Spinal Stenosis

Bones, joints and muscles
1

I have recently attended an appointment with the Pain Clinic, at the Walton Centre, Liverpool.

I had been previously diagnosed as suffering from Degenerative Disc Desease, however when I spoke with doctor he said the couldn't understand why my previous consultant had made that diagnosis as he could find no evidence of DDD on the latest MRI pictures.

He did however inform me that I do have Spinal Stenosis in my Lumbar region, but that I also have Stenosis higher on my spine as well. I am now really confused as to where I stand now, has anyone been in the same position as me and if so please let me know what's happened since with you.

Thanks in advance Reddave8

2

A few years after a TLIF fusion from L3 through S1, I encountered severe foraminal stenosis at L2/L3.  Chiro and pain shots do not work for this...at least for me.  Needed a fusion of L2/L3...

https://patient.info/forums/discuss/the-expandable-spacer-570509

This was a freaking miracle!!!!!  One overnight, no brace, no rehab, instant stenosis relief.  Search YouTube for "globus lateral" to see a cute animation of the procedure.  They can do this at the two points of issue in your lumbar spine.  See the posterior and lateral pics attached.

3

Usually, the radiologist reading the MRI pictures will state...'degerative disc disease'. You have spinal stenosis, which is narrowing of the spinal canal. You didn't say if it was mild, moderate or severe. If it was severe...you've got quite a problem on your hands, & the Dr. would have called you in by now. 

In case you didn't know...foraminal stenosis is a narrowing of the opening where the nerves come out of the disc. I have severe foraminal narrowing at C4-C5 on the right side, & moderate narrowing on the left. Yes, my right hand it starting to bother me with pins/needles., & my shoulders get sore too. I also get headaches. I will be seeing my Neuro Oct. 5 for followup.

If you could get a written copy of your MRI you might get a better understanding of what's going on with your spine. Here in Canada, we can obtain those copies through either the hospital where the MRI had taken place, or you can ask for a copy from your Doctor. Usually the specialist or hospital sends copies to your GP...likely you can get the copy from him/her..but I don't know what the rules are in the UK.

Best of luck. Let us know how you get on.

4

I agree with Mike that it depends on the severity of the narrowing.  Also, the vertebrae involved will create different symptoms because of the specific nerve roots involved.  At L2/L3, I felt like I had sciatica down the back and front of both legs simultaneously.  It will be different for each vertebra. The location of your pain is a clue for the neurosurgeon as to where in the spine the problem is originating from.  You can try all the non-invasive methods you want but if the cause is severe stenosis, surgery is the permanent fix and an LLIF is the way to go.  Do NOT get talked into a TLIF with all it's recovery time and pain.  Find a competent LLIF neurosurgeon.

5

Thanks for your advice and by the sounds of it I have moderate stenosis on 2 levels, well I hope its moderate as it's still so bloody painful even with the 90mg slow release capsules I'm prescribed and taking. Until this recent appointment no one has mentioned anything else and we believe what our consultant tells us as that's their specialty after all, I do feel a tad betrayed by someone not being honest with me and I will be asking for a written copy of the MRI test results.

Regards Reddave8

6

Thanks for your advice and I will be reading up on the procedure so that I will have an informed knowledge before confronting doc to and consultant.

 Regards Reddave8

7

Reddave8...I'm sure by now, you know what 'stenosis' means...it means "narrowing'. Yours is moderate, or so  you say. Were you told it was 'moderate', or is this a guess??? I'd say you have more to worry about if it were 'severe'., & very likely the doctor would have done something about it, because to let it go, would encourage instability in the spine. Regardless, you're in a lot of pain. I don't know what medications you're taking, but I've developed an attitude toward medicine. In a lot of cases, people do need the meds. I'm not suggesting for a moment you don't need them, but medication simply masks what's going on. If they took the pain away, we'd have no idea as to whether or not the symptoms were progressing!! 

I would think when the word "Consultant" is used, you're referring to your GP or Family Dr. Here in Canada we refer to our primary care physician as the Family Doctor or GP. Anything beyond that is a Specialist. I too have some moderate stenosis in the cervical (neck) spine..& the narrowing at C4-C5 on the right is severe. What are they going to do about it if anything??...I don't know, because I don't see the Neurologist 'til Oct. 5. Yes, I get headaches...yes I have sore shoulder muscles, & sometimes experience pain in my shoulder blades. The headaches drive me crazy at times, but not only does my headache, I can become nauseous. Experiencing this at least 4x week diminished my quality of life.

Truly, get a copy of your MRI results...& if you haven't seen a Neurologist as yet, ask to see one. The GP can only do so much. 

8

Hi Mike, I have been under the care of a Neurologist at our local Orthapedic hospital for the past 4 years and have put my faith in him as he is the man with the specialist knowledge. 

