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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Hi Heather....let's start with an anatomy's the best way for you to understand what is going on in your neck. If you know this stuff already, please forgive me but others may learn from it.

Your spinal cord descends out of the base of the brain and into the spinal canal. The spinal canal is inside the vertebrae of the spine at the back of the bone.The much maligned disks are in the front of the vertebrae and in between them as well. That is why they list the areas as 2 vertebrae with their disk in between as that is where the most problems lie.

So the first vertebra is C1 and it's a simple circle with a hole in the middle and no disk below it. It gives you the rotation of your head. C2 is a regular vertebra with a bone sticking up on top that C1 sits on. So at C2, nerves peel off the sides of the spinal cord and go out to the body. They serve the back/sides/top of the scalp and wraps around the neck. It MAY have a branch that serves the lower sides of the face and overlaps with the facial nerves that come directly from the brain. There is a disk between C2 and C3. At C3, another pair of nerves peels off and goes out to the body and serves the back of the neck and wraps around to the collar bone area. C4 has nerves that go to the shoulder area. C5 serves the upper part of the outer arm. C6 serves the lower arm on the outside down to the thumb and index finger. C7 shows up on the skin only at the middle finger. And C8...the nerve that comes out between C7 and T1 serves the ring and little fingers.

So as you look at the spine from the back, if cut in half, you'd see all these vertebrae. At the front is the disk and behind it is the open canal for the spinal cord. The canal holds the cord and the cord is covered with a lining that holds spinal fluid in around it. They call this lining, the thecal sac. And at each vertebra, a pair of nerves peels off the cord and goes out from the thecal sac and then out through holes on either side of the bone called the neural foramina. Most of our pain comes from bone spurs or bits of herniated disks that hit these exiting nerves. When something hits the cord, it really doesn't hurt as like the brain, the spinal cord itself has no nerve endings but it can cause problems below, in your legs. Yes, you can have numb toes from a problem in your neck...the pressure on the cord transfers inward to affect the inner most nerves that serve the lower part of the body.

If you look a the spine from the side, it has multiple curves. At the neck, the spine curves inward toward the throat, known as lordosis, the curves outward at the chest, called kyphosis, then back in again at the waist, called lordosis again and then it actually curves back out at the sacral area for the final kyphotic curve. As we age, we naturally start to lose the normal lordotic curves in both the neck and the lumbar regions. Injury, arthritis and congenital problems can all make it happen faster. When the curve in your neck goes the opposite way(kyphosis), you end up not being able to lift your head.

So that is basic anatomy. Terminology.....spondylosis is a fancy word for arthritis of the spine. Osteophytes are bone spurs caused by arthritis. Stenosis is a fancy word for "closing up" whether it be the spinal canal or a heart valve. Physiatrist...a doctor who specializes in physical rehabilitation.

So here is what your docs have found: C1 and 2...fine. C2 is slightly(3mms) forward where it sits on C3. Inside of C3-4, there is severe impingement of the nerves that leave the cord to the body.....according to spine clinic but not reported elsewhere. As noted above, this would cause pain at the back of your neck and wrap around to the collarbones. Probably what is causing the muscle spasms in your neck and the vast majority of your problems. have that congenital fusion which means you may have been born with this or it happened on it's own during your lifetime. At C6-7 the same thing is are fusing naturally. Natural fusions happen when bone spurs from arthritis build up and form solid bone connecting across the bones surfaces.

You have a narrowed spinal canal with these natural/congenital fusions as it builds bone and not always where we want it to. It shows that bone spurs and some disk material have pushed up against the thecal sac and as a result, filled up the spinal canal. HOWEVER, and this is a big one, you can have your spinal cord compressed down to half thickness before it causes problems or needs to be fixed. You only have stuff touching the sac and possibly the cord was flat as a pancake(instead of oval) and compressed to the point where you couldn't see any spinal fluid around it. A normal spinal cord in women is 10-12mms and I was crushed down to 5-6mms. So you have a way to go before it needs fixing. I suspect the doc made a big deal about it as it was something he could show off and so he did. You should see my MRI.

He also made a big thing about the loss of lordotic curve and that is something that happens naturally but in your case, was sped up by that natural fusion. And since they are already fused naturally, it can't be fixed. But the good news is, it won't get any worse and shouldn't really cause that much pain unless you spend a lot of time looking up at the sky.

So the bottom line is that your neck is not that bad with the exception of the closed up foramina at C3-4 that is pressing on the nerves to your neck muscles. This produces severe spasms and the more you try not to move your neck to avoid the spasms, the worse they actually get. After a while, the muscles freeze in place.....what I suspect has happened to you.

Which of your symptoms does this explain? The headaches which can trigger migraines. Loss of neck mobility and spasms. And that is about it.

Surgery to fuse C3-4 and remove the disk and bone spurs would probably help a lot but then you are looking at man-made and congenital fusions from C3 to C7 and you'd lose a lot of head movement but you've lost that from the spasms anyhow. But I would see the physiatrist first. I see one and she is great. Has me doing all sorts of physical therapy to keep my muscles loose so I don't spasm like you do. And I take the same muscle relaxer that the doc suggested...Soma.....quite strong. I doubt they'll do surgery until you get the muscles moving. Home traction units can be very helpful to relieve the pressure on your nerves as well and should give pain relief as well.

As for all the other symptoms, I suspect your GP needs to keep looking. Have they done a brain MRI or MRA?

