# Cervical Spinal Stenosis, End to MTB? OH NO!!



## myitch (Jan 25, 2004)

Cervical Stenosis with Myelopathy: Symptoms, Treatments, Surgery

Well, after years of racing DH and trail riding rock-infested singletrack, my neck and shoulders have constant, unlenting pain and muscle tension from spinal stenosis at my C4,5,6 vertebrae.

The MRI report read,"Severe stenosis with mild encroachment on the cord..." Not good.

Interesting, much research says its more common after age 50. Voila, I turned 51 this year. Dang, I hate getting older!

I read about surgery but of course, they usually try to treat the symptoms first with pain meds, Physical therapy, joint manipulations, cortisone injections, range of motion exercises. But those only treat the symptoms, not the cause - the stenosis. Surgery is always risky too, especially when we're talking being next to the spinal cord.

Sooo, I'm coming to a reality that I may have to give up my most beloved sport in the world. Or I could just cruise XC style and just do mellow trails not technical. But I may get bored and I'm not a fan of climbing all the time. I love fast DH. And trails aren't supposed to be smooth so I'm not going to get off the bike and walk every time there's some rocks. I wanna ride the damn trail.

Maybe I could get into enduro motorcycles, just trail riding and get some speed that way.

Anyone else out there going through or have gone through these issues? I'm about ready to :sad:


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## pwrtrainer (Oct 23, 2005)

It's common over 50 because it's normal. Your pain may not even be from your neck. A correlation doesn't mean the stenosis is the generator. What about all those old guys with severe stenosis and no pain. See a PT that knows current pain science and graded exposure. Surgery outcomes for necks are pretty much a coin flip. PT is too but it's not 50 grand of a waste. I have gnarly pain in my neck and shoulder that persists if I ride when it hurts and when I don't do good balanced upper body exercise. I love what an MRI can find but unless there are significant pins and needles that were sudden I don't feel they are necessary. They end up finding problems that weren't problems to begin with. Imagine if your doc diagnosed you with reduced follicle pigmentation disorder or gray hair. It's the same thing. Have you tried a couple months of therapy yet?


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## Cayenne_Pepa (Dec 18, 2007)

Too much can go wrong with surgery.....and, it's irreversible. Stick with the PT and meds. Heal well....


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## myitch (Jan 25, 2004)

Thanks for the replies fellas. Yes, the acute muscle spasms may not be from the stenosis itself but it is from nerve impingement. The impingement is likely from the vertebrae compressing on the axillary cervical nerves, hence why I only experience it unilaterally on the left side only, same pattern as my chronic neck/shoulder pain. 

It's also possible to have stenosis w/o symptoms as the nerve has been contacted by the lamina. In my case, the lamina are encroaching on my spinal cord "moderately." That's the scary part. "Moderate cord encroachment" If I continue subjecting my vertebrae to impacts, jarring, or other trauma such as associated with rocky or bumpy terrain while riding, it MAY get worse. That's the caveat: May get worse. So the stenosis and disc herniation MAY get worse or stay the same. I have to listen to the pain. 

Yeah, surgery is usually the last resort with the inherent risks involved. But myself being in the medical field, I have seen what happens to those who haven't listened and are now years later paying the price. I don't want to be one of them. 

I was reading in another related post here that one dude had a prosthetic disc inserted at his lower back. This sounds promising. But still, it's not like replacing a shifter and you're back to new again. 

Enduro motorcycle riding might be the way for me to go. Gobs more travel on those bikes and similar trails. I can still get my high speed thrills with more kush.


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## PrivateProperty (Sep 26, 2012)

What would the problem with symptom management be, If it allows you to be out riding?
Pain meds in the correct dose wont make you high, and you will build tolerance but it will allow you to bike as you will, once they find the right treatment/regimen for you.

I personally would never have cash to throw at a surgery like that and I love to bike, so I would opt for management and just keep biking, see what happens. I am also half your age though, at 25.

I am not the most fit, far from it, round actually :F but I do enjoy light technical trails, never done downhill but I am dropping weight and increasing skill.

Even started riding a bmx after treatments of my crash, and I am waiting to hop back on the 29er again. No trick riding with the bmx, but the single speed is fun!


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## bigdog100 (Sep 13, 2009)

read Mcgill's work backfitpro.com. He is publishing a lay book very soon. Go to interview section and read. Also check out Dr. Lyftogt neural prolo. Fascial impingements can mimic cord and peripheral pain generators.


