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Cervical Spinal Stenosis - surgery in my future.

Apr 13, 2014 - 4 comments
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Cervical Spinal Stenosis

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Cervical spondylosis

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cervical degenerative disc dis



Twelve years ago I had a ruptured C6-7 disc, which was the most horrendously painful experience I think one could go through.  On the traditional pain-scale of 0-10 I would have rated it as a "15", meaning to me that suicide would have been far better than to endure that for very long. As a physician it gave me a new understanding of chronic pain, and the realization that although many people are quick to criticize our prescribing of opiate pain medications - often because some people use them to commit suicide - I will remind those people that chronic pain IS a major cause of suicide. George Eastman (of Eastman-Kodak), although one of the richest men in the world at the time, committed suicide because no one could help his spinal stenosis (in the lower back).  The bad thing about the pain of a pinched nerve, I found, is that nothing really does much to help that pain. I found that two Advil, a Darvocet (no longer available), some Biofreeze, and the heating pad helped me sleep for two hours or so - and helped just as well as the Percocet, although admittedly I did not take much of that because I had to have mental clarity to continue to work as a physician.

Surgery was successful - the pain was gone and I had good range of motion in my neck.

Several years later I was told that the almost constant pain in my shoulders and thighs was due to fibromyalgia - and yet I never have had any of the "tender points" which are a hallmark of FM. I have managed that pain with Advil and twice-a-day tramadol. I wondered for a while if pressure on my nerve roots or even spinal stenosis might be the cause.

Spinal stenosis is when degenerative disc disease progresses, the bodies of the vertebrae develop bone spurs, and the spinal canal gets narrowed to the point of squeezing the spinal cord. When this happens in the neck it can cause symptoms in the arms as well as the rest of the body.

I went along fine for years - not knowing that my spinal stenosis was slowly getting worse. I knew that the nerve roots were getting more compressed over time - I would frequently wake up at night with one arm or the other having paresthesias - the nerve tingling "asleep" feeling that we all know. I suspected that I would need to get this checked out sometime soon. But spinal stenosis creeps on quietly - it doesn't tend to cause spinal-cord related symptoms until it reaches a critical point. That critical point happened a month ago.

Lhermites' Sign is an electrical sensation described a century or more ago. It is an unusual hallmark of spinal stenosis. In 25 years of primary care practice I have not had a patient who has described this. One evening after taking a shower (and leaning forward to wash my hair) I suddenly had a feeling in my fingertips like I was sticking them in an electrical outlet. This was much different than the paresthesias.  It was a pulsing almost-painful electrical sensation at the tips of my fingertips - ALL of my fingertips! It clearly was not just a single nerve being irritated, which would only effect one hand, and not all of the fingers. In addition, at the same time the small toes in my right foot went numb. This only lasted about 20 seconds, but as a physician, I knew that this created what we sometimes refer to as an "oh ****" diagnosis - where the diagnosis is obvious - and not very good. (Things like a melanoma, a hard mass in the belly, or a smoker with absent breath sounds in part of their lungs are typical "oh ****" diagnoses that we make...)  

So I had an MRI, which shows spinal stenosis with a canal diameter of 7mm (should  be greater than 10) and multiple levels of "severe" neuro-foraminal stenosis. The neural foramina are the openings in the spine where the nerves exit. I guess it is amazing that I am not having severe pain.

So - I am not very happy about this turn of events. The only good news is that I have a friend from college who always said his goal was to be a neurosurgeon at the Mayo Clinic. It turns out that he worked hard and is a neurosurgeon at the Mayo Clinic - and his specialty is complex spine surgery.

The kind of spine surgery that I will need is most likely the kind where they open up the back of your neck, take the back of the spine off, and rebuild it with metal and bone grafts to give the nerves and the spinal cord more room. Recovery will probably require a "halo" - a steel ring literally bolted to your skull and attached to rods that rest on a harness that goes around your shoulders - to keep the neck immobilized while the bones heal.

I have my appointment in a few weeks. I really understand the kinds of concerns that my patients have - not only about success of surgery, risks of complications (paralysis, infection) - but also the more practical things like taking leave from work, making sure my disability insurance will cover me if I am out for a number of months, etc. There are lots of unknowns. It is also depressing to be "relatively young" and to feel like your body is failing.