Cervical Spinal Stenosis with Radiculopathy

9/11/2009 12:30pm

For many years I have suffered with back and neck pain, often with radiating pain down my left arm. Back in the 1990s, I thought the problem was associated with either a developing heart problem or with a back & neck injury I suffered on July 8, 1991, after a nearly 30 foot fall at an amusement park in Houston. The pain often coincided with difficulty breathing (dyspnea).

I sought out professional help from a wide variety of specialists. The variety of diagnoses ranged from depression/anxiety (sic!) to natural aging to insufficient mattress support. With the exception of one doctor, none took seriously my back injury, and even that doc felt that a few weeks of rehab therapy might 'fix' the problem. Of course, I endured test after test, including stress tests for the heart, pulmonary tests for my dyspnea, X-Rays, MRIs, and CTs. Each time the doctors could find no reason for my pain; so, they would eventually give up.

Part of the reason for the nearly 20 year trail of failed diagnostic work is connected to how the medical profession works. Part of the blame falls on my inability to assess what has really been going on with my body. My symptoms have been processed through my own concerns, like worries about heart disease or blockage, or other unrelated medical issues. But part of the problem has been that each physician I consulted searched for only one thing at a time; they addressed only one problem at a time. There was never any over-arching plan to thoroughly test each potential cause. They would focus on one issue and once that was resolved, they would consider their work done. In short, they tried to treat the "problem" at hand, but never treated ME.

For instance, if I mentioned that my shoulder sometimes ached during an episode of back pain and difficulty breathing, my physician might send me for an X-Ray or MRI of the shoulder. When they could see no cause, they would refer me to a heart specialist, who would only look for heart disease or bloackage. One doc would take X-rays of the neck and back, but when s/he couldn't see anything, they would conclude that no further imaging studies were needed, and either consider their work done, or pass me on to someone else.

For nearly 20 years, my condition has slowly progressed, sometimes seemingly improving, other times worsening. My unrelated health issues like the creeping obesity I've suffered since 1991, and other age related problems with cholesterol, blood sugar, abnormally low hormone levels complicated matters.

Finally, I gave up and decided to just bear my burden and accept my fate. I learned to manage my dyspnea through self-developed relaxation techniques. I kept the back pain to myself most of the time, and in later years, began a daily aspirin regimen, just in case the real cause of that chest and back pain was my heart. The aspirin significantly improved my dyspnea, so I took whatever improvements I could get.

But without realizing it, my periodic back, neck and left shoulder pain slowly increased in intensity. The tingling down in my left hand and down my left arm, period left arm weakness, etc. were intermittent, so, somewhat bearable. But the episodes tended to linger longer as time progressed. All the while, specialist after specialist chased phantoms and arrived at no definitive conclusions.

Then I moved to College Station in 2008. My new primary care physician (PCP) continued the mishandling of my medical management, focusing on ordinary age-related issues like cholesterol, blood sugar, and obesity. For my other symptoms, he simply referred me to his doctor friends, who generally didn't search any further than my docs in the past.

Then in September 2008, seemingly from nowhere, I had my first major attack. My neck, back and shoulder pain became extreme. I could feel the pain in a much more localized area of my neck. The pain radiated down my arm. I experienced loss of motor function, in addition to numbness. The pain was so severe, my PCP decided I needed to see one more specialist.

By 'accident,' I was misreferred to an orthopedist who specialized in sports medicine. But it turned out for the best. With a single CT scan and a few X-rays, he diagnosed me with cervical spinal stenosis. The radiological studies were largely inconclusive. The radiologist's report of Sept 2008 remarked that there was mild cervical stenosis, but nothing else out of the ordinary. But my orthopedist decided that a short term steroid course might help, and prescribed a 6-day 'weaning' regimen of Methylprednisolone. He explained why he thought my primary problem was stenosis and encouraged me to give the steroid regimen a try.

