Quick background. Never had any back related issues before and I have winning lotto genetics. So this really came as a surprise. Back around the beginning of may I started to have what initially felt like pain/soreness/stiffness in both wrists and elbows. I thought maybe it was because were were building and constructing on our ranch and I was maybe overdoing it a bit. Issues persist so I made appointment with Primary Care Doc. Initial exam, x-rays, and a referral to physical therapy all came back that muscles and bone structure are fine. So MRi is done on cervical vertex aka neck.

C-1 to C-2 is fine, C-2 through T-1 all show moderate to severe bulging with stenosis in c-6 being the worst. I have an appointment the end of this month with a Orthopedic Neurosurgeon that specializes in intervention.

I have questions, but I am not sure what the right ones are.

Are we going to do an MRI on the entire spine, not just the neck?

Are the bulged discs the cause of the stenosis?

Is fixing the stenosis and bulged discs two separate jobs or can they be worked on together?

Where am I at on a scale of no surgery to must have surgery?

If I am in a position to do maintenance and not surgery, how long should we be able to push this out and what results are we looking for?

I can think of more, but this seems like a good start.

As of now there is nothing occuring that stops any of my daily routine or any tasks I do. Built an 80'x 5' stone wall, still shooting just fine, 1-2 mile walks with the dog daily, riding horses 3-8 miles at a go 3-4 times a week.

So SigForum invisible friends, whatcha got?

This message has been edited. Last edited by: Sigolicious,

I have a older brother who is dealing with this. He had 3 or 4 discs removed and some type of metal replacement. His was caused by the same repetitive work functions for 35 years. He too had the wrist and arm issues. He still complains of not being able to keep his arms up very long. He quit therapy because it was difficult. He is diabetic also and just doesnt take care of his health. A quitter. However, he gets some relief from medical pot and the girl who brings it monthly also brings him a bag of non prescription pot..powerful stuff. He claims it helps his mobility. He is a hot head and a big mouth. You dont go in for medical help telling the pros what is wrong with you. Judging by his condition, I would have preferred some regiman of therapy and strength excercises. Even some way to realign the discs. BTW, they cut him at right front throat to operate.

This is based on my personal experience-

Mild stenosis, bulges, arthritis, etc. that are only minor issues get treated conservatively. Be wary of anyone wanting to jump straight to surgery for problems that are not seriously impacting your ability to live day to day.

Physical therapy, meds, various spinal injections, etc. all can help mild issues.

Surgery, even the modern methods, do not always help.

Nerve pain can get severe, unlike any other, and improve very, very slowly - like months.

When it gets to be a major threat or impairment, surgery may be the only option.

I had a similar situation in 2009. Shoulder pain and dropping glasses/bottles more frequently. Assumed buzzing in hands was circulation. Went to my shoulder Dr (have had 5 cuff/bicep repairs) and said let’s X-ray your neck.

Confused me but ok, from there got MRI then reference to surgeon. Turns out an old car wreck (rear ended in 81 F150 withou headrest - took out window) plus wear and tear had caused a “beak” to build at c5-c6 and was threatening to cut into spinal cord. Double issue was a bunch of bone “bone spurs” growing around nerves to shoulder and hands from C5-C6. Triple issue was at some point after diagnosis my disk burst and squeezed those nerves and cord further.

All of this fell into a bucket called stenosis. From diagnosis to surgery was 3 weeks to minimize any chance of permanent nerve damage. The longer you wait when nerves have serious pressure /damage the less likely they can heal - thus with multiple opinions from Dr went and had the surgery. ACF (cut from front) with cadaver bone fusion, titanium plate and the whole thing cleaned out.

Best thing I did. Had always had lots of chronic shoulder pain and that went away. Retrained hands and rehabbed back to 98%.

So yes get the MRI, talk to orthopedic guy and surgeon. Don’t be in a hurry unless Drs tell you to rush. Also Stenosis happens to some degree in everyone as they age, in most not a big deal. MRI and Dr will help. You can see the pinch and beak in mri I had.