One of the secrets I use for pain relief is therapy....not physical therapy but the emotional type. Chronic pain can drive you to suicide. I don't know of anyone who doesn't battle depression and anxiety from chronic pain. Psychotherapists who specialize in treating chronic pain can teach you a lot of ways to deal with it and it has paid off tremendously for me. I cannot suggest a better thing to do for yourself.

So now that I've done my usual anatomy class and terminology class and looked at your records, I hope this doesn't upset you. Your neck is really not bad but you have a big problem in one spot that no one is addressing very well. If you could read some of the MRIs we have here!

Anyhow, I'm here for questions and I bet you have a ton of them.

hugs.......Jenny(fused C3 to T1)
so you actually had your docs pager # then? great idea heather, bypassing the "sick" stupid LPN who wants to be wayyy more than she is. there used to be a nurse for my sons doc like that who i had called to let her know to tell my sons doc when he ended up suffering a major brain injury?? she NEVER ever mentioned it to him. so when i called about a few days later to give an "update' on my sons condition and he called me back later that night(another nurse had taken THIS messege) he was soo angry and shocked that his own alleged' nurse had not even mentioned this to him or at LEAST written a note or something. duh?? what a sick woman,ya know? and i had to deal with the NP from hell who was my neurosurgeons NP when i had my two surgerys done on my c spine(an acdf followed by hardware placement only 9 mo later when i was finally ABLE to see him) despite the fact i KNEW without a doubt and so did my actual primary that i did not fuse at least one endplate since the symptoms were worse than when i had originally walked in there, she would NOT let me make an appt with him. she said it would be a "waste of HIS precious time. it was a call to my surgeon FROM my really wonderful primary that finally got me over HER head and in to see him for an eval,and yep, something did not fuse. god i was soo angry and sick of having to deal with that woman. she too kept acting like SHE was my NS or something. quite the lil 'gatekeeper" there.

i would make dang sure, if you can recall dates when you called or anything at all to back up just how many times that ONE sick LPN decided to be "creative' FOR HIM, and took things onto herself that 'should have' gone thru to your own actual doc for decisions about your ongoing care. they seriously NEED to get rid of someone like that. she does not "deserve' that job or THAT much power over his own patients either. she could end up actually killing someone by not relaying critical info for gods sake(if only at LPN, she simply does NOT always know what even IS or is not a possible symptom of potentially devistating situations patients are calling about. not too good as far as triaging patients, ya know?). unfortunetly you find alot of these types of stupid people at just about every clinic, and esp when you start seeing the "specialists? these(usually surgeons) are usually pretty busy and booked solid and constantly buzzing around, so they DO need to have at least an NP opr PA to 'do' alot of what would be dumped on him that they just do not have time for when doing surgeries and seeing patients in clinic too. some are wonderful, like my orthos PA, and some are sick and seem to think they hold powers they do not(kinda like a certain 'mom' i have heard about??). hopefully your doc WILL fire this woman before she does REAL harm to one of his patients(she IS a big liability to him). i would PUSH this with him when you see him. its ridiculous and sick that you had been trying to get a hold of him since freakin JULY and she never ever let him know that? yikes. it IS a pretty sick world of medicine out there at times when you seriously just have to need constant care and people like that get in our ways of just getting our needs met from our own docs.

so do you have an appt with him then? at least you DO have him thinking like we are, and that IS half the battle in getting our needs met when we just have to have certain testings done. i DO really feel that once that MRA can be done, at least then we will know what it is that is blocking up there, and more than likely also generating ALOT of your more profound symptoms too(this just WILL show your whole arterial set up and what that blockage consists of too). i would take some time here tho to look up everything that our sympathetic nervous systems simply govern, then compare what has been going on with you too with YOUR symptoms? make a list, just because this 'could be' being impacted from your way overly tightened muscles within your neck that easily could be irritating the heck out of either side of that sympathetic ganglion(they DO sit on both sides of our trachea, then go downwards), or at some point along that chain(this pops into and out of that cord so it IS kind of susceptable to be impacted outside in the actual spinal column) too given the issues you have there? it just IS possible to end up with some really sick pain syndromes among other crap when our SNS is being impacted or as in my case, damaged during my surgery on my cord(i am and have been stuck in the "fight or flight" mode since it went into that mode when it(the SNS) felt 'attacked? then stayed there since the "hit'). so it DOES need to be defined. it simply governs a TON of our body system functions at the more 'base' levels. just something more to add to your 'list' of possible involvements.

just make certain actually write down everything that you need from him when you see him. i know I forget alot at times, esp when i am at my docs. my brain just does not seem to want to work with me here at times either, so i DO make a ton of "lists' for many things.

i do hope this can all be done asap so you can finally get some levels of answers here for your pain and suffering among other things heather. make certain to ALWAYS obtain every single 'testiing results" for any all tests/scans run on you for YOUR own files you can keep at home. then you also have good 'baselines' to compare future testing with too. i have alll my ongoing crap in one big expanding folder that i also take with me to most of my ongoing appts too. its just not eay trying to remeber every stupid detail of every test or stupid surgerys i have had to have since 2001(6 surgeries and an annie coiling all since that year, and about 20 or so MRIs among other scans). its easier to just pop into my file,lol. i personally want to see the MRA scan results myself to just see what the heck has been doing this to you. this type of crap at times just can be something you were born with, or something that somehow 'formed itself' along the way too. good luck and DO most definitely keep us posted hon, marcia

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