms in your arms (incoordination of the hands, numbness and “a feeling of being off”), these could not be generated by your thoracic spinal cord compression. You need to address your cervical spine very soon with ADCFs. Cord compression is not well tolerated and further damage to the cord does not heal well.

    I- to this very day, do not understand why some surgeons will hold off on surgery in the face of cord compression that compromises the integrity of the cord. In my opinion, the only reason to avoid surgery in this case is if surgery would cause greater risks than the risk of cord damage.

    It is impossible to know at this point how much thoracic cord compression is causing thoracic myelopathy as your current leg symptoms most likely are also caused by the cord compression in the neck. Without seeing your MRI of the cervical and thoracic spines, my estimated guess would be to have the cervical ADCF now and see what type of relief is gained.

    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.
    Jellyhall
    Participant
    Post count: 90

    I have been told that if I was in an accident or if I had a fall, I could risk bruising my cord because there is no spinal fluid around it to cushion it. This could cause me serious problems.

    I work in a school and we have some difficult children who can be unpredictable. I am excused playground duty because of my spine problems.
    After cervical fusion surgery, will my neck return to a normal risk level once it is fused?

    We are going on holiday over Easter (2nd – 13th April). Also we had planned to go and visit our son in Switzerland at the beginning of June during the school break.
    Can surgery safely wait until after this?
    How long after ACDF do you think we would be able to travel to Switzerland or go on a restful holiday abroad?

    I really appreciate being able to ask you all these questions.
    Thank you so much.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    My advice to you is based upon only what you have told me so take everything with a grain of salt. You are in some danger with the symptoms and the cord compression that you have described.

    The spinal canal enlarges with neck flexion (bending the head forward) and narrows with extension (bending the head backwards). If you have a fall onto the front of your forehead that causes your head to bend backwards, you could injure your spinal cord. This could even happen if you are rear-ended in a motor vehicle accident so you need to take precautions.

    The surgery generally makes your neck stable immediately depending upon the type of surgery and the skill of the surgeon. I personally allow patients to travel within one week of surgery (they fly in, stay a week and then depart) but I cannot tell you what your surgeon would suggest.

    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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