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Spinal Cord compression

      Re: Spinal Cord compression

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Posted by CCF NEURO MD on May 29, 1997 at 15:19:05:

In Reply to: Spinal Cord compression posted by Diane Tait on May 21, 1997 at 22:28:14:

: My husband is 61 years and suffers from RA. He has severe disk degeneration ans has had 4 major surgeries plus some smaller ones in the past two years. 1 Laminotomy in the neck 2. laminectomy and discectomy in the lumbar area. 3 Aorto/femoral bypass and left hip replacement. The smaller surgeries were cataracts and CT release in both hands. He has just undergone an MRI which show a spinal cord compression somewhere in the L5 to L7.
  The possibility of surgery was discussed a little in that there were two ways to go. Anterially or from the back of the neck. His health is not the best as he has a "touch" of emphyzema. Is that like being a "little bit pregnant?) and he has high blood pressure and is on digoxin for atrial fib.(Had one attack). His limbs  go numb,he has pain shooting through his head and gets  dizzy. He gets tunnel like vision at times. Does anyone have any alternatives or advice or suggestions or anything that they can tell me. He has complained for two years about this problem (just after the neck surgery) but no one has listened until now. What if he doesn't have any surgery? Will he become totally incapacitated, should he risk having the surgery knowing his health is not going to improve as he gets older? Please help!!!
Rheumatoid arthritis is known to affect the cervical spine.  This may cause instability of the spine, leading to spinal cord compression and neurologic deficits.  It affects the upper cervical vertebrae (C1 and C2), and atlantoaxial junction.  The complication could be subluxation or migration which would produce spinal cord compression resulting in weakness or paralysis of the arms and legs.  People may also develop cervical spondylosis (the spine loses its normal alignment, there is narrowing of the spinal canal and foramina) which causes spinal cord compression as well.  Your question states that L5 and L7 are involved, I assume you are referring to the cervical region.  There is also a difference from rheumatoid arthritis and osteoarthritis.  Osteoarthritis (OA) is more common and is less destructive than RA.  OA tends to diffusely affect the spine and cause degenerative changes most frequently in the cervical and lumbar region.  It results in a gradual narrowing of the spinal cord and roots producing symptoms of weakness, pain, numbness and stiffness.  
For RA conservative management would involve analgesics, antiinflammatories, and collar immobilization.  Those who are experiencing neurologic dysfunction may have to undergo a surgical procedure.  What approach to use is up to the judgement of the surgeon depending on the extent of involvement and what needs to be fused.  I would recommend an experienced spine surgeon, especially because of your husbands medical problems.  It is resonable to ask for a second opinion as well.  
It is difficult to recommend approaches and treatments in your case, as I do not know the severity of his disease. Nor can I predict what will happen to him without surgery. The arthritis may be causing his weakness, and may be causing referred pain to his head.  It does not explain the tunnel vision.  
I can recommend our Spine Center, Neurology department and Spine Neurosurgeons at the Cleveland Clinic.  If you would like to set up a second opinion call 1-800-223-2273 ext 45559 or 216-444-5559.  
If you would like other referrals or information call:
North American Spine Society
6300 North River Rd. Suite 500
Rosemont, IL 60018-4231

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