[rosebud28]

#20107

Dear Dr Corenman,

Thank You so much for this website, the time that you dedicate to it and the invaluable advice and support that you provide.

I am a 35 year old female living in the UK. I am normally fit and active. 5ft 6″. 9st aprox.

At the end of March 2015 I began to experience severe pain in my neck, shoulders and left arm. I also had radiating pain, burning and tingling down my left arm and into my fingers. I had an MRI on the 21st May 2015 which showed the following:

There is a loss of cervical lordosis associated with discovertabral disease between C3 AND C6
No sinister bone marrow signal shown
C3/C4: There is moderate right C4 exit foraminal stenosis. Posterior disc/osteophytes in the right central position causes slight flattening of the hemi cord.
C4/C5: There is moderate right and mild left C5 exit foraminal stenosis
C5/C6: A combination of focal left foaminal disc protrusion and osteophyte causes severe narrowing of the left C6 exit canal. At this level posterior osteophyte causes mild central spinal stenosis with slight flattening of the cord. This is more prominent on the left. The spinal cord itself images normally and no abnormality is shown at the cranial-cervical junction.

My doctor immediately referred me for neurosurgical opinion; I have my first consultation on 22nd September 2015.

After losing all memory of April and May to Oramorph, Tramadol, Gabapentin, Naproxen, diazepam and Amitriptyline, I asked my doctor to give me something that would enable me to function so that I could leave my bed and be able to care for my child by myself and without the aid of several family members. At first I was given 5 ug/h Bu Trans patch; I am now on a 10 and a 5 simultaneously. Since wearing the patches I really have gotten my life back to a certain extent. I am not in searing pain, can look after my child and am able to lift, carry and do my housework. I do have very mild pain and slight discomfort, my memory is pretty bad and I find myself having very heightened emotions.

Over the last 6 weeks or so however I have been experiencing some changes. I am suffering from chronic dizziness. My blood pressure is naturally low but is on the lower side of what it should be. At times everything goes black and can take up to 30 seconds or so for my sight to come back. More worrying, I have been waking up several times a night with numbness in my arms and fingers. Initially, it was just my left arm, my thumb, forefinger and little finger. As soon as I woke up and shifted position it would correct itself. It has worsened over time however and last night I woke up several times unable to feel or move both arms or any of my fingers. I also experienced it in my legs which I am very puzzled about. It took a much longer time for the feeling to come back. My fingers were also very swollen and I have found it very difficult to clench my fists tightly all day.

My questions are, I guess, the following: 1) can you please properly explain what my conditions are? 2) despite my pain being managed with the patches, will I have to have surgery. 3) Is the dizziness and loss of feeling in my arms and fingers related to the narrowing of my exit canals? and 3) if so, is it an indication of my condition worsening?

Thank You very much for you time and help.

[Donald Corenman, MD, DC]

#20108

Even though America is on the English measurement system, I still don’t know what “stone” is the equivalent in pounds.

You sound to have a typical cervical radiculopathy (nerve pain from compression of the nerve root). The left C6 nerve is compressed due to disc spur and herniation (“focal left foraminal disc protrusion and osteophyte causes severe narrowing of the left C6 exit canal”). You have other degenerative levels but I will assume that before this current severe episode, you had tolerable symptoms and would have not sought a consultation due to symptoms.

It seems that the National Heath Care system in the UK is a little slow to get you to a surgeon as you have had significant medications for quite a long period of time prior to your referral. The confusion that you have experienced is typical with the doses and types of medications that you have used to control your symptoms.

If you have had “normal” low blood pressure and take the medications you note, you might have developed orthostatic hypotension. This is a condition where the heart does not pump “hard enough” when you stand up to supply blood to the brain and you develop a temporary lack of blood flow to the brain. This causes dizziness and “black out” episodes when you get up quickly. This condition should resolve when you stop the pain medications but if not, a work-up is necessary.

Symptoms in your legs could be a result of the narrowing of the spinal canal in the cervical spine but I suspect that this might not be the case. A physical examination will reveal if these new symptoms are a result of cord compression or a result of “globalization” of symptoms due to pain which is not uncommon.

It appears that surgery is in your future due to significant pain. You might also have motor weakness (again revealed by a physical examination) which is another indication for surgery.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[rosebud28]

#20111

Dear Dr Corenman,

Many thanks for your reply.

I had to google the conversion! Its 129 lbs.

Yes, the National Health Service is notoriously slow which can be very frustrating. However, what I have read from my american counterparts, I am very lucky to have the backing of the NHS considering my current condition.

Can ask your opinion on the numbness that I am experiencing at night time please? Is this typical of the cervical radiculopathy,or is it a sign of further deterioration?

Thank You once again for your time, it is greatly appreciated!

[Donald Corenman, MD, DC]

#20115

Numbness develops from compression of a nerve root. SInce you have narrowing already and when you are asleep, you don’t “realize” that your head is twisted enough to compress the nerve, the numbing occurs and when it gets substantial enough to trigger your reticular activating system, you wake up.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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