Is cervical instability the cause of lumbar canal stenosis?

pattismith

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Is cervical instability the cause of lumbar canal stenosis?

Atul Goel,1,2 Ravikiran Vutha,1 Abhidha Shah,1 Survendra Rai,1 and Abhinandan Patil3
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1Department of Neurosurgery, KEM Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
2019

Abstract
Aim:
On the basis of an experience with 12 cases, the validity and rationale of cervical spinal stabilization for cases having both cervical and lumbar spinal canal stenosis is analyzed.

Materials and Methods:
From March 2017 to May 2018, 12 patients presented with a major symptom of neurogenic claudication pain generally related to lumbar canal stenosis in addition to other symptoms related to cervical myelopathy.

The average age was 57 years. All patients were clinically and radiologically diagnosed to have both cervical and lumbar spinal canal stenosis.

Based on the concept that degenerative spinal spondylotic myelopathy is an outcome of spinal instability, all patients underwent cervical spinal stabilization.
No decompression by bone resection was done
.

The lumbar spine was not surgically treated.


Visual analog scale, the Japanese Orthopaedic Association, and Oswestry Disability Index were used to monitor patients before and after surgery.

Results:
There was dramatic relief from symptoms related both to cervical and to lumbar canal stenosis in the postoperative period. During the average period of follow-up of 12 months, none of the patients have experienced recurrence of lumbar pain or needed any surgery.

Conclusion:
The report highlights the possibility of recovery in lumbar canal stenosis related symptoms following cervical spinal stabilization surgery for associated cervical spinal stenosis. We conclude that in select cases, cervical spinal instability may be the cause of clinical and radiological observations in cases having lumbar canal stenosis.
 

pattismith

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This study is amazing, and we are lucky to have a free access!

"As per our defined and previously published protocol, only spinal fixation using transarticular technique was deployed for surgery on the cervical spine.[1,2,3] No decompression by bone or ligamentous resection was done.
The levels of spinal fixation were determined by considering both radiological and clinical parameters in addition to direct observation of facetal instability.
Complete amelioration of symptoms attributed to lumbar canal stenosis in the immediate postoperative phase was a surprise but a consistent observation.

The general observation is that the duration of clinical symptoms related to lumbar canal stenosis has an impact on the extent and duration of recovery. In all our cases, irrespective of influencing parameters, the recovery was in the postoperative phase after reversal from anesthesia. Although the relief from claudication pain could be determined only on walking for a distance, the patients were relieved of nagging pain in the back in the immediate postoperative period.
The relief from symptoms related to lumbar canal stenosis was quick and lasting; indicating that the radiological alterations in the lumbar spine and clinical symptoms related to lumbar canal stenosis had a direct relationship with cervical spinal instability."

"Our earlier observation was that in the event of chronic atlantoaxial instability, natural protective prolonged neck muscle spasm could lead to shortening of neck size, torticollis, secondary cervical spinal spondylotic changes and a range of other musculoskeletal abnormalities.[21]"
 
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This is encouraging!

I am seeing a neurosurgeon this Thursday to operate on my cervical spine to correct spinal stenosis. My radius has shrunk to a little less than 8mm. I also have three herniated disks and the curve in my spinal cord is reversed. My spinal cord is being severed from the disks and the bone spurs. I have been terrified about having surgery.

My issues do not belong in the CCI threads. I have not posted much at all about this issue.

This gives me more hope for healing! I would love to have some of my life back. I have so much to do still!
Thanks for the thread!
 

pattismith

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This is encouraging!

I am seeing a neurosurgeon this Thursday to operate on my cervical spine to correct spinal stenosis. My radius has shrunk to a little less than 8mm. I also have three herniated disks and the curve in my spinal cord is reversed. My spinal cord is being severed from the disks and the bone spurs. I have been terrified about having surgery.

My issues do not belong in the CCI threads. I have not posted much at all about this issue.

This gives me more hope for healing! I would love to have some of my life back. I have so much to do still!
Thanks for the thread!
Jesse, there is a chance that your ME/CFS will improve once your cervical stenosis will be fixed!
I will think about you on thursday, I hope you will give us quick news after your surgery.
 

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pattismith

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An american study found rather similar results as the more recent Indian one.

Note that the combined cervical + lumbar stenosis is called Tandem Spinal Stenosis in some studies:
Relief of Lumbar Symptoms After Cervical Decompression in Patients with Tandem Spinal Stenosis Presenting with Primarily Lumbar Pain

Daniel R Felbaum,1 Islam Fayed,
1 Jeffrey J Stewart,2 and Faheem A Sandhu1
Author information Article notes Copyright and License information Disclaimer
1 Neurosurgery, Medstar Georgetown University Hospital
2 Georgetown University School of Medicine, Georgetown University

Abstract

Objective: Tandem cervical and lumbar spinal stenosis (TSS) is classically described as intermittent claudication, gait disturbance, and clinical findings of mixed myelopathy and polyradiculopathy. Rarely, patients can present with TSS manifesting in isolated lumbar pain.
Several reports have demonstrated improved lumbar back pain and radiculopathy after decompressive cervical spine procedures. We present six patients with dramatic resolution of lumbar spine related symptoms after decompression of the cervical spinal cord despite presenting solely with lower back complaints.

Methods: Clinical records of the senior author (F.A.S.) gathered from April 2006 to March 2013 were retrospectively reviewed identifying six patients presenting solely with lumbar symptoms and diagnosed with TSS based on history and physical examination.

Results: Six patients with a mean age of 55 (range 39 to 60) presented with solely lower back symptoms and clinical findings suspicious for TSS. Mean follow-up time for all patients was 12 months (range three to 27 months, median 11.5 months). Three patients underwent a cervical procedure as the principal operation, while the remainder had the lumbar spine decompressed initially. All patients that underwent a cervical procedure initially experienced a dramatic decrease or complete resolution of their preoperative lower back pain and radiculopathy (mean preoperative VAS of 6.7 vs. 3.7 postoperative). The remainder of patients with persistent lumbar symptoms resolved after a subsequent cervical operation.


Conclusion: Patients presenting with lumbar symptoms out of proportion to imaging require further investigation. We highlight the resolution of lumbar symptoms after a cervical procedure in a select group of patients presenting with lone lower back complaints. In patients presenting with symptoms disproportionate to lumbar imaging, treatment of cervical pathology may provide robust long-term relief of the initial lumbar-related presentation.
 
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*update My neurosurgeon agrees that I need the anterior cervical discectomy & fusion. I have to go through some other steps first. I will be assessed for a round of water physical therapy, a new anti inflammatory, he wants me to have an epidural in my cervical spine. I am trying to work up the courage to do that part!
 

pattismith

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*update My neurosurgeon agrees that I need the anterior cervical discectomy & fusion. I have to go through some other steps first. I will be assessed for a round of water physical therapy, a new anti inflammatory, he wants me to have an epidural in my cervical spine. I am trying to work up the courage to do that part!
Do you know what he is looking for with the epidural?
I managed to get an appointement with a neurosurgeon to see if there is something wrong in my neck.
Not sure if any neurosurgeon here will do any spine surgery just for ME/CFS/Fibro type of symptoms, but I will be pleased to have his opinion.
However, I think I won't insist on my "atypical" symptoms, I will rather point the ones he may be more used/sensitive to...
 
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I have three herniated discs and am in constant pain. I don't think it will help the compresion from the spinal stenosis. He is thinking that it will help my pain and range of motion.

I had a physical therapy assessment today and will have water therapy twice a week for a month.