cervical spondylosis

[Michael]

I am a 41 year old, relatively inactive and unathletic dermatologist who was recently diagnosed with cervical spondylosis and a C6 radiculopathy.  8 months ago I developed for the first time sharp pain at the base of my neck unrelated to any activity and no known injury.  Evaluation revealed a normal C-spine xray and the pain very gradually faded away completely over a 5 week period.  About 6-7 weeks ago a sharp pain developed in my left posterior shoulder and also would appear in the left biceps area.  The orthopedic surgeon could find no problem and a neck and shoulder x-ray were normal as well as a shoulder MRI.  Several days later some tingling was noted in the left 1st, 2nd, and 3rd fingers.  An MRI of my neck showed fairly significant spondylosis and narrowing at the C6 level.  Degenerative changes in the disks at C5-6 and C6-7 were noted.  I eventually saw a neurosurgeon who felt the disk disease was not too bad and my symptoms were related to the narrowing at C6. He said many people my age would have similar MRI finding if they were "MRI'd".   Symptoms have included fairly significant pain in the neck, shoulder and biceps as well as numbness along the lateral aspect of the thumb and and lateral forearm. The tingling in the 1st and 2nd fingers completely resolved as the numbness in the thumb intensified. Especially troubling has been intermittent parathesias from the thumb up the forearm and arm throughout the day and night (awakening me several times a night).  I have some weakness of the left biceps and a decreased biceps reflex.

The neurosurgeon told me that the process would likely resolve spontaneously over the next 6 weeks and tends to resolve spontaneously in 80% of people-only a small percentage require surgery.  He did not feel any intervention other than time would be useful and said studies have not shown PT or NSAIDS to be helpful.

My questions:  Is this reasonable?  No NSAIDS have touched this and physical therapy and traction were not felt to be beneficial in the neurosurgeon's opinion.  What is the "natural history" (if one can generalize) of cervical spondylosis?  The pain and parathesias are really getting to me-my psychiatric friend thought neurontin at HS might be helpful.  Is this something I just need to "ride out" and is there a good likelihood it will completely resolve?  Am I destined to intermittent 3 month periods of agony the rest of my life if I don't have an operation to open the narrowed foramen?

Any and all thoughts would be greatly appreciated.

Michael MD

[CCF Neuro[P]-M.D.-RPS]

Dear Michael:

I am sorry that your having problems with your cervical spine.  Like the kind neurosurgeon told you, this is a very common problem.  At least he/she did not try and convince you that "a chance to cut is a chance to cure".  I think he gave you "some" good advice.  I would think, and I do use antiinflammatory medications.  The spondy is irritiating the nerve and setting up an inflammatory process.  Pain is also an issue and NSAIDS as you know can help with pain.  But the risk of stomach problems is present.  Neurotin works well for neuropathic pain and we use it like candy (I have no arrangement with the makers of gabapentin).  Rehab is far and away the best treatment.  In a NEJM article, they found that osteopathic treatment of back pain was as usful as medications and better than chiropractors (but I use chiropractors and have found good results).  If this happened to me I would seek out a good rehab person and begin rehab.  Muscle strengthening exercises for the paraspinals, NSAIDs for the inflammation, and neurotin for the pain.  The very, very last resort is surgery.  

Sincerely,

CCF Neuro MD

[Doc3]

I am a Chiropractor and have dealt extensively with pathologies such as yours.  You need to strengthen the cervical and upper thoracic paraspinal musculature in order to inhibit forward flexion.  The future problem lies continuing to have a forward flexed posture,and in "draping" the cord over the osteophytes on the posterior aspect of the vertebral bodies.  Those osteophytes will traverse into the subarachnoid space and alter the vasculature to the anterior motor horn cells on the ventral cord.  The Rx of NSAIDS and Neurotin will definately reduce the symptoms and are a great idea, but you want to inhibit progression so as not to develop cord compression not just band-aid the symptoms.  So you need to change your biomechanics. There are terrible chiropractors and great ones.  What city are you in?  Keep searching and you will find the solutions.

[AndyA]

Hello and thanks for the response Doc3--I am "Michael" even thought the Nickname for this comment is under AndyA.
I have actually spoken to a chiropractor that attends my wife's church.  As you might imagine, and I'm sure you are all too familiar with, I am skeptical of chiropractors, myself being in traditional medicine.  This probably stems from cases I have seen where the chiropractor has tried to treat something outside his/her area of expertise (believe me, I have seen that within traditional medicine as well).  I do believe, however, that the area of biomechanics of the spine is probably your (chiropractor)true area of expertise.  I told the chiropractor I spoke with that I would want to have any intervention "cleared" with the neurosurgeon--obviously I would not want to do anything to exacerbate the problem.  I am very open to anything that might help and/or prevent progression.

It seems very reasonable (and safe) to strengthen the neck muscles.  Interestingly I know I have poor posture and tend to "stoop"  forward--also I have recently noticed that my problem has become more positional.  If I start to feel intense tingling in my thumb and arm I can sometimes stop it by "straightening" (extending) my neck.

Is the kind of exercise you are talking about something one would teach to me so that I could do it at home or does it involve "adjustments" or manipulations in the chiropractor's office?  I have to admit that I am wary of any "adjustments".

The neurologist who originally answered my posted question at this site referred to a "good rehab" person.  As a chiropractor, do you feel you are the best specialist to address the issue?--I guess I am wondering where a physical therapist fits into the picture.


To answer your question, I live in the greater New Haven, Connecticut area.  I certainly appreciate your help and any other information or details on the "exercises" etc. would be greatly appreciated.  Again, thank you.

AndyA (aka Michael)

[Basil]

I was given some exercises at the Cleveland Clinic in December. I thought "yeah, right".  I now do cervical and thoracic aerobic, stretching and strengthening exercises while I read the morning paper.  Believe me it helps to feel stronger.  My problem is back spasm, for two years now.  Zanaflex helps there.  I have some control of my life now and I can quilt again.  Good wishes for help with your pain.