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Cervical Spine Deterioration

  : : 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.

  I have already been told I do not have carpal tunnel and the wrist has no correlation with the headaches or the hand numbness.  The headache pain is hard to describe but always accompanies the neck pressure at the base of my skull and upper shoulder.   The pain radiates all over the head and eye areas very like toothache nerve pain....all over and very fiery and constant.   My right arm is directly affected and the MRI confirm that the damage is indicative of the right side bone spurs.   If I do anything that stresses the right shoulder like playing with gkids or shoveling, or sweeping or even exercises where I pick up my body with arms....I suffer headaches later.
  Sometimes warm compresses on the back of my neck and upper right shoulder ease the sharpness of the pain and headaches.  It is very hard to describe the pain, and you would have to be inside my body to know....but there is a lightening like shooting from the neck to all points int he head.....often preceding these headaches my neck is painful and I must support my head as it feels like I can no longer support it without help.  A head rest is necessary while I compute at home.   I am very tempted at the most painful times to let the Ortho doc operate, but when the pain is gone, I forget my problem.  What can I expect from surgery?  What insurances will pay for out of state surgery,
  so I can come to Cleveland.  I live in Buffalo NY.
  : : 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.
Thanks for your reply.  The symptoms described regarding your neck discomfort
suggests at least two separate possibilities.  Firstly, because your neck
pain is aleviated to a certain degree with localized warmth, it is suggestive
of a musculo-skeletal explanation for your symptoms.  In addition, because
of the close temporal correlation between your headache and your neck pain,
it is likely that the headache is caused by the neck discomfort.
However, the presence of "electric shock-like" symptoms when you move the neck
also suggests the possibility of an intra-medullary process, that is, within
the spinal cord itself.  This possibility is usually adequately evaluated
by the cervical MRI that you already had.
Unfortunately, I cannot provide any information regarding insurance coverage,
and referrals to out-of-state institutions.  Your family physician might be
helpful is this regard.
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.

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