Tuesday, February 26, 2013
It is time to formally welcome: Cervical and Lumbar spines to the party called my Life in Pain.
The severe trauma that my spine went through at age 16, is now (at 53) rapidly and suddenly showing in the two spinal levels more commonly known to have disc and spur issues, pain, and/or surgeries. The Thoracic spine is not a level to routinely find herniations, etc., nor to have spinal surgery performed on.
The Cervical and Lumbar spines, however, are often seen on the surgical board for the day. It is common to see procedures and other attempts at 'fixing' these two spinal areas, much more than in the Thoracic spine.
The most uncommon part for me right now, is that I do not know which level to pay attention to, from one day to the next. Even seeing a Spine surgeon is challenging due to the fact that I may be there to see the doc about one level, and the day of the appointment, that level is quiet, yet the other level is screaming out in pain. (This is common to find in Spine patients with a history of spinal trauma/surgeries, and must be accounted for in a patient with a c/o spinal pain; also seen in the randomness of how pain may one day be off the charts, and the next day feel tolerable.)
The Newest Guests and what they bring to the table:
Cervical Radiculopathy Upper extremity, R side, shoulder, arm, hand, thumb, index finger. (Six shooter) L arm/fingers suddenly numb on occasion.
Lumbar Radiculopathy Lower extremity, R side, sciatica, anterior thigh, numb below knee, to toes.
Radiculopathy: The consequence of nerve root damage (from any cause) is known as a radiculopathy (L. radicula = little root; pathos = disease) When the exiting spinal nerve is compressed, usually by disc or arthritic spur, causing severe pain and tingling, leading to numbness of the extremities.
In my Cervical spine, there are again a number of Osteophytes. At C6-C7, they are seen, also disc herniations are a strong possibility of another source of compression. This level's soft tissue studies are not completed as of this writing. C6-7 is the level that would innervate the exact areas I feel painful tingling, electrical shocks, numbness, severe muscle spasms, etc. When the exiting spinal nerve root is compressed, causing radiculopathy, the patient can trace 'like the best anatomist', along the exact nerve path.
For the Lumbar spine, the soft tissue study has been done, and this was ready to be seen online during the visit. However, when I went to the spine surgeon's, the L-spine was not the issue. (Oddly, to match, the entire office system had gone down, rendering my Lumbar CT scan irretrievable online.) That day, that appointment hour, it was all about my Cervical spine. This physician was interested in my entire history of spinal trauma at a young age, the subsequent surgeries and procedures, and he was also very open about his feelings when I relayed the past year's hard work of titrating down the long-acting opiate medication completely to nothing. He was not only moved that I had done that by choice, but obviously very pleased to hear me say that I would never agree to any long-acting opiate in my Pain Management again.
So I am there for a spinal level that isn't even hurting at the time. Trauma/ injuries to multiple spinal levels will often alternate from one level to another. From day to day, down to even hours. I told him about the C-spine showing up suddenly and painfully after a recent rear-end hit and run. He immediately said, "Let's look at that, since that is what's hurting you right now."
I had just gone to the ER for this sudden, scary and very painful Radiculopathy. One of the best ER visits I have ever had. (That is another post--to give kudos--well-deserved by some outstanding medical personnel.) I was in so much pain and with the quickening numbness down my right arm to my fingers, I had to push through the instant, 'No I will not go to the ER for any type of spine-related pain', block wall in my head that instantly arises when I am faced with seeking help for severe pain arising from my spine, and just do it. Most Chronic Pain patients understand this aversion.
So spine doc does some UE (Upper Extremity) strength and reflex tests, feeling and looking strong there, no apparent muscle weakness, and next step is a Nerve Conduction study. Gotta start the ruling out process. Carpal tunnel? Or Cervical spine? We both know the answer.
Either way, the focus has shifted, and the pain is not from and in 'just' my Thoracic spine anymore, but also from the levels above and below-- Cervical and Lumbar are joining the party. They came out to play, and they play hard. May as well give the 'newbies' a nice welcome. ;)
'Did You Know'..........That we have 8 cervical roots? Yet only 7 cervical vertebrae.....
*Because there are only 7 cervical vertebrae despite 8 cervical roots, the root number exiting between two vertebrae is always the number of the lower vertebra. For example, the C5 root exits between the C4-C5 vertebrae and would be effected by a C4/5 disc herniation; the C8 root exits between C7-T1 vertebrae and would be compressed by a C7-T1 disc.
Pain due to a C6 and C7 radiculopathy radiates from the neck and from around the shoulder into outer aspect of the arm and forearm. C6 radiculopathy may cause pain and numbness along the dorsal aspect of the thumb and index finger, C7- pain and paresthesia may radiate into the middle finger.* Exactly what I am experiencing. Down to the exact fingers and location of pain.
*Thanks to Neuroanatomy from Wisconsin U. An excellent resource!