neck pain/headache

[geordie97]

The reason I am writing is that I have been to a Neurologist because of neck pain (rear) and headaches. To backtrack slightly, I had lumbar stenosis and had a lumbar laminectomy and discectomy in 2000 (I am 53 years old now). I had an MRI which revealed 1) Congenitally small cervical spinal canal, 2) Disc-osteophyte at C3-C4 producing cord compression to the right midline and bilateral bony foraminal stenosis, more severe on the right and 3) Central and left C6-C7 disc protrusion producing moderate canal stenosis but no cord signal abnormality.
I will be seeing a Neurosurgeon in a couple of weeks but was wondering if, since I have no pain or numbness in my hands, arms or shoulders, is it possible to just get a nerve block to relieve the pain for a time? I realize that I will probably have to have surgery (what does that involve and how long would the expected recovery time be?) but would like to put it off until after I retire in Feb 2010. Since the pain gets worse as the day wears on, and it is difficult to find a comfortable position when I sleep (on my side), would one of the cervical support pillow help at all? What should I be doing while waiting for my appt? Ice? Heat? Exercise?
Thank you for all your assistance.

Larry

[MG (Admin)]

Dear Larry,

Thanks for your question..it is an important one.

Basically, what we need to address is the reasons that surgery may be considered in the case of a problem in the neck (cervical) spine.

Assuming we are dealing with age-related general disc / bone issue then the main issue is whether there is evidence of significant neurological impairment. This is mainly determined by a detailed neurological examination and, to a lesser extent, what is shown on the imaging.

Although a surgeon may suggest surgery more often than a neurologist, in my opinion (and bear in mind that I am a neurologist ) surgery should only be performed in cases of actual or potential, significant neurological impairment. In other words, my advice to you would be to go to a good neurologist to hear your story and examine you and ask what he thinks about surgery, before you go to a surgeon. In general, if the neurologist does not think surgery is an option then you would not need to see a surgeon in any case.

Hope that helps and let me know how it goes.

[geordie97]

Thanks .

I have been to a neurologist and he ordered the MRI. When I saw him earlier this week, he told me that he only refers about 10% of his patients to a surgeon, but that I'm in that 10%. I went to him originally with neck pain and headaches. He gave me a prescription for Zanaflex, started me on physical therapy (he thought it was arthritis and prescribed traction and ice) and ordered the MRI. If it would help, I can transcribe the complete report for you. The prescription seemed to help the headache but the neck pain persists, and gets worse as the day progresses (except today when I woke up with it and it's not any better). I will see the surgeon in about 9 days but was wondering if you think a nerve block would be a possible option, since I'm not having any pain, numbness or loss of feeling in my arms?
BTW....you may remember we discussed my wife and her fall back around December. Thanks for your help.

Larry

[MG (Admin)]

Yes I remember...I hope she is OK...how is she doing?

I am not sure why surgery is indicated in your case...I would recommend you ask him what the risk is of not having the surgery and let us know so we can have a better idea.

As far as the nerve block goes you are talking about...well this is actually a matter for a pain specialist rather than a neurologist...but I would like to know which medications you have tried for the pain and in which doses.

[geordie97]

I'm happy to say that she is doing MUCH better .

As far as what the Dr's have done for me...not much. Let me start at the beginning. I started to have neck and rear skull pain and a constant forehead headache a few months ago. I went to our G.P. who said it was my sinuses and treated me for that. So, then I went to our Internist who said it wasn't sunuses and referred me to a Neurologist. The Neurologist ordered an MRI (results follow) and gave me some Zanaflex for the headache. When I returned for the MRI results, he said he was referring me to a Neurosurgeon, who I see on June 2, 2008. A little background...I had a Lumbar Laminectomy in 2000 for Lumbar spinal stenosis from the pedicle of L2 to the sacrum. Suggestion of central disc herniation at L4-L5, and central and left-sided disc herniation at L5-S1. Lumbar osteoarthritis and degenerative joint disease. Congenital spinal canal narrowing.

MRI Results

Findings
Cervical vertebral body heights, alignment and marrow signal intensities are normal. The cervical spinal canal is small on a congenital basis.

C3-C4
There is moderate disc space narrowing and a generalized disc-osteophyte complex that is larger to the right of midline. There is mild cord compression to the right of midline, but no definite cord signal abnormality. There is a small dorsal extradural abnormality due to the ligamentum flavum. Midline AP sac diameter measures approximately 6mm. There is severe bony foraminal narrowing of the left due to uncovertebral joint hypertrophy.

C4-C5
There disc in unremarkable. There is bony foraminal narrowing on the right due to uncovertebral joint hypertrophy.

C5-C6
There is minimal disc-osteopyte complex. There is probably mild foraminal stenosis bilaterally.

C6-C7
There is a central and left disc protrusion. Midline AP sac diameter is approximately 6mm. The ventral surface of the cord is flattened, and the dorsal subarachnoid space is completely effaced, but there is no abnormal cord signal visible.

C7-T1
No significant abnormalities

Given technical artifacts on sagittal sequences, no gross spinal cord signal intensity abnormalities are apparent. The foramen magnum is widely patent, and prevertebral soft tissues are normal.

Okay...now you have the whole report. Any ideas or suggestions?? Thanks for all your help.

[MG (Admin)]

There is mild cord compression to the right of midline, but no definite cord signal abnormality.

This seems to be the most important finding. If it is causing symptoms (weakness, numbness or tingling, problems passing urine) or there are signs of a problem on exam then in some cases surgery would be considered.

My feeling is that surgery should not be considered for pain alone, in the absence of a neurological problem, unless there is reason ot expect that a neurological problem will appear or there is severe pain which has not responded to all the other options available.

I recommend that you find-out the precise reason why surgery is being considered.

[geordie97]

Thanks MG

I don't really know that surgery is being recommended, just that the neurologist is sending me to a neurosurgeon. My feeling is that, since I am only having neck pain (granted, it gets bad at times) and no other neurological symptoms, I don't plan on having surgery unless the Dr feels that I might cause physical damage by waiting. I am still working as a Federal Law Enforcement Officer, a volunteer fire fighter and still able to bowl in 2 leagues. I do believe that surgery will eventually be necessary, as it was for my lower back. I can deal with pain as long as I'm not doing any physical harm to myself.

BTW...I don't know if I will ever get to where you practice, but if you ever get to the Memphis, TN area, I would love to meet you for all your help over the past year.

Larry

[MG (Admin)]

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