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Neurology (Expert Forum)
Vagus nerve damage?
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Vagus nerve damage?
by Kimr, Jul 03, 2005 12:00AM
I had a fusion of C5-6 in 1993 which failed (graph collapsed). In 1998 I had a double corpectomy where my vertebral bodies were removed, a graph consisting of a piramesh cage, my own crushed bone and then plated anteriorly. During the surgery it was discovered that my vertebra were hypermobile to which the neurosurgeon attributed the extreme pain I was having. The surgery improved my pain and definitely left me more stable but my throat was damaged in the surgery and became paralyzed. My graph collapsed within the first 6 months and I have also have had some spinal cord compression on my last MRI/CT with contrast in 1999. Since that time I have been unable to swallow and was left with very little voice. I had a medialation procedure (vocal cord implant) which helped my voice (although it is soft and still unpredictable) but I still can't seal my airway or swallow fully and my cough does not work if something gets stuck. I have also have reflux and have been treated with prevacid with some but not full relief. I had swallowing studies and the barium swallow showed an area of stasis in my esophagus, reflux, and some esophageal compression caused by instrumentation. Also my stroboscopy studies showed pooling in the pyriform, incomplete closure of the vocal cords and other vocal quality problems. I should also mention that C5-6 did not recover and I have had chronic pain in my shoulder and right arm evidenced also on EMG. Also in this my bowel stopped working properly and I was told after a long stretch of different meds and tests that it was a motility problem. I was treated with enemas, milk of magnesia and most recently Senna has been giving me some relief. The straining has caused some additional damage and I now have hemorrhoids, retrocel and cystocele.
I was tried on many medications for pain, bowel, and I also have chronic severe and frequent migraines (which I had before the second surgery, but due seem correlated with the level of muscle spasm in my shoulder and neck. We finally found that a combination of elavil, inderal, soma and ibuprofen gave me best relief. I was on the elavil and inderal before my last surgery. Recently, I was taken off the inderal because I was having difficulty with circulation in my feet and hands. I was also very depressed so my doctor changed me from the inderal to efforex. In the beginning, the efforex seemed to help the headaches, but I was either having a lucky period or it stopped. My depression is better although it still seems mostly related to my pain levels. My heart rate has also been found to routinely be in the 90's and 100's without exertion since the inderal was stopped. I have been stated on Tenormin now which is giving me better migraine control and has brought my heart rate back down to 80-90's.
Okay, so now finally here is my question. My right arm is getting worse and I am starting to drop things again. My right shoulder is much lower than my left and my 3 small fingers are numb. I have had a big increase in pain too, but I don't want to take addictive pain killers. I have no family so I am my only means of support so I need to function. While researching what nerves might be causing problems in my neck I discovered a plethora of articles about various degrees of vagus nerve damage from the type of surgery I had and a light bulb went off in my head about the reflux, bowel motility, choking, heart rate problems and an increase in brochospasms (have some small history- but have had more especially with all of the choking- I aspirate my reflux a lot). Could this be the cause? If so can anything be done to help?
Also, any advice about my arm and shoulder?
I was tried on many medications for pain, bowel, and I also have chronic severe and frequent migraines (which I had before the second surgery, but due seem correlated with the level of muscle spasm in my shoulder and neck. We finally found that a combination of elavil, inderal, soma and ibuprofen gave me best relief. I was on the elavil and inderal before my last surgery. Recently, I was taken off the inderal because I was having difficulty with circulation in my feet and hands. I was also very depressed so my doctor changed me from the inderal to efforex. In the beginning, the efforex seemed to help the headaches, but I was either having a lucky period or it stopped. My depression is better although it still seems mostly related to my pain levels. My heart rate has also been found to routinely be in the 90's and 100's without exertion since the inderal was stopped. I have been stated on Tenormin now which is giving me better migraine control and has brought my heart rate back down to 80-90's.
Okay, so now finally here is my question. My right arm is getting worse and I am starting to drop things again. My right shoulder is much lower than my left and my 3 small fingers are numb. I have had a big increase in pain too, but I don't want to take addictive pain killers. I have no family so I am my only means of support so I need to function. While researching what nerves might be causing problems in my neck I discovered a plethora of articles about various degrees of vagus nerve damage from the type of surgery I had and a light bulb went off in my head about the reflux, bowel motility, choking, heart rate problems and an increase in brochospasms (have some small history- but have had more especially with all of the choking- I aspirate my reflux a lot). Could this be the cause? If so can anything be done to help?
Also, any advice about my arm and shoulder?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jul 07, 2005 12:00AM
Several nerves run in the soft tissue of the neck such as the glossophayngeal nerve (swallowing), hypoglossal nerve (tongue), vagus nerve (swallow, cough, GI), and the spinal accessory nerve (damage produces shoulder droop)
these nerves have the potential to be damaged during neck surgery. the nerves to the arm are protected in the neck by teh spinal bones but may be compressed by ie discs or bony spurs. I do not know i this is specifically the case in yours without seeing you or your scans. An EMG could tell (compared to your last study) if a nerve root is more compressed than it was in the past. Symptoms in the shoulder and upper arm may be due to compression of the C5 nerve root. The right shoulder being lower is suggestive of spinal accessary nerve dysfunction. The numbess in the 3 small fingers is best evaluated with EMG and may be from an ulnar nerve neuropathy, or a C8 or C7 nerve root problem.
Good luck
these nerves have the potential to be damaged during neck surgery. the nerves to the arm are protected in the neck by teh spinal bones but may be compressed by ie discs or bony spurs. I do not know i this is specifically the case in yours without seeing you or your scans. An EMG could tell (compared to your last study) if a nerve root is more compressed than it was in the past. Symptoms in the shoulder and upper arm may be due to compression of the C5 nerve root. The right shoulder being lower is suggestive of spinal accessary nerve dysfunction. The numbess in the 3 small fingers is best evaluated with EMG and may be from an ulnar nerve neuropathy, or a C8 or C7 nerve root problem.
Good luck
Member Comments (2)
by Kimr, Jul 03, 2005 12:00AM
I forgot to mention that the corpectomy fused me from C4-C7. Also it was a bone fragment from the graph which was compressing the cord on the left side and my symptoms are right sided with the exception that I do have some numbness intermittently on the left 3 small fingers. Thanks