I have sadly progressed from the initial aspirin and ibuprofen, through to pain relief patches leading to the current opioids with now of a mind that I'm still in constant pain never below 6 on the 1-10 sliding pain scale. So I'm desperate to find a suitable solution, without the significant side effects of morphine. I'm currently waiting on the letter my new specialist has assured me will be coming as he's copying me in, then I can take it further. 

The main problem aside from the acute pain is that my spine is so unstable and it isn't one thing that sets of the spikes of pain and muscle spasms that once activated can last for hours or days at a time, with mood swings thrown in for good measure. 

The worst part for me and I'm hoping it's not like that for you is that the stenosis is affecting everything that I do or attempt to do!

 

9

Reddave8...Hang in there, Buddy!!  I'm relieved to know that at least you've been under the care of a Neurologist rather than fighting with your GP to get something done. 

Yes, it's sad that you've progressed from aspirin & ibuprofen, pain relief patched, & opiods. Here in Canada, Drs. don't like to prescribe opiods because of the high risk of addiction, AND there are a very limited number of tablets that are prescribed at any one time. If they discover that the patient has gone through the prescribed dosage before the estimated time, they can be accused of abusing the drug, & it winding up ending the doctor/patient relationship. 

In my cervical spine (neck) I have moderate spinal canal at C4-C5, & mild spinal canal at C5-C6. I do believe this along with the severe right narrowing of the neural foraminal opening at C4-C5 is what's giving me the headaches, sore shoulders, etc...or it could be everything combined that's going on in the neck. 

You went on to mention a letter that your new specialist will be sending. I'm a little confused here. At the beginning of your writing, you stated that you'd been under the care of a Neurologist for the past 4 years. Have you switched specialists? Also, what is the letter supposed to entail?

Personally, I would not accept progression to a higher dosage of drugs. All that's going to do is mask what's going on & yes, relieve your pain, BUT the cause is still in existence, isn't it. 

I still believe you need to find out for sure just how extensive the stenosis is. Is it mild.,is it moderate, or is it severe. If it's moderate, they may take a "watch & see" approach. 

As you Brits put things...I think you're 'in a bit of sticky wicket". 

Hope you're feeling better today. Please keep me up to date.

10

Hi Mike, I have been referred to a new Neurologist after my previous one informed me that owing to financial constraints impose by Shropshire CCG that all spinal procedures were to cease.

This left me with no option other than to either (1) except the situation or (2) fight on for a solution, I've picked option 2.

I'm not exactly sure what the letter will contain, other than he was going to challenge my previous guy to explain his findings and diagnosis leading me through many different drugs and procedures that the new man feels was either unnecessary or wrong! I will have to find the answer regarding the severity of my stenosis and then either take further advice or help. You are right about us Brits we do seem to be a nation of wait and see, instead of challenging from the beginning.

i hope you are having a better day yourself, regards Dave.

11

Reddave8...I would assupme Shropshire CCG is a spinal procedures organization or whatever. I don't understand why procedures regarding spine would cease just because of financial restraints unless it's not recognized as a truly medical necessity. I would assume that if someone required surgery, it would be done by a qualified surgeon, & therefore would come to fruition. You must be careful of all these 'spinal specialists' that seem to pop up out of nowhere. There are places where you hang by your feet, & they claim it will straighten your spine. I'm frightened of the idea of what that might do for bulging discs, etc. If things were that simple, people wouldn't be seeing qualified physicians.

For sure  you need to find out just what the severity of the stenosis is. It may be mild, moderate or severe, but I'm sure if it were severe, you'd have heard something by now. Yes, you need an answer. 

Remember Dave..this is your spine...get it seen to.

12

Thanks Mike, once I finally receive the letter I'm told is coming I will hopefully have a better idea and will let you know what they say mate. Cheers for the advice to date . 

Regards Dave

13

Hi Mike, I've received my letter this morning and it did confirm that I do have spinal stenosis L4-5 & S1 but it also states that I also have it L1-2 as well. He has also confirmed that owing to his diagnosis I'm unsuitable for a Spinal Cord Stimulator, with the fact that I've exhausted all non surgical options the only option left open to me is 2 separate surgical decompression procedures. He has also referred me to a psychologist, Neurological pain specialist and also a specialist Physio and an opioid reduction/alternative program. He hasn't stated my severity but I will contact him again and hopefully discover my level.

Regards Dave 

14

Reddave8...yes you need to know the severity of the stenosis. Reddave8...just who is this guy? Is he a Neurologist??? He state you're unsuitable for spinal cordstimulator, & you've exhausted allnon surgical optins, with the only option being 2 seperate surgical decompression procedures. Now you're being referred to a Psychologist, neuro pain specialist and specialist Physcio & opiod reduction/alternative program?  Why a Psychologist??? You still have some unanswered questions here, at least they'd be unanswered to me.