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## smilinsteve (Jul 21, 2009)

My neck MRI looks like I was in a skydiving accident and I should be paralyzed from the neck down. But, my symptoms have only been some numbness and tingling in my hands and an achey neck. 

I didn't put much faith in the cortizone injection idea, because like you said, that's not going to make those discs go back to normal or those bone spurs disappear. 

But I did the injections and it got rid of 80% of my symptoms. Docs say results can be good for 6 months and sometimes people have relief for years from an injection. 

Bottom line is that sometimes things aren't as bad as the MRI would lead you to believe. 

I will avoid surgery as long as I can, but if the choice becomes surgery or stop riding, pull out the scalpel and cut away.


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## danorano (Nov 14, 2012)

The best thing you could probably do is change your diet to one that promotes reduced inflammation. Also, learn a couple of neck flexing exercises and do these a couple times a day. This is a several year process, but with time you will will be able to ride. Don't go jumping or taking on highly technical trails. The real problem is if you wreck, since your neck most likely has a considerable amount of bone spurs and a sudden jar could compromise it. Try to get a seatpost that has a shock absorbancy like the thudbuster or nitro pro.

Welcome to Thudbuster.com
NitroPro - Gas Suspension Seatposts


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## duncanish (Sep 30, 2005)

I second MCgil's backfitpro.com. Awesome resource!
Cervical stenosis is dangerous because of the risk of myelopathy, compression on the cord affecting nerve conduction. Beware any change in sensation strength, discoordination, bowel or bladder control difficulties. 

Seek a second opinion from a Sports medicine doctor who trained in Physical medicine and rehabilitation. A designated physician, whom you trust should be handling this. 
Good luck.


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## kenn72 (Jun 4, 2007)

*sooo......*

so what did you end up doing? I'm going through something really similar, and I don't want to give up riding. What did you do, andthe results? BTW I'm mid 40's and had a bad C6 impact.



myitch said:


> Thanks for the replies fellas. Yes, the acute muscle spasms may not be from the stenosis itself but it is from nerve impingement. The impingement is likely from the vertebrae compressing on the axillary cervical nerves, hence why I only experience it unilaterally on the left side only, same pattern as my chronic neck/shoulder pain.
> 
> It's also possible to have stenosis w/o symptoms as the nerve has been contacted by the lamina. In my case, the lamina are encroaching on my spinal cord "moderately." That's the scary part. "Moderate cord encroachment" If I continue subjecting my vertebrae to impacts, jarring, or other trauma such as associated with rocky or bumpy terrain while riding, it MAY get worse. That's the caveat: May get worse. So the stenosis and disc herniation MAY get worse or stay the same. I have to listen to the pain.
> 
> ...


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## loneviking (Mar 30, 2015)

I understand where you're coming from. I've got the same thing all over my spine plus a natural fusion from a Laminectomy. And yet, I'm pain free most of the time and about the only symptom I have is occasional numbness in the fingers. I had an orthopedic doc tell me once he had patients on disability who had backs that looked better than mine. 

I just shrug and go on. I ride my bike, lift weights, do whatever I want to as long as it doesn't hurt. The only way I'll have surgery is as an absolute last resort.

BTW, I'm 54.


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## Oh My Sack! (Aug 21, 2006)

The surgery saved my life and put me on a mountain bike.


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## Guest (Jul 6, 2016)

*revival*

I've read nothing close to my condition so why not share??

Day after ride symptoms leave me miserable and only recently have received affirmation my cervical issues lead to the 3 amigos, massive migraine type headaches, vomiting and neck-shoulder spasms when standing erect. These were only lasting a few hours early on but now the latest onset was a full 24hrs of all 3 amigos. Why so long before affirmation one may ask? well i'm scared of what it may have been, i.e cancer/tumor and did not want to cope. Now and as the weeks pass i will seek more health professional opinions, diagnosis, testing to confirm the severity of my condition. Most likely disc herniation, nerve impingement, spinal stenosis and perhaps a host of medical terms i've yet to know their names and or definition, but may soon receive my edumacation.


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## Oh My Sack! (Aug 21, 2006)

Those don't sound like enjoyable symptoms after a ride.


