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Neurology (Expert Forum)
Ongoing Cervical and Lumbar Problems
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Ongoing Cervical and Lumbar Problems
by Kikko, Nov 19, 2006 12:00AM
About 20 yrs ago had cervical laminectomy and 3 yrs ago had multilevel cervical anterior fusion at C3 to C5. One yr ago had lumbar fusion at L4 to S1. I am a healthy 66 yr old female.
Problems are: Weak painful arms and shoulders, head always feels too heavy to hold up. (have been told my cervical spine is unstable and tilting forward as the vertebrae are slipping on top of each other). Am constantly dropping things. I have hand tremors and my handwriting shows it. Recent Cervical MRI with and without contrast, shows posterior disc protrusion, spondylosis and spinal stenosis at C5-6, with extradural defect upon anterior thecal sac and abutment of anterior margin of the cervical cord at this level. Nerve root compression on right at this level. I also have been suffering with very severe sciatic pain in my left leg to the point that even Loritab 7.5/500 does not touch it nor does Lyrica. Can all the above problems be caused from the cervical stenosis? Can the sciatica by caused by the cervical problems? Other than more surgery, is there anything to do for the cervical problems and the sciatica? I was using my treadmill daily, but can no longer do so because of the leg pain. I did recently have 3 injections to try to help the sciatica, with temporary relief of a just a few days.
Problems are: Weak painful arms and shoulders, head always feels too heavy to hold up. (have been told my cervical spine is unstable and tilting forward as the vertebrae are slipping on top of each other). Am constantly dropping things. I have hand tremors and my handwriting shows it. Recent Cervical MRI with and without contrast, shows posterior disc protrusion, spondylosis and spinal stenosis at C5-6, with extradural defect upon anterior thecal sac and abutment of anterior margin of the cervical cord at this level. Nerve root compression on right at this level. I also have been suffering with very severe sciatic pain in my left leg to the point that even Loritab 7.5/500 does not touch it nor does Lyrica. Can all the above problems be caused from the cervical stenosis? Can the sciatica by caused by the cervical problems? Other than more surgery, is there anything to do for the cervical problems and the sciatica? I was using my treadmill daily, but can no longer do so because of the leg pain. I did recently have 3 injections to try to help the sciatica, with temporary relief of a just a few days.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Dec 10, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story that you present are complex and can not be fully addressed without an examination, but I will try to answer the specific questions you asked. First, all of your symptoms can not be explained in the cervical spine. The weakness and pain in the arms and shoulders is likely due to your cervical spine problems. However the tremor that affects your handwriting is a classic symptom of Parkinsons disease (along with shuffling gait, loss of facial expression, slowed movements, etc), but can also be seen in many different types of tremor. The "sciatic pain" that you described is unlikely to be caused in the cervical spine, and has numerous causes in the lumbo-sacral area. I would recommend that you get an EMG of the upper and lower extremity and a SSEP (somatosensory evoked potential) to assess the degree of problems that are coming from pinched nerves vs spinal cord compression. I would also recommend that you switch pain medications. Each person responds a differently, and if one is not working you should give others a try. Medications such as neurontin, elavil, effexor, cymbalta, tegretol, etc. have been shown to be effective in the type of pain that you describe. You should also be evaluated by a movement disorder specialist (neurologist that did further training in movement disorders) to assess whether you tremor may be early Parkinsons or a more benign tremor.
I hope this has been helpful.
The symptoms and story that you present are complex and can not be fully addressed without an examination, but I will try to answer the specific questions you asked. First, all of your symptoms can not be explained in the cervical spine. The weakness and pain in the arms and shoulders is likely due to your cervical spine problems. However the tremor that affects your handwriting is a classic symptom of Parkinsons disease (along with shuffling gait, loss of facial expression, slowed movements, etc), but can also be seen in many different types of tremor. The "sciatic pain" that you described is unlikely to be caused in the cervical spine, and has numerous causes in the lumbo-sacral area. I would recommend that you get an EMG of the upper and lower extremity and a SSEP (somatosensory evoked potential) to assess the degree of problems that are coming from pinched nerves vs spinal cord compression. I would also recommend that you switch pain medications. Each person responds a differently, and if one is not working you should give others a try. Medications such as neurontin, elavil, effexor, cymbalta, tegretol, etc. have been shown to be effective in the type of pain that you describe. You should also be evaluated by a movement disorder specialist (neurologist that did further training in movement disorders) to assess whether you tremor may be early Parkinsons or a more benign tremor.
I hope this has been helpful.