Cervical Epidural: Five Days Later

As I have mentioned before, last Wednesday I was given the first in a series of three cervical epidural injections. Five days later I still have not found much pain relief as was hoped. I was beginning to become a little depressed about this because the doctor who administered the injection told me that there would not be any subsequent injections if I did not feel any change in my pain level. That had the potential to mean the fast track to surgery number two.

I called my surgeon’s office and asked if there really wouldn’t be any more injections if I didn’t respond well to the first. They said sometimes patients don’t feel any appreciable change after the first shot, and so the surgeon’s judgment supersedes that of the doctor who actually performs the procedure. This means I will be getting all three, and that actually makes me a little happier because even though the injections aren’t a whole lot of fun, they do offer me hope that I will find some temporary relief, and even a remote possibility of permanently ending the pain.

I have also been somewhat upset lately because I try to educate myself by looking at all the X-Rays, MRI films, and reports. I supplement all that information by asking questions of my doctors, physical therapists, and anyone else I think might have some insight, and then I go to the internet and Google everything I can think of. In the end I have come to realize that I don’t always fully understand my condition, or how the nervous system works, and therefore I get discouraged for no real good reason.

For example, below is a picture of an MRI film showing the stenosis, (a narrowing of any canal that the spinal cord or nerves pass through,) around my spinal cord at the C3-C4 level. This is after last year’s surgery at the C4-C5, and C5-C6 levels that included removal of two discs, fusion of adjoining vertebrae, removal of a nasty bone spur, and opening the canal for the spinal cord.

I have am still suffering pretty severe pain, and the doctors are now looking at this new area of stenosis and trying to determine if more surgery is warranted. If I do not respond to the three epidurals, and if new X-Ray’s indicate movement between C3 and C4, (further restricting the spinal cord,) I will in all probability end up back on the cutting room table.

When I went for this MRI I was of course looking for answers. Primarily I wanted to know why I was still in pain a full year after my surgery. After the MRI was completed, there was going to be a three or four week wait before I could get in to go over the results with the surgeon, so as soon as I got my hands on a copy of the report and films, I examined them myself to see if I could come up with any answers on my own.

What really worried me about the picture above, and the rest of the series in general, was that while it shows a new problem at C3, it didn’t explain to me why I would still have pain. I figured I would see a compressed nerve root around the C4-C5 level where the nerves running to your shoulders, arms, and hands are. Instead there is stenosis at the C3 level, which I believed when I first looked at the films was unrelated to my pain since no nerves from that level travel to where I experience most of my pain.

What I would later learn from my primary doctor is that it is conceivable the stenosis seen in this picture could affect everything below the area of stenosis. So in other words I could have pain anywhere from the neck down, including my shoulders, arms, and hands. As bad as this sounds, I was kind of relieved because it was the first time I heard a plausible explanation for the pain.

Here is another picture of the stenosis as if you were looking straight down from the top of my head.

If you look closely straight up from the three, and about three lines up on that set of bars on the right, you can see my spinal cord as represented by a light gray area surrounded by a whiter area. You can also see how the white is squishing the gray.

Aside from possibly being the cause of my pain, this is not a desirable situation. From what I have been told you don’t want your gray squished by your white. In the event of a blow or other physical trauma to the neck or spine, it is the function of the spinal fluid to protect the spinal cord. If for any reason a person with my condition were to suffer trauma in the neck area it could be, in the words of my surgeon, “devastating”. Therefore, the main thrust of the surgery is to open the space that the spinal cord travels through allowing the spinal fluid to once again surround the spinal cord.

Like I said, I did this once complete with the removal of a couple of cervical discs etc., the whole of which resulted in a metal plate being screwed into three cervical vertebrae. If it turns out that I will be in need of a second operation, the original plate and screws will be removed; the surgeon will scrape out a path for my spinal cord through the vertebrae, and I will be the recipient of another, albeit smaller plate.

Honestly I think it’s a matter of time before I will end up with a second operation. From what I have seen the stenosis looks like it isn’t going anywhere, and that it isn’t about to be intimidated by any stinking needles. Then again, I never did finish Neurosurgeon School, so what do I know?

Posted by Jeff at November 8, 2004 9:17 AM