A week later, my pain was gone, and it was clear to me that the steriods made the difference. I learned from my wife how steroids help reduce the inflammation associated with a pinched nerve or spinal cord compression, and how this reduction helped ease the pressure on the spinal cord or pinched nerves. My orthopedist was satisfied and suggested that we try to manage my problem in a similar fashion if the condition flared up again. He thought that I would eventually need surgery, since cervical spinal stenosis is generally a progressive disease, but that he hoped we might be able to avoid surgery for a few years.

Well, I experienced another 'flare up' in February, 2009 and again two weeks ago, beginning August 29, 2009. The steroid approach quickly resolved the February episode, but it has only partially helped this last time. The orthopedist came to the conclusion that it was time to consider surgical options. Once again, he referred me to a surgeon in his group, rather than consider my best interest first. Fortunately, the physician to which he referred me is not within my health insurance's "network," so my insurance won't cover me if I see him.

I will say here that this latest episode has been the most extremely painful experience of my life. The neck, upper back, and shoulder/arm pain have been so severe that I have slept little this past week. On more than one occasion the intensity of the pain has driven me to tears. I have found little relief during the worst periods of pain, which usually occur at night. For a few hours last week I lost total use of my left arm, due to near complete paralysis, and even after the paralysis passed, was unable to dress myself without help until a couple of days ago.

I have been unable to lay down without a high level of pain, and no change of position seems to result in any lessening of the pain. I have been relatively sleep deprived for the last 10 days, even with the heavy pain meds, muscle relaxers, NSAIDs (Aleve) and steroids. I can tell the heavy meds are helping dull the edge of the pain, but they do not seem to be working as effectively as they have in the past. I am still significantly impaired, with my left arm remaining compromised and head/neck movement severely restricted.

Well, today, I finally found a surgeon in Houston who will see me next week: Tuesday, 9/15/2009 at 9am. He is both a board certified orthopedic surgeon and a board certified neurosurgeon. His specialty is cervical spinal stenosis, and he is an expert on minimally invasive surgery techniques specifically for spinal stenosis surgery!

My condition is technically called CERVICAL SPINAL STENOSIS with RADICULOPATHY.

Until recently, I didn't know that my two brothers also suffer from this condition, and that my grandfather was paralyzed by this very condition back in the 1970s. In the past, this degenerative condition was called "creeping paralysis," because there was little doctors could do to stop the progression of this disease. Sometimes the more severe conditions would lead to death. Both of my brothers have required surgical intervention for their stenosis, one of which has endured TWO surgeries.

I am not certain that my neurosurgeon will start with surgery. I suspect, he'll want to do some imaging studies first, and may try a direct injection to alleviate the pain, if he thinks the condition is not severe enough for surgery yet. I just know that I can't handle this pain much longer. We'll see how things progress.

For everyone's information, cervical spinal stenosis is essentially a narrowing of the spinal canal in the neck, usually producing cord compression and thereby impairing nerve function, and often causing pain. There are a number of causes for this 'narrowing,' including bulging disks, bone spurs and calcification, disk compression, and even degeneration of the canal itself. My condition appears to not be related to disk misalignment, but rather is due to a general degeneration and narrowing of the spinal canal. As I noted above, in my case, it appears an inherited genetic condition.

Radiculopathy, implies that the compression on the spinal cord or nerves is affecting one of my arms. In my case, the cord compression is affecting my left arm, which is my "writing" arm. As stated above, I have experienced a lot of numbness and pain in my left arm, as well as impairment and temporary paralysis. I still am unable to lift my arm higher than horizontal to the floor. What's worse, if I then lift my right arm, my left arm falls helpless to my side, and I am unable to use my left arm until I put my right arm down. There is uncertainty whether surgery will restore my left arm motor function back to normal, but it should take care of the pain.

So, that's what is going on with me at the moment. I have been reluctant to share all this with everyone until I know more. But with the increasing number of inquiries from all my WONDERFUL, DEAR friends and family, I think it's time just to tell you everything.

Thank you for your kind words and gestures of concern. You are all the best. I will keep you informed.

David Adcock (2pm)
daadcock@suddenlink.net
College Station, Texas