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Narrow Spinal Canal,lumbar Laminectomy,MRI,stenosis,nerve Pain In Elbow.Surgery?
Question: 61 years old, 170 lbs, congenitally narrow spinal canal. Had lumbar laminectomy by a neurosurgeon 8 months ago.Pain was releived but neuropathy that I had from the compression before the surgery has not reversed and I was told that before surgery that neuropthy probably would not be corrected. Now I am having hand and arm problems. MRI of cervical spine shows severe stenosis at c5-7 with biggest problem at c5. My symptions are nerve pain in elbow and hand on left side and numbness, tingling, burning and freezing sensations in palm and little finger and ring finger, pain in elbow. MRI also showed "signals"? Is surgery needed? If so which approach anterior or posterior would be better?
Hi,
Thanks for your query.
I can appreciate that you must be dealing with frustrating symptoms regarding the pain as well as neuropathy which you haven't described. The symptoms you described including numbness and tingling as well as some degree of pain in the upper extremity is certainly attributable to narrowing of the cervical spinal canal.
The MRI finding of increased signal which you mentioned generally refers at times to inflammation that can be associated with nerves which have been affected by stenosis. As far as the most appropriate treatment for this there are a couple of options. You could continue to observe symptoms for a period of time. During this time you might consider a trial of anti-inflammatory medications or possibly steroids. The anti-inflammatory medication and steroids can sometimes decrease swelling and symptoms associated with stenosis but it would be better to discuss this option with your treating doctor.
I have to say that I am doubtful that a conservative approach such as observation will provide you with the relief you are seeking. I think that ultimately surgery will be indicated in your case.
Regarding your question of anterior or posterior approach this really depends on the expertise of the surgeon. I can say that's more recently the surgeons which practice in my region have been using an anterior approach. Again this really depends on the experience and the expertise of the surgeon.
I also would recommend consideration of physical therapy to see if this can provide you with some relief of your symptoms over time.
Hope this answers your query. If you have any follow up questions I would be happy to address them.
Thanks for your query.
I can appreciate that you must be dealing with frustrating symptoms regarding the pain as well as neuropathy which you haven't described. The symptoms you described including numbness and tingling as well as some degree of pain in the upper extremity is certainly attributable to narrowing of the cervical spinal canal.
The MRI finding of increased signal which you mentioned generally refers at times to inflammation that can be associated with nerves which have been affected by stenosis. As far as the most appropriate treatment for this there are a couple of options. You could continue to observe symptoms for a period of time. During this time you might consider a trial of anti-inflammatory medications or possibly steroids. The anti-inflammatory medication and steroids can sometimes decrease swelling and symptoms associated with stenosis but it would be better to discuss this option with your treating doctor.
I have to say that I am doubtful that a conservative approach such as observation will provide you with the relief you are seeking. I think that ultimately surgery will be indicated in your case.
Regarding your question of anterior or posterior approach this really depends on the expertise of the surgeon. I can say that's more recently the surgeons which practice in my region have been using an anterior approach. Again this really depends on the experience and the expertise of the surgeon.
I also would recommend consideration of physical therapy to see if this can provide you with some relief of your symptoms over time.
Hope this answers your query. If you have any follow up questions I would be happy to address them.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your opinion. I will be seeing the neurosurgeon in 2 weeks. In the mean time I am thinking of trying Aleve (naproxin) which is available over the counter since you suggested an anti-inflammatory. My question is whether the anti-inflammatory can do anything otther than decrease pain. Does it actually help alleviate the stenosis? And dors it do anything for nerve pain? Currently I am taking Lyrica and occasionally I need to top that up with Percoset. As you suggested I am going to ask the doctor about physiotherapy.
Hi,
Thanks for the followup.
Regarding alleve - yes it is an anti-inflammatory and it is theoretically possible that it may alleviate some of the symptoms of the stenosis. I have to say that while it may help some symptoms, it may not decrease the actual stenosis. I see no problem with starting the Alleve in your case as the potential benefit of taking it is significant and there are minimal side effects. Please take it as recommended on the bottle or as advised by your doctor.
For nerve pain Lyrica is good medication. Another option would be gabapentin or neurontin. This is a prescription drug that has demonstrated some success in alleviating neuralgia or nerve pain.
Hope this answers your query.
I wish you all the best and continued good health.
Thanks for the followup.
Regarding alleve - yes it is an anti-inflammatory and it is theoretically possible that it may alleviate some of the symptoms of the stenosis. I have to say that while it may help some symptoms, it may not decrease the actual stenosis. I see no problem with starting the Alleve in your case as the potential benefit of taking it is significant and there are minimal side effects. Please take it as recommended on the bottle or as advised by your doctor.
For nerve pain Lyrica is good medication. Another option would be gabapentin or neurontin. This is a prescription drug that has demonstrated some success in alleviating neuralgia or nerve pain.
Hope this answers your query.
I wish you all the best and continued good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the follow-up answer- very helpful. My final query concerns the possible surgery. My cervical stenosis is shown on the MRI as c5-C6 and C6-C7 with C5 being the worst. What I am confused about is whether the surgery would be a laminectomy like I had on my lumbar spine (L3-L6) which was successful or would the procedure be a discectomy and then require a graft of some kind. That option seems to be used more now but seems much more difficult and risky. Why are posterior cervical laminectomies not being done that much? I would appreciate your feedback on the possible surgery.
Hi,
I would be inclined to think a laminectomy would be an optimal procedure in your case. I think some research has shown that healing may be better and easier and post-operative complications may be fewer if an anterior approach is used by a skilled surgeon. I would have a long and careful discussion with the neurosurgeon and listen to the surgeons reasoning and recommendations regarding this. Neurosurgeons train for over 7 years and have an expertise in a very specialized field. If you have a good feeling and good communication with the surgeon then I think your experience including surgery if needed will be a good one with an excellent outcome.
Thank you again.
Dr. Galamaga
I would be inclined to think a laminectomy would be an optimal procedure in your case. I think some research has shown that healing may be better and easier and post-operative complications may be fewer if an anterior approach is used by a skilled surgeon. I would have a long and careful discussion with the neurosurgeon and listen to the surgeons reasoning and recommendations regarding this. Neurosurgeons train for over 7 years and have an expertise in a very specialized field. If you have a good feeling and good communication with the surgeon then I think your experience including surgery if needed will be a good one with an excellent outcome.
Thank you again.
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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