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Sugegst treatment for congenital cervical spinal stenosis

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Orthopaedic Surgeon
Practicing since : 2003
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Hello, I have been diagnosed with congenital cervical spinal stenosis. My MRI indicated compression on the spinal cord at C4-C5 and encroachment on the central canal at C5-C6. The C4-C5 causes pain in a specific area of my neck and radiates down the deltoid. The pain is much better now than it was 3 weeks ago when I first learned of the condition. I have made a number of behavior changes that I believe are helping. A spinal surgeon I saw here concluded the C5-C6 area was stable and not symptomatic, so he did not recommend surgery. A spinal rehabilitation specialist I saw today, stated that he thought the risk was from the C4-C-5 area; which is symptomatic. He did not recommend surgery ether; yet he did say that I might want to see a Neuro-Surgeon in the future and that I should repeat the MRI. I am strong and quite fit; yet he thought I had lost a little strength in my left toe area because as he leaned on it I could not hold it up. I had a similar situation when he leaned on one of my wrists. He said my strength in those areas was a 4 rather than a 5. My question is this: no one is recommending surgery; yet I can tell everyone is concerned. What risks am I taking by not having surgery in terms of possible, irreversible, neurological damage if the spinal cord is further damaged? As I have mentioned my pain and symptoms are much better from 16 days ago with behavior changes. One additional question: should the two physicians reach a consensus on which area they are concerned about, C4-C-5; which is symptomatic, or C5-C6, which is not? Thank you I need to clarify one thing because I was in a hurry earlier. The spine surgeon I spoke with indicated that he was most concerned about the C5-C6 area and that because it was not symptomatic, it was therefore stable, and as a result he did not recommend surgery. The rehabilitation spine doctor has not read the surgeons conclusions yet. His position was that the C4-C5 area that compresses the spinal cord, rather than encroaching the central canal as is the case with C5-C6, is what he is concerned with. I had my first physical therapy session today and as I mentioned my symptoms are much better than 16 days ago. My biggest concern is permanent neurological loss as a result of this situation. The pain, which is improving, is not my major concern. I apologize for the length of this communication. I have an additional questions, which condition is considered worse, a spinal cord compression, or spinal cord encroachment? I have pain in the deltoid is that from C4-C5 (area of compression), or C5-C6; which was defined on MRI as an area of encroachment.
Posted Thu, 27 Mar 2014 in Bones, Muscles and Joints
Answered by Dr. Chander Mohan Singh 43 hours later
Brief Answer: Surgery needed if power is 3 or less. Detailed Answer: Hi, I have read your query. From the history you have mentioned, in my opinion you should not opt for surgery because power in your wrist and toe is 4, instead you should opt for physiotherapy for strengthening exercises. But you should regularly consult you doctor if ever you feel decrease in further power, other wise no need to worry for having power 4. Every doctor who examine a patient uses his clinical sense to judge the level of compression of cord or nerve if any, so of any doctor find that c4-5/c5-6 level is/are symptomatic then he may definitely advise you surgery if power is 3 or less. For preventing any neurological loss you should do muscle strengthening exercises as advise by your doctor. Cervical canal stenosis or encroachment are medical terms. You should remember one thing that whether cervical canal is stenosed or encroached condition is worse only if symptoms are severe enough to cause decrease in power 3 or less, other wise no need to worry much. But always be vigilant to know any decrease in further power and sensory loss if any. I hope it helps. You are welcome to ask further health related queries. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer 5 points for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: Let me know if you have any concerns. Thanks. Dr.Singh.
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