Edited to ad that Oz is spot on. Surgery won’t always help and nerve pain sucks and is really strange. I was fit, stay fit and still do the rehab exercises. Lost precision in fingers and forearm strength but if stay on top I’m 98%.

My spine is a mess. This Friday I have an appointment at the University of Colorado Anschutz Medical Center to see a neurosurgeon. I have 3 issues contributing to my C-spine and L-spine problems: traumatic injury, congenital stenosis, and the degenerative effects of arthritis as a result of the traumatic injury. I have “spondylolisthesis” (movement between vertebrae) at C2-3, T1-2, L2-3 and L4-5. Two degenerated disks at the location of the spondylolisthesis in the lumbar spine, as well as in my neck. My neurologist is concerned because an MRI of my C-spine shows absence of CS Fluid down around C4-5. She says if I take a bad fall or get T-boned in an intersection, there’s no room for my spinal cord to swell; could produce paralysis.

In spite of everything I’ve written above, I am actually very highly functioning. You would never know that I had all these issues. I am limited in how much weight I can lift and the intensity of exercise I can perform, otherwise, I stand erect, walk normally, and can live with the pain—usually without NSAIDs.

I was driven to get definitive answers because of my dad. At the time of his death, my dad presented like a stroke patient; he was essentially paralyzed on the right side of his body as a result of spinal stenosis. He waited too long to have the issue addressed and progressively deteriorated more and more until the end stage. I don’t want spinal surgery, particularly on my C-spine, but I don’t want my wife to spend her retirement years wiping my ass either.

Good luck, hope you (and I) get the answers needed to make informed decisions. I graduated from the University of Arizona and, of course, the School of Medicine is there in Tucson. If it looks like surgery, I’ll darn sure talk to 2 or 3 neurosurgeons before getting cut on, and UofA Med Center is one place I’d get an opinion, if I were you.

The cause of the bulging and stenosis, 99% of the time, is an overall or "global" set of incorrect curvatures in the spine. Using surgery to fix the worst area may give you some relief, but will not affect the underlying cause.

The primary cause is misalignment of the upper cervical complex, which includes the skull to C2. Thousands of proprioceptors embedded in muscles in that area have been giving incorrect signals to the brain. The brain responded by controlling muscles along the spine, twisting and bending the spine. Over time discs become damaged, degenerate, and bulge.

When researching back surgery for my Dad, I was told repeatedly to go to a neurosurgeon, NOT an ortho.

Also, looked to me (8 or 10 years ago anyway) like 1/3 surgery helps, 1/3 it's about the same and 1/3 it made it worse.

Surgery should always be a last resort but too many cutters want to cut.

IANADr, YMMV, lather,rinse, repeat, etc.

Welcome the gett'in old club brother. It happens to us all to a degree.

As an old now in greener pastures friend used to tell me. " Gett'in old isn't for sissy's"

She was right of course.

Good luck buddy. Just keep on keep'in on.

quote:

Originally posted by nukeandpave:
When researching back surgery for my Dad, I was told repeatedly to go to a neurosurgeon, NOT an ortho.

Also, looked to me (8 or 10 years ago anyway) like 1/3 surgery helps, 1/3 it's about the same and 1/3 it made it worse.

Surgery should always be a last resort but too many cutters want to cut.

IANADr, YMMV, lather,rinse, repeat, etc.

Still the same. My Ortho referred me to a Neurosurgeon and we jointly discussed options. Neurosurgeon did the surgery and glad he did, was a bigger mess than expected but good outcome. But it is risky..I had to weigh existing partial paralysis against chance to get function back and less pain in my life. Gamble worked, but won’t fir everyone.

I was an Xray tech and worked my last 10 years or so primarily with neurosurgeons and orthopedic surgeons. I paid attention, and have some clue. But nothing I say is based on a medical education.
Generally speaking, neuro docs do the detail work, like fixing/trimming bulged discs and ortho docs will implant the hardware and screws, if needed. Sometimes members of each specialty can do both, but more often they work in conjunction.
The vertebral areas of concern can be localized by the symptoms, and yours is certainly cervical by those symptoms. However an MRI is not so expensive or time consuming that they wouldn't do one of your thoracic and lumbar, just to see. But it's not automatic.
The stenosis, or narrowing or compacting, is the cause of the bulged discs not vice versa. Imagine squishing an Oreo and watching the creme ooze outward.
The bulged discs can be trimmed or "surgically repaired" without any other action. Or they may feel that plating certain levels is necessary to prevent more stenotic encroachment. Plates are attached by screws and merely serve to stabilize, or hold the disc space open.
The last two questions you had can only be determined by a competent neurosurgeon, based on your symptoms and the images he/she or they have obtained.
Just about all the doctors I worked with said to avoid surgery as long as possible.