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## Guest (Jul 7, 2016)

Oh My Sack! said:


> Those don't sound like enjoyable symptoms after a ride.


no sir they are not, sadly from roadie or mtb they occur. Part swaps can get the cockpit more user friendly(upright) but thats a bandaid of sorts to get by.


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## Jesse/29 (Apr 30, 2012)

Guys, so, I think I'm in this club. Was just "diagnosed" with "Mid cervical spondylosis with prominent discogenic degenerative narrowing at the C5-C6 and C6-C7 levels." Common in truck drivers. So there's that new comaraderie. I'm starting PT soon - but frankly, am just curious if there are others "like me" out there and how they are doing, and WHAT they are doing about it. Of course, stopping riding isn't the solution. Currently riding F/S 29'er, and stem has been brought in to increase upright position. Fun fact, this diagnosis was determined after I thought I was having a stroke, left side of body went numb, good times!


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## Oh My Sack! (Aug 21, 2006)

Jesse/29 said:


> Guys, so, I think I'm in this club. Was just "diagnosed" with "Mid cervical spondylosis with prominent discogenic degenerative narrowing at the C5-C6 and C6-C7 levels." Common in truck drivers. So there's that new comaraderie. I'm starting PT soon - but frankly, am just curious if there are others "like me" out there and how they are doing, and WHAT they are doing about it. Of course, stopping riding isn't the solution. Currently riding F/S 29'er, and stem has been brought in to increase upright position. Fun fact, this diagnosis was determined after I thought I was having a stroke, left side of body went numb, good times!


Has there NOT been a suggestion for surgery?


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## Jesse/29 (Apr 30, 2012)

Oh My Sack! said:


> Has there NOT been a suggestion for surgery?


There has been a suggestion of eventual surgery, but theoretically not for a decade or two. I'm 43, FWIW. I'm going to start PT soon, then possibly move to the injections.


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## Guest (Jul 27, 2016)

Jesse/29 said:


> There has been a suggestion of eventual surgery, but theoretically not for a decade or two. I'm 43, FWIW. I'm going to start PT soon, then possibly move to the injections.


positive vibes your way sir. The PT sounds good.

Due to my muscle spasms when standing and or tilting my noodle up my case is a bit more severe so I'm seeking a neuro surgeon for testing to determine the condition of nerves and assoc parts.


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## rockcrusher (Aug 28, 2003)

nvphatty said:


> positive vibes your way sir. The PT sounds good.
> 
> Due to my muscle spasms when standing and or tilting my noodle up my case is a bit more severe so I'm seeking a neuro surgeon for testing to determine the condition of nerves and assoc parts.


While I don't have full blown stenosis, i have minor degenerative disc issues in my cervical spine and I have a reduction in curvature of that part of the spine.

I have stopped sleeping on my stomach, which was exacerbating it, I raised my stem on my commuter up much higher and run big fat tires to take the edge off the bumps. I do stretches and other items from the PT visits.

My initial symptoms was a very sore neck. I massaged it excessively and that inflamed it to the point that I couldn't sit upright. I had numbness in my left hand and weakness in my left shoulder and lots and lots of pain (though not as bad as yours obviously).

I requested and use a stand up desk at my office, stretch throughout the day and definitely make sure that my hamstrings are stretched but I think the worst offender for me is my pillow and bed. I am going to order one of these: https://www.amazon.com/dp/B000ET9TX...lid=15HHZM5GR2QP8&coliid=I2GETCM2EHFOXK&psc=1


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## Guest (Jul 28, 2016)

rockcrusher said:


> While I don't have full blown stenosis, i have minor degenerative disc issues in my cervical spine and I have a reduction in curvature of that part of the spine.
> 
> I have stopped sleeping on my stomach, which was exacerbating it, I raised my stem on my commuter up much higher and run big fat tires to take the edge off the bumps. I do stretches and other items from the PT visits.
> 
> ...


thanks RC.

My quest has me doing the slow step by step approach to pin point the determined issue. Our bodies degenerate regardless of how we care nutrition wise, fitness wise it's just the fact it happens. To what degree depends on age mostly so @ near 60 I want to continue with my passion to ride so I must remain focused. Riding has been the trigger(sadly) to date but the question remains, why? I can throw parts @ my bikes to alter cockpit ergos but to me that's a temp fix...kind of like steroid injections as a precursor to surgery.


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## Jesse/29 (Apr 30, 2012)

@rockcrusher thanks for that, I just ordered that pillow. 

