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A debate in my own bent mind - body .. Neckie vs. Backie

MetalneckMetalneck Island of Misfit toysPosts: 1,364
edited 06/11/2012 - 9:01 AM in Spinal Stenosis
Ok ... first of all - I am a bothie.

But since the addition of my Lumbar to my mix, I have had my own debate going on in my own mind/body ... Which is worse - my neck or my back? First pain wise ... and then in the big picture - potential danger - wise. (Obviously I have way too much time).

In searching our own SH site I found some very interesting
comments from one of our physician contributors relative to stenosis. (This was prompted by wondering why I don't hear more people talking about SEEP testing).http://www.spine-health.com/treatment/diagnostic-tests/somatosensory-evoked-potentials-ssep.

"Lumbar Spinal Stenosis vs. Cervical Spinal Stenosis
•In lumbar stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of sciatica -- tingling, weakness or numbness that radiates from the low back and into the buttocks and legs --especially with activity.

•Spinal stenosis pain in the neck (cervical spinal stenosis) can be far more dangerous by compressing the spinal cord. Spinal cord stenosis may lead to serious symptoms, including major body weakness or even paralysis. Such severe spinal stenosis symptoms are virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine."

From http://www.spine-health.com/conditions/spinal-stenosis/what-spinal-stenosis

I was mostly interested by the last couple of lines as it relates to the Neuro vs. Ortho debate also.

When it all shakes out ... At times I question our makers designs. (and corresponding sense of humor-irony-tragedy?).


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  • dilaurodilauro ConnecticutPosts: 9,865
    This topic comes up from time to time here. It seems that when a spinal patient is one of those, at a later point in time, they have the other one.

    So, this is out to all those who are in the special club of having both Cervical and Lumbar surgeries.

    Dave identified some very good articles to read. I for one always was more afraid of the cervical problem/surgery, only because IF there was a screwup, I could potentially be paralyzed from the neck down.

    With Lumbar surgery, that changed to being paralyzed from the waist below.

    I know that may sound a bit morbid , but thats how I did approach both of those.

    Everything being said, I feel that my cervical surgeries were easier, the recovery was more simple, the physical therapy easier and the long term impacts not as great.

    My last cervical surgery was in 2000 and unless I really do something stupid, I do not have any more pain or symptoms associated with cervical discs.

    I still have lumbar problems, flare ups, etc even though my last lumbar surgery was around 1984. I do KNOW that I did screw up and did many wrong things and perhaps this is why my lumbar area has never forgiven me.

    Now as far as restrictions, I have more with my cervical situation. I still have a limited range of motion side to side, I can not really turn my neck around enough when merging into oncoming traffic, plus a number of other things.

    I've been reading about Peyton Manning. No question one of the best quarterbacks we have even seen. He has had several cervical surgeries. This year, his team released him, partially because of the medical situation. He has nothing to prove to anyone anymore, because he has done it all, but he has signed on with another team. One strong hit the head/neck and he could be paralyzed for life.... Would that be worth it?

    To net it all out..... IF I was to select if I wanted to be a Neckie or a Backie (not both), I would select Neckie....
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    Thank you for your personal insights and experiences.

    Wouldn't ya love to see Mannings x-ray to see what kinda deck he is playing with?? (Nice clean modern ADR(s)with great R.O.M.??)

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  • and am a Broncos fan. I'm terribly concerned as to why we spent $96m for a QB with 4 cervical surgeries under his belt (or turtleneck LOL). Sure, he can throw fine, but what if he's not protected enough? Fans here are split pretty even, but I think we should've kept Tebow.

    Anyway, on to the subject, I'm a bothie too. I have mechanical problems above and below my lumbar fusion due to the strenuous nature of my work, and additional problems with facet joints, spurs, etc., above my cervical fusion. They've just gotten worse since my surgery in 2008.

    I know that cervical surgery is easier on the patient but harder on the surgeon, whereas lumbar surgery is easier on the surgeon and harder on the patient. I believe that.

    Dave, my lumbar problems included stenosis and it was very, very painful in my hips, back and legs before the surgery, but what have you read about the symptoms of stenosis in the cervical area? Can it be a symptom when you would lose bladder/bowel control? Or is it more radiculopathic in nature, like in the arms and hands and muscle spasms in the upper back?

    Just curious. The spine is so complex, it's difficult to know what comes from where and why and it makes you realize how hard it must be for even spine doctors to find a definitive diagnosis, unless it's very present on the testing like mine was.

  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    edited 06/28/2012 - 9:37 AM
    As far as I know, at C1-C7 EVERYTHING is in potential jeopardy.

    My greatest concern was not as much the potential of being a quad .... but being a quad on a vent ... I had a doctor tell me once that C5 keeps you alive.
    (meaning that the nerves that control your respitory diaphram emerges the from the cord at or about C5)

    I've looked on dermatomes and could never really find that .... But then again the spinal cord is more like a hand full of long spagetti ... getting thicker the higher you go .... so a cervical fracture that was "a complete injury to the cord at C1 could "cut" all the noodles" .... and All control below would be lost.

    Thats why they use SSEP on cervical surgerys and not lumbar.


    I've never met a dermatome I really liked!!


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  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    I appreciate the comments, insight, and knowledge!

    Good Stuff!

