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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Hi Kym...glad we've made you feel a little better about your situation.

Let's start with a little spine anatomy. Your spinal cord comes off the base of the brain and goes down into the vertebrae. C1 and 2 are first and they rotate and hook together to move your head. At each vertebra except C1 there are a pair of nerves that peels off the cord and go out to the nerve to each side. In between the vertebrae are the disks, big spongy pads that cushion the bones. The backside of the disks abuts the spinal cord canal so if you happen to get a rupture of the disk at the back, then it go into the canal and affect both the cord and the nerves. They rate the amount of compression or blockage either of the cord or the nerves with the terms minimal, mild, moderate and severe.

Your neck looks okay except for 2 areas...C5-6 and C6-7. Since disks cause the most problems, they look specifically for the area between the vertebrae so that is why you have 2 vertebrae listed in each level.

At C5-6 you have some osteophytes...bone spurs caused by the posterolateral(postero...back and the sides) of the disk or the front and sides of the spinal canal...the disk is right up against the front of the canal. They aren't bothering your spinal cord but the are blocking the hole(foramen) where the spinal nerves go out to the body...but it's listed as mild. But mild still hurts.

At C6-7, you have both disk and bone spur problems. You have a right paracentral(to the right of center)disk herniation that is pressing on your spinal cord to a mild degree causing the cord to be pushed very slightly to the back of the spinal canal. This sounds worse than it is. The cord, if compressed slowly over time can take a lot of compression. I had no idea I had the same problem until I had an MRI and my cord was squeezed down to half it's normal thickness and pushed up against the back of the canal. I was considered moderate to severe compression and you are you are not in danger right now.

But you also have more bone spurs and between the disk bulge and the bone spurs, they have blocked up the holes(neural foraminal narrowing) on both sides of C6-7 to a moderate step below the worst(severe). Here is your main pain/numbness maker.

The C5 nerve is felt on the outside of the upper arm. C6 is felt on the outside of the lower arm and down into the thumb and index finger. C7 is felt in the middle finger, back and front of the hand. but the nerves still travel through the rest of the shoulder and neck and pain can be felt from them there as well.

From my experience and many of those here, most spine docs will not operate until you hit the severe level of nerve compression. But numbness in those fingers means you may be starting to reach the severe level. Numbness can be a sign of the nerve having trouble surviving the compression and so the doc may feel it's time based on your symptoms. Even if the MRI says moderate, your symptoms say it's worse. the doc may order an EMG/NCS (electromyelography and nerve conduction studies) to see which it is or he/she may just go base their decision based on your symptoms.

Is there a way to avoid a fusion...yes. There is a new surgery called a laminoplasty that opens the back of the spinal canal and reshapes the bone and then replaces it, doubling the size of the canal, allowing the cord the cord to move away from the disk. In addition, they open the foramen(holes for the nerves)and then they can also move away from the disk and bone spurs. However, it is a new surgery and you find someone who does it. But you have time to look.

From experience, you should always get a second opinion and even a third. You want a surgeon, either ortho or neuro who does nothing but spine surgery. You don't want a neuro who does brains and spines or an ortho who dies spines and knees. Spines and only spines. This is an extension of your brain and you want the best specialist you can get.

Most docs will probably suggest an ACDF...the standard fusion surgery done from the front of the neck to remove the bad disk and fuse together the vertebrae on either side of the missing disk. It's up to you and the doc you chose whether you have the standard or the new surgery. Since they can't do a laminoplasty on C7, you might be better off with the ACDF.

I hope this helps and know others will be along to give you more support.

hugs........Jenny(fused C3 to T1)
First, let's talk about the difference between nerve compression and cord compression. When you have a compressed nerve, it causes pain and the other symptoms you have down the arm. But cord compression does not. It causes symptoms anywhere in the body BELOW the level of anywhere below C7 it will show up...most likely in the toes or legs. You've probably heard that the brain itself doesn't feel any pain because it has no nerve endings...same with the doesn't hurt. So you get problems like numbness or muscles not working right...signs of very early paralysis. I had numb toes, my leg muscles were very stiff and some days I could only take baby steps, I was losing co-ordination(walked like a drunk when I could walk)and balance. Since I had cord compression at C4,5 and 6, I also had arm symptoms...something called Clumsy Hand Syndrome. I'd drop things I thought I was holding on to, had trouble signing my name, was losing fine motor control of my hands. Cord compression makes big changes over a wide area.

Nerve compression gets very nerve specific. You have numbness that goes to a particular nerve, and pain that follows that nerve through the limb. Specific reflexes are affected and they can be less or more than normal. Because a spinal nerve does feel pain, pain is one of the first symptoms followed by numbness once it gets worse where as with the cord, numbness may be the first sign.

To a spine surgeon, pain really doesn't mean much. A nerve has to be alive to hurt so they look for signs of a nerve that is in danger...numbness, tingling, pins and needles, muscle weakness. So concentrate on the signs that the docs are looking for....if you complain of only pain they send you to pain management.

But do realize that surgery is not without risk as well so they wait until you show those signs of nerve damage to go in.

I know Webdozer doesn't like any signs of cord compression but I had a lot of it and got everything back after surgery. The normal cord is about 10-12mms in diameter and I was down to 5-6mms at C6 and 7-8mms at C5 and 4. I woke up with all numbness and weakness and muscle dysfunction, gone. Your MRI didn't give the cord dimensions so ask the neurosurgeon.

But I saw 4 spine docs prior to surgery and 3 said I needed surgery and 1 said I could wait even a cord compressed to half thickness is not enough for some docs to justify surgery. He went by how I was at 9am...and I wasn't bad first thing in the AM. But the others all saw me late in the afternoon to get a better assessment. Nothing worked well by then...important to remember when you schedule appointments...if you are worse late in the day...make your appointments for then. I didn't know that when I saw that one that said no to surgery. But my neurologist said I needed surgery ASAP and I totally trusted her....she clued me into going late in the day.

So the cord can take a lot and it does frighten many but your doc is the best one to assess how well it is doing with tests and a careful inspection of your reflexes....they can really be valuable in assessing the problem.

So if you don't have any lower body symptoms, your cord is okay.

I'll see what I can find on your doc.


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