Here's a maybe obvious point, but it's helping me a little. My normal ride is a F/S Ellsworth Evolve 29, but it's in the midst of a shock rebuild so I'm riding my fully rigid, steel, single speed, "backup" Raleigh XXIX.

It forces me to stand for obvious reasons, all the time. And...my neck and back are considerably better after a ride on this tank than on my full squish. So it doesn't take M Night Shamalan to figure out where I'm going with this one, standing the entire ride is saving my body a bit. The rides are a little shorter because my fitness is also in for repair  but it's something you may want to try, something a full rigid really forces you to do. The Raleigh was $800 bucks, not a big experiment.:thumbsup:


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## sammon287 (Apr 7, 2010)

I'm posting in this old thread to see if any of the original contributors have any updates from the past seven years. I'm in the same boat as the original poster, only at 47 instead of 51. Multi level cervical spondylosis with radiculopathy on the left side. I tried PT first, then had MRI and a nerve study, and have a consultation for injections soon. I'm trying to stay hopeful that something will let me keep riding, even if it's surgery.


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## Philco (Dec 31, 2021)

Sammon, Get the surgery while you are young. When you are older your body can not fight an infection where they operated and you die. I got an infection where they operated in my spine and almost died. 

They wouldn't believe me when I said something was wrong but I finally forced them to MRI 60 days post surgery. They never read the MRI report. "Infection in operated space". My body was literally on fire for months. I was A- blood, now A+. Can't sue em or anything because they were contracted by Veterans Affairs. I was exhibit A in "United States ex rel Kevin Ryan vs Nuvasive". Doctors paid kickbacks to do XLIF and bill as a spine fusion when they never fused the spine, just hammered in plastic hockey pucks. Took YEARS to fuse.

*Don't get the surgery thru Veterans Affairs. They will kill you.


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## smilinsteve (Jul 21, 2009)

Philco said:


> Sammon, Get the surgery while you are young. When you are older your body can not fight an infection where they operated and you die. I got an infection where they operated in my spine and almost died.
> 
> They wouldn't believe me when I said something was wrong but I finally forced them to MRI 60 days post surgery. They never read the MRI report. "Infection in operated space". My body was literally on fire for months. I was A- blood, now A+. Can't sue em or anything because they were contracted by Veterans Affairs. I was exhibit A in "United States ex rel Kevin Ryan vs Nuvasive". Doctors paid kickbacks to do XLIF and bill as a spine fusion when they never fused the spine, just hammered in plastic hockey pucks. Took YEARS to fuse.
> 
> *Don't get the surgery thru Veterans Affairs. They will kill you.


Just curious how your blood type changed?


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## smilinsteve (Jul 21, 2009)

I joined this thread in 2014 when my neck was a problem. Now its lumbar stenosis and I'm focused on ending this problem with surgery. I have tried PT and chiropractic etc, and has helped a lot. I can be pretty much pain free as long as I am sitting on my a$$. Riding is actually doable, but activities like walking, physical working, stacking wood , fixing fences around the ranch etc are torture. As a result, I am much less active which has affected my mind and my health. I think surgery is well worth the risk, because I do not want to be so limited in what I can do pain free.


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## Philco (Dec 31, 2021)

The tube they stick in your side thru a tiny incision that then expands and opens you up so they can see your spine, that tool could not be disassembled to be sterilized. FDA ordered the company to redesign the surgical tool years back. The report is public in the FDA MAUDE reports.

Think thats how my blood went from A- to A+ and a spine infection where they operated. But who knows, Veterans Affairs. Guy who operated wasn't a surgeon, he was a psychologist. Nuvasive company rep in the surgery fled the country to Australia and sells their stuff their now. Couple UC Davis med students watching got a crash course in OMG because their "minimally invasive" one level spine surgery took 8 hours and I woke up and couldn't move or feel my legs.


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## BansheeRune (Nov 27, 2011)

After reading this thread, realizing that some folks have some serious conditions, I am looking at my situation with scoliosis. Time to look into another set of images to look at progress and hope that it has not progressed by much in the last few years.
A couple years since I had imaging done with the scamdemic and cancer treatment this year.