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  • I had suffered from cervical for a long time, so I was more "used" to that pain and those issues. I developed sciatic pain and pain in the "butt" and more foot was more and more numb and starting to get numbness in my calf. The leg issues were what I went to the surgeon for. He saw the issues. I mentioned to him about the issues in my arms and neck and he walked me down the hall to the Ortho surgeon who addressed neck issues. He looked at the neck MRI (I tend to take my most recent of neck and back with me and whatever other relevant tests) and said neck trumps back. That led to a 4 level ACDF, which the surgeon considered more conservative than a 1 level which would lead to more surgeries.. That recovery was tough. Eight months later he did the laminectomy and discectomy, which was what he considered conservative. Unfortunately, 6 month later the symptoms are worse. The surgeon did another MRI and said when the symptoms are bad enough that I can't deal with it anymore, to come back. Next week I have an EMG of the lower extremities to see what's going on...

    It's tough for me to say which is tougher. I've had the cervical pain longer, but the lumbar is kicking my butt at this point.

    Thank you all for listening.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    My Physiatrist wants me to get EMG's - Why to confirm that I have the neuropathy that I feel and know is real??? Duh ... I will wait until I talk whit my pain doc next week who will probably schedule me for ESI's ASAP - no stinkin EMG's needed!!!
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  • jellyhalljjellyhall Posts: 4,373
    edited 07/09/2012 - 6:52 AM

    I have just been given an appointment to have these next week.
    Last August I was sent for them, but they only tested my arms, which I found very frustrating.
    I was pretty sure that the symptoms in my arms were coming from my neck. It was all the leg and foot symptoms that I wanted to know what was causing them.
    I hope that next week they will test my legs.

    I have already had a lumbar fusion in March 2010. At that time I was also having symptoms in my arms and hands and pain in my neck and shoulders. In August that year I was referred to a neurologist about my neck. It took 8 months before I saw him! I was told that I had two levels on compression on my cord, but that we would wait and they would see me again in 6 months. I have been review at 6 monthly intervals and it seems that my symptoms are only progressing slowly. At my last check up the neurosurgeon registrar said she wasn't even sure that my symptoms were coming from my neck. I have now been referred to a neurologist who is testing to rule out MS.
    A different neurosurgeon has said that my symptoms are coming from my neck and that he recommends a 2 level ACDF. I am waiting to hear a conclusive diagnosis from the neurologist before scheduling any surgery.

    I do also have protruding discs in my thoracic spine, one of which is on the cord. I have been offered ESIs for that, but at the moment, I am managing this with pain killers.

    It is strange that I have so many problems in my spine. I haven't been in an accident. However, I do have lax ligaments and have been told that this may be part of my problem. Spinal problems do also seem to run in the family.

  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    I saw my pain doc (who is also a neurologist) and as anticipated he said NO need for an EMG!!

    Regarding the ligamental laxiscity?? Did you do aggressive Chiropractic or PT at anytime during the recent, middle, or far past??

    I have heard that this is one of the negative side effects of aggressive repeated manipulation of the spine.

    With concern,

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  • I think my lax ligaments is something that I have had since a child. I have always been very double jointed and used to be told I should be in a circus.
    It was only recently, when talking to my physio that I realised that this wasn't a good thing! I used to be quite proud of being able to do the splits after age 40 and how I could bend my thumbs back to touch my wrist etc.

    I have always had very clicky joints, especially my hips, but now also my knees, ankles, wrists, shoulders and even my spine.

    I did see a chiropractor for very many visits when I was trying to avoid lumbar surgery, but he used an activator which is less aggressive. He had to be careful because I had a spondylolisthesis which could have slipped further. He did adjust my neck and was surprised that I wasn't having more problems with it. I did used to have lots of headaches, but not the arm problems that I now get. He would adjust my thoracic spine too and told me from an x-ray that I had bony spurs at that level. I now know that there are protruding discs too.

    My appointment for my EMG and nerve testing is next Wednesday.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    edited 07/11/2012 - 10:05 AM
    There are times I feel that we are all in a circus now. :(

    Regards and hope,

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  • ...I really think that having lumbar problems is worse than cervical. I've had them both, of course, and although I have known problems to keep an eye on with my cervical, the problems in my lumbar have increased so much in the last year - since I've had a job.

    I had x-rays in June 2011 to check the hardware and everything looked beautiful. I just had x-rays again and you wouldn't believe the difference. Where did my L1/2 disc go? There's nothing there...why do I have such severe spondylolisthesis when I bend forward that I can actually feel it with my hand when I bend. Then I just had facet joint injections at L3/4 due to facet, stenosis and instability problems, which of course lasted a whole week.= ($390 bucks down the toidy). I wasn't having nerve pain a couple of months ago in my legs but now am having problems in the front of my right thigh and buttock.

    This will all eventually lead to a 5-lvl fusion, not if but when, beginning at T-10 and ending at L3/4 (one level above my current fusion) because if you fuse L1/2, the above disc will go out very fast so you have to do those, and you can't just leave L2/3 hanging out in the middle between two fusions for the same reason.

    So, I can honestly believe that for most with both problems, there's so much more than can go wrong in too many areas in the lumbar than cervical. There's a limited space up there, but so much more opportunity in our lumbar spines that can keep just going up and down.

    So there. Ththththth.
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