Re: Cervical Spine Deterioration

Posted By CCF Neurology MD - AY on September 06, 1998 at 16:40:40:

In Reply to: Cervical Spine Deterioration posted by Barbee on September 06, 1998 at 14:27:00:






I am a 54 yr old woman who has suffered for 10 yrs with deteriorating disk
disease between C5-6 and 6-7.  My MRI shows also bone spurs.  The orthopaedic
I went to said he would operate, but I wasn't sure if I should be operated on
by an Ortho or Neurologist.  I went to a Neurologist and he said he would
not operate until I lost the use of my hands.  (What a prognosis!)  I have
not lost the use of the hands, but they are now numb a good deal of the time,
especially at night during sleep.  I also suffer excrusiating headaches that
last for 3 -4 days.  They can occur often or sometimes I get a break of
several weeks between.  I am a secretary who depends on her hands to make
a living.  Sometimes my fingers go numb on the keyboard of my computer.
The headaches are so severe I am reduced to missing so much work that my job
is endangered.  I feel as though if I did nothing all day, it would be the
only way to escape pain and headaches as they occur as soon as I do anything physical.
Now when I play with my grandchildren, my most precious pasttime, I suffer later.
Is there any solution to my problem?  How can I enjoy these last years of
my life that I feel are being wasted being practically an invalid.




Thanks for your questions.  It is very likely that your hand/spine problems
are not directly correlated with your headache issues so I will address them
separately.
Because you mentioned that you use the keyboard at your work, and you also
stated worsening of your hand symptoms after spending time with your grandchildren,
one should definitely consider the possibility of Carpal Tunnel Syndrome (CTS).
This is a "compression-type" lesion to your Median Nerve around the wrist
area, where this nerve goes underneath a thick fibrous band to tissue.
This particular "tunnel" of tissue become narrower whenever one bent the
wrist downward, or if the wrist is held for prolonged periods of time
semi-cocked, such as when one is typing at a keyboard.  A good physical
exam by a neurologist and possibly a test called an EMG (Electromyography)
could like diagnose a CTS, and also separate that from problems caused
at your spinal cord.
Regarding the issue of indication for immediate surgery, I am assuming that
the physicians that evaluated you were an orthopedic surgeon and a
NEUROSURGEON, since neurologists do not operate.  It has been my observation
in working with neurosurgeons that they prefer a medical treatment (medications,
physical therapy, postural changes, etc.) when the bulk of the symptoms are
restricted to pain/discomfort.  Although, I understand the possible frustration
from the patients, I personally agree with this more "conservative" approach
because there is always a chance that the pain symptoms will persist or
return shortly after such a major surgery.  Once again, an EMG exam would
potentially give a better idea about the degree of nerve damage cause by
those anomalous MRI scans.
The description of the headaches that you provided in the message is a bit
too sparce for me to make any significant comments.  These are the
important elements to know for a proper diagnosis:  Location; Character (sharp,
dull, pounding/throbbing, "tight", burning, etc.); Duration of each episode;
Usual interval between episodes; Any particular time of the day (random,
always when you wake up, at work); Associated symptoms (light or sound being
extremely bothersome, nausea, vomiting, vertigo, any visual alterations, etc.);
Any triggering factors (tension, food, smell, activity); Any particular time
of a month, or a season
I hope this information is helpful.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.