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## BarryR (6 mo ago)

So, in addition to specializing in Brain Injury Medicine (I just posted on the concussion thread), my other specialty is Spinal Cord Medicine (not back pain, that's different). Standard disclaimer: I am not your doctor & not giving medical advice.
The issue with back and neck and risks is this:

1) You have a spinal cord in your neck and thorax which ends at the beginning of your lumbar spine. There (lumbar) you have the cauda equina which is nerve roots. Thus, pressure/narrowing/injury in the central spinal canal above the lumbar spine is much more of a potential problem since it can squish the spinal cord resulting in myelopathy. This doesn't happen in the lumbar cord although with severe narrowing, the nerve roots can be severely damaged resulting in some paralysis, pain and bowel and bladder problems. But again, it takes a lot more narrowing to do this as the nerve roots can move unlike the solid cord. Also, the nerve roots, being part of the peripheral nervous system can recover better than the cord.

2) If the problem is foramenal stenosis affecting the exiting nerve roots (causing a radiculopathy) the risk is pain, numbness and mild weakness (since only on nerve root on one side is typically affected). So, for this type of problem, whether neck or back, decisions to treat or not treat are mostly based on patient preference and tolerance of symptoms. Usually, surgery is not indicated.

Cervical myelopathy can be subtle and PCPs rarely pick it up. One key is if you're getting spasticity /spasms in arms or legs or if your neck problem is affecting your legs.
Some people are born with narrow canals putting them at higher risk for problems as they age.

If I have a radiculopathy or lumbar stenosis, I (personally) would basically base decisions to ride on pain and whether it made me better, worse or no change.
If I had severe cervical stenosis I'd ask my neurosurgeon for advice / guidance and if there was myelopathy, I'd want surgery to decompress.
Also, in case you're wondering - thoracic problems are rare (except in severe trauma or violence/gunshot wounds, tumors, etc) as that is a very stable area due to the rib cage and the fact that not much movement occurs in the thoracic spine.

If one does have severe central cervical stenosis and has a hyperextension neck injury, the cord can get compressed (or "dinged" as we say) resulting in a (usually partial) spinal cord injury -- not good.

One thing about surgery BTW: If fusions are done, then the level above and below the fusion needs to make up for that requiring greater movement and strain above & below & possible future issues there.


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## FredCoMTB (Jul 25, 2020)

BarryR said:


> So, in addition to specializing in Brain Injury Medicine (I just posted on the concussion thread), my other specialty is Spinal Cord Medicine (not back pain, that's different). Standard disclaimer: I am not your doctor & not giving medical advice.
> The issue with back and neck and risks is this:
> 
> 1) You have a spinal cord in your neck and thorax which ends at the beginning of your lumbar spine. There (lumbar) you have the cauda equina which is nerve roots. Thus, pressure/narrowing/injury in the central spinal canal above the lumbar spine is much more of a potential problem since it can squish the spinal cord resulting in myelopathy. This doesn't happen in the lumbar cord although with severe narrowing, the nerve roots can be severely damaged resulting in some paralysis, pain and bowel and bladder problems. But again, it takes a lot more narrowing to do this as the nerve roots can move unlike the solid cord. Also, the nerve roots, being part of the peripheral nervous system can recover better than the cord.
> ...


Thank for sharing that. Have been following this, as I have a facet joint hitting a nerve root at L5/S1 and a mild (by size) herniation at the same level on the same side in the lateral recess. Originally issue was a road bike accident (also got a pretty nasty concussion). An ablation helped with local facet pain, but, of course, doesn't help sciatica. 

To your original point... not asking for any medical advice, just your opinion if you care to share it. If someone goes through a decade of treatment (tons of PT, general health and diet, steroids,etc.) and still has mild to moderate sciatica, what do you think of a Microdiscectomy/decompression/foraminotomy for a quality of life improvement? 

I know one surgery can lead to another, to another, etc. At the same time I feel like surgery has its place, but shouldn't be a first line option, and have seen some folks get an MD and not have a repeat going on 15+ years. 

Sent from my SM-S906U using Tapatalk


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## BarryR (6 mo ago)

FredCoMTB said:


> Thank for sharing that. Have been following this, as I have a facet joint hitting a nerve root at L5/S1 and a mild (by size) herniation at the same level on the same side in the lateral recess. Originally issue was a road bike accident (also got a pretty nasty concussion). An ablation helped with local facet pain, but, of course, doesn't help sciatica.
> 
> To your original point... not asking for any medical advice, just your opinion if you care to share it. If someone goes through a decade of treatment (tons of PT, general health and diet, steroids,etc.) and still has mild to moderate sciatica, what do you think of a Microdiscectomy/decompression/foraminotomy for a quality of life improvement?
> 
> ...


