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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Hi Phlox...stenosis 101, huh. Here goes what I know about it(and I have it). Stenosis means "closing up" and you can have stenosis in all sorts of places where they are openings that are closing for some reason. A heart valve that is infected and closing up has stenosis. So that's what it means...closing up. In the cervical spine, you have the central canal for the spinal cord and that can have stenosis and be closing up around the spinal cord. You can be born with an abnormally small spinal canal or you can develop one through arthritis or injury. Both arthritis and injury can cause the bone to start growing to repair itself and as a result, overgrow making the inside canal smaller. Any injury or arthritis in someone born with stenosis, will cause problems as they are already small to start with. Sounds like with your thoracic problems, this might be your situation.

Then there are the holes in the vertebrae where the nerves exit the vertebrae. Each vertebra has a set of nerves that peel off the cord on each side and go out to the body. They too have a hole-called the foramina- they can get "closed up". And then, in the neck only, you have arteries that go up to the head and their holes can get closed up too.

But for this discussion, we will stick to the nerves and spinal cord. If the holes where the nerves to your body are closing up and pinching the nerves, you'll feel it. Personally, my pain was in the shoulder area and then would skip down to just above my elbow and then be mid forearm. Those were the "aching" areas for me but then I'd get pain radiating all the way to my fingers along with the aches. The vertebrae in the neck covers all the way from your head to your upper chest area and both arms so not knowing which ones are affected, it's just a guess at to what is affected there.

And then there is stenosis of the spinal canal. That can press on the spinal cord itself and that doesn't hurt. What happens is you start to get symptoms of loss of function below the level of the compression. So let's say you have an area of bone compression at C6-C7. That would cause symptoms below that level but not above it. Let's say you were in an accident and your spinal cord was cut between C6 and'd end up with paralyzed legs, wrists and hands but could move your shoulders and elbows. So the docs look for any loss of function in legs, wrists and hands if you have cord compression in those areas. My worst area of cord compression was exactly there and I had very stiff legs that caused me to take baby steps when I walked. I kept dropping things with my hands and had difficulty doing things like painting, stirring foods on the stove. My hands and wrist were weak and clumsy with some slight numbness of the skin throughout. My toes felt numb and the skin on my legs felt different from the rest of my body. That is what loss of function is....a very slow progression towards paralysis. Not pain, but loss of function.

That slow paralysis is one of the main reasons docs operate. They fear that if you have a fall or an accident that causes whiplash that it might cut off the blood supply to your spinal cord and leave you paralyzed. Think of it this way....if you take a bottle full of soda with the top off and bend the bottle to 45* what will happen? The soda will come rushing out the top as there is not enough room for it. If you put the same bottle of soda inside a bigger bottle so it has room to move around and bend the outer bottle to 45*, the soda bottle will simply move away from the bend. It might get bent a little but probably not enough to cause all the soda to come rushing upwards and out. That is what happens in a canal with lose the protective outer canal where there is spinal fluid to cushion the cord from disaster.The chances aren't that great(3%) that your cord would become that damaged so some docs don't want operate until you're badly affected. I had one neurosurgeon who thought I wasn't bad enough and another who thought I was. My deciding person was the neurologist I saw regularly as she knew me best. She voted to operate. It really is a decision you have to make with people you trust.

So here is what you need to find out. What exactly is compressed by stenosis? Nerves or spinal cord or both? Having pain worse on one side than the other is a reflection of the compression being worse on that side so you next need to find out which side is worse and is it the side where you major pain is? Remember, you have nerves that exit to both sides in each vertebra. It can be bad on the left in one vertebra and worse on the right in the next one up or down. Is the nerve compression mild, moderate or severe? If the cord is compressed, how badly? They can measure it. A normal spinal cord is 11-12 millimeter wide in the neck. Is it below that? By how much and at what level? I had multiple areas of cord compression at different levels and to different degrees with the smallest being 6 millimeters between C6 and 7.

As for pain meds to treat it, I am not a good person to speak to that issue because I had the pain but it was years before. I found out I had a major problem when I could barely walk. So I'll let someone else deal with that question.

On the shoulder pain and whether it could be your heart or lung from smoking, you'll have an idea when you know if you have nerve compression on the left side. If you don't then you need to go looking for source elsewhere. I had so much shoulder pain I ended up having surgery on both shoulders(it was needed) but it only took away half the pain...the other half was from my neck.

So I take it you have had a cervical MRI and are waiting to go see your doc for results. Ask the questions I posed above and even ask to see the MRI and have them show you and explain it. It's really a very visual experience. I'll never forget my neurologist putting the MRI up on the screen, pointing to one picture in particular and saying.....spinal cords should not look like pancakes!

I hope this helps. Any questions, ask away.

gentle hugs.................Jenny

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