Hope that clarifies. If your doctor tells you differently, believe him.

Thanks for all the replies. I am taking notes, keep them coming.

Yes, I'll be 50 in a few days and the getting old club seems to be a place I'll regularly visit as life goes on. I'll be keepin on keepin on.

For me, unless there is broad consensus between a couple of doctors, surgery is the last thing I want. But if it comes to that, given my living circumstances, it will have to be a planned event.

As of now this is being done under the VA community care act. So I have referrals to doctors of my choice as long as they accept VA managed care. One of my concerns is that the VA figures out I need surgery and they then want me to go to a VA hospital for it. I know others have had good results at the VA and my local clinic is pretty good. I am in the Phoenix region and the VA there has the worst reputation in the country, I have not got a death wish. So at that point I'll switch over to my .mil retiree Tricare and pay my co-pays to go where I have researched and want to go.

No fucking way I would let the VA take a scalpel to me, especially a neck / back issue.

Whatever it costs to go elsewhere is money well spent.

quote:

As of now this is being done under the VA community care act. So I have referrals to doctors of my choice as long as they accept VA managed care. One of my concerns is that the VA figures out I need surgery and they then want me to go to a VA hospital for it. I know others have had good results at the VA and my local clinic is pretty good. I am in the Phoenix region and the VA there has the worst reputation in the country, I have not got a death wish. So at that point I'll switch over to my .mil retiree Tricare and pay my co-pays to go where I have researched and want to go.

^^^^^^^^^^
The VA choice program is varied. The rates are set at a low level, medical records must be provided, and payment is often not forthcoming. As a result many of the doctors on the Choice Network NEED the business. Tricare is somewhat better, and although their rates are low there are more options. Yep, the Phoenix VA is where the latest fiasco happened with creative scheduling to look like vets were being seen on a timely basis.

E-mail me (my address is in my profile).

I went through successful four-level cervical fusion surgery in 2015 and can answer a lot of questions you probably have and tell you what questions you need to ask the specialists you interview.

I suffered though years of sciatica, until it was 100% relieved by NUCCA chiropractic. I also broke L1 into 53 pieces in a mtn. bike accident, and lost most of the nucleus of L4 disc in a lifting injury. Spinal surgery was used for both acute injuries, but NUCCA chiropractic is what solved the chronic problems.

I ended up being a long distance trail runner, usually putting 30-35 miles a week. Very few persons overcome injuries such as mine and be fully active. No way would regular medical treatment provide such a long term solution.

I’m 5 weeks recovering from a Laminoplasty with fusion. C-2 to T2. If you want more details and pictures, email me. Good luck.

Been struggling a year with lower L4/L5 spondy and stenosis. And the disc is wrecked. Went to a spinal PT person and finally -- maybe -- I'm seeing some results. Other PT folks did no good. I'm cautiously optimistic.

I’m fused at two different levels, a fracture years ago led to all of it. The last fusion was to correct stenosis, my spinal canal was pinched down to like 2 or 3mm. Physically, the problems was fixed...but I live in near constant pain. I would exhaust every resource possible before having a fusion.

quote:

Originally posted by Oz_Shadow:
Mild stenosis, bulges, arthritis, etc. that are only minor issues get treated conservatively. Be wary of anyone wanting to jump straight to surgery for problems that are not seriously impacting your ability to live day to day.

I am reminded of a quote -
"to a man with a hammer, every problem looks like a nail"

I know a person who has total back fusion from lower back up into the neck area. Lives in constant pain and is very stiff. Get a second and third opinon before having any fusion done.