A microdiscectomy shouldn't be a big deal. If it's fairly certain that your pain correlates to where the impingement is seen it is a reasonable option (remember though, I'm not subspecialized in this pain stuff though it is in my purview as a PM&R doc. It is possible with chronic pain though that it won't solve the problem as chronic pain "circuits" sometimes persist even when they cause has been reversed. CBT (cognitive behavioral therapy) has sometimes helped a lot with chronic pain. It's essentially teaching your brain to ignore the faulty signal and can sometimes shift the perception from pain to discomfort. 

Also, I'm not sure of the details. Ask if it while affect movement at that level. If you fuse anything then other levels need to compensate.


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## FredCoMTB (Jul 25, 2020)

BarryR said:


> A microdiscectomy shouldn't be a big deal. If it's fairly certain that your pain correlates to where the impingement is seen it is a reasonable option (remember though, I'm not subspecialized in this pain stuff though it is in my purview as a PM&R doc. It is possible with chronic pain though that it won't solve the problem as chronic pain "circuits" sometimes persist even when they cause has been reversed. CBT (cognitive behavioral therapy) has sometimes helped a lot with chronic pain. It's essentially teaching your brain to ignore the faulty signal and can sometimes shift the perception from pain to discomfort.
> 
> Also, I'm not sure of the details. Ask if it while affect movement at that level. If you fuse anything then other levels need to compensate.


Thank you for that. You're right on the mobility concern though... I'm 35 and hope to be active for a long time, so really don't ever want a fusion unless absolutely needed. Don't even really want to start with the MD until I'm sure... the intensity is intermittent so I'm still trying to hold off. The MRIs do show impingement but it's variable enough I'm still forcing myself to wait right now. 

I'm glad you mentioned the CBT though. I remember hearing about it, but admittedly I think I was pretty dismissive because I was in the depths of a flare up. Going to check it out more now. Thank you! 

Sent from my SM-S906U using Tapatalk


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## Desert Ryder (Aug 27, 2021)

just thought I'd jump into this thread. 

Had cervical spinal fusion to C4-C7 on 12/7/22. Outpatient surgery. Checked in at 7 am, and was home by 2 pm. Surprisingly, no pain after surgery.
Still wearing a hard cervical neck collar.

2 yrs, 2 neurologists, multiple MRIs. x-rays. nerve tests, PT, and blood tests. The first neurologist said it was a motor neuron disease, Second one, Not a neurological problem.

Physical therapy didn't do much except for the cervical traction sessions.

I had pain and loss of strength before which originally sent me to have it looked at. I told them I think I had a pinched nerve in my neck.
After all this time it was...nerve impingement and spinal stenosis...layman terms...pinched nerve and disc degeneration.

Here's where they went in. About 3" long on the left side of my neck. Internal sutures also.


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## Mikes70 (Oct 24, 2016)

Its simply incredible what the docs can do these daze.
Heel up well! 🍻


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## milehi (Nov 2, 1997)

Knowing what I know, I'd jump right into surgery. Thousands of these cases directed and I hold patents on some pedical screw designs, along with other ortho devices. I'd find a doc that likes to cut, then follow up with a removal of hardware surgery down the road.


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## BansheeRune (Nov 27, 2011)

milehi said:


> Knowing what I know, I'd jump right into surgery. Thousands of these cases directed and I hold patents on some pedical screw designs, along with other ortho devices. I'd find a doc that likes to cut, then follow up with a removal of hardware surgery down the road.


Just wait til your bike finds out you got some Ti bits... It'll be on, bike goes shoppin for Ti bits!


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## BarryR (6 mo ago)

K


milehi said:


> Knowing what I know, I'd jump right into surgery. Thousands of these cases directed and I hold patents on some pedical screw designs, along with other ortho devices. I'd find a doc that likes to cut, then follow up with a removal of hardware surgery down the road.


This is not good advice! (IMHO).
ALL surgeons like to cut, that's why they are surgeons! The good ones (and ethical ones) only cut when they think it's the best option (rather than because car or tuition payments are due).
As I mentioned somewhere above, if the spinal CORD is being compressed and damaged, don't mess around, it needs to be decompressed (i.e., surgery). For nerve root stuff (or even central below the cord - lumbar), there is way more latitude, options, and conservative treatment. Sure, if weakness is progressing, pain is unbearable or it's just not getting better surgery might be appropriate.

If normal function can be restored without surgery, that's vastly preferable!
Also, things can go wrong in surgery.

I would recommend starting with a Physiatrist who does back/ neck pain (and ideally comes highly recommended). If the physiatrist sends you to a neurosurgeon, it's probably time.

Neurologists can certainly diagnose these things but their training doesn't really focus on the treatment..
PS: Desert Ryder - I assume you had some spinal cord involvement as that can look like ALS but typically a doc would get a c-spine MRI (while praying that patient has cervical myelopathy & not ALS) BEFORE telling them they have ALS!


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## elder_mtber (Jan 13, 2004)

Desert Ryder said:


> just thought I'd jump into this thread.
> 
> Had cervical spinal fusion to C4-C7 on 12/7/22. Outpatient surgery. Checked in at 7 am, and was home by 2 pm. Surprisingly, no pain after surgery.
> Still wearing a hard cervical neck collar.
> ...


I have that scar. C3-4-5 fusion. My neck hurt and I lost the use of my right arm. The surgery outcome was not perfect but OK. Regained the use of the arm. This was about 15 years ago.


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## milehi (Nov 2, 1997)

BarryR said:


> K
> 
> This is not good advice! (IMHO).
> ALL surgeons like to cut, that's why they are surgeons! The good ones (and ethical ones) only cut when they think it's the best option (rather than because car or tuition payments are due).
> ...


Half the orthos I worked for wouldn't touch the spine. Joints only.


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## BarryR (6 mo ago)

milehi said:


> Half the orthos I worked for wouldn't touch the spine. Joints only.



Ortho SPINE docs operate on spines as do neurosurgeons.
Other orthopedists operate on the other stuff.
Then some specialize in joint replacements and do that.

I didn't say that they like to cut so much that they'll do stuff they're not qualified for. 
Let's just say some can be over enthusiastic.


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## RingDings (2 mo ago)

@Desert Ryder I wish you a speedy and good recovery


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## elder_mtber (Jan 13, 2004)

milehi said:


> Half the orthos I worked for wouldn't touch the spine. Joints only.


Spinal outcomes vary widely. I know, I've had three (3) lumbar spinal fusions and my most recent surgeon says I need another one. My back hurts a lot every day.


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## elder_mtber (Jan 13, 2004)

smilinsteve said:


> I joined this thread in 2014 when my neck was a problem. Now its lumbar stenosis and I'm focused on ending this problem with surgery. I have tried PT and chiropractic etc, and has helped a lot. I can be pretty much pain free as long as I am sitting on my a$$. Riding is actually doable, but activities like walking, physical working, stacking wood , fixing fences around the ranch etc are torture. As a result, I am much less active which has affected my mind and my health. I think surgery is well worth the risk, because I do not want to be so limited in what I can do pain free.


I have like exactly the same symptoms. Sitting is good, riding is actually OK, anything standing is horrible, and has been for about 3 years, since my most recent herniated disk and lumbar fusion. I've done tons of physical therapy and a $2000 chiro ripoff (CoreCare) and nerve ablation and many shots but no real relief. Right now trying Nevro spinal cord stimulation (It shows some promise.). My back hurts every fu**ing day.


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## BarryR (6 mo ago)

Key issues here as far as whether or not to get surgery are:
1) Has conservative treatment failed
2) Is there a clear identifiable anatomical problem that can be addressed with surgery.

So, if you have severe lumbar stenosis (both clinically & on MRI) and conservative treatment has failed, a decompression is completely appropriate. If you have a pinched nerve identified on MRI, symptoms which correlate well with exactly that (numbness, pain, weakness in the corresponding nerve root distribution) and either the weakness is progressing or the pain won't go away despite meds, PT and epidural injections, the decompressing that nerve is a fine option.

If your spinal CORD is getting compressed and damaged (as I mentioned above) it needs to be decompressed (as I think Desert Ryder is all too aware of).

When it gets more nebulous than that though, it's time for skepticism.
Ditto with multiple repeat surgery for "failed back syndrome".


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## Desert Ryder (Aug 27, 2021)

hardware pics


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## milehi (Nov 2, 1997)

Nice work. My keychain is a cervical plate. Not mine but expired stock.


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