All Posts in Category: Health Basics

Asymptomatic Cervical Stenosis

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Your condition involves narrowing of the cervical spinal canal discovered on imaging that appears to have no current symptoms nor findings on exam and therefore surgery is not indicated at this point even though there is pressure to some degree on your spinal cord.  Neck pain without other red flag symptoms does not warrant surgical recommendations. 

 

            Normal Canal           Cervical Stenosis


 

 

 

 

Why one person with cervical spinal stenosis is having major symptoms and another with the same MRI findings has none is unknown but very commonly seen.


In the normal spinal canal the spinal cord floats freely in the cerebrospinal fluid, CSF or spinal fluid, which serves as a protective shock absorber.  In patients with Cervical Spinal Stenosis the amount of CSF around the spinal cord is markedly diminished reducing the ability to protect the spinal cord from normal impacts or stronger forces.   This increases the risk of injury to the spinal cord from various normally tolerated forces.  You have seen this in football games when a player gets a sudden hard impact to the head and neck and suddenly goes paralyzed.   Most of these patients had this impact injury develop due to having such a blow in the setting of previously asymptomatic cervical spinal stenosis that was likely present since birth but never known to exist until the injury.   Fortunately the NCAA and NFL have focused on these “targeting” incidents in recent years. 

 

Most of the time if the patient has no symptoms neurosurgeons will suggest non surgical follow up observation only with recommendations to avoid high risk activities unless:

  • The cervical spinal stenosis is particularly severe in degree
  • There is associated with spinal cord edema
  • The patient’s career has unavoidable risk of high impact injuries
  • The patient has no symptoms yet does have positive findings on   neurological examination of spinal cord dysfunction
  • The cervical spinal stenosis is progressively worsening on follow up MRI scans

 

   Many patients ask why do we not go ahead and do surgery if there is cervical spinal stenosis even without symptoms or exam findings?

The answer:

  • The risk of surgery for cervical spinal stenosis must be weighed against the risk of observation. In most patients who are without symptoms the risk benefit ratio favors observation only.
  • Most people who have asymptomatic cervical spinal stenosis do not ever develop the need for surgery by never becoming symptomatic nor showing exam findings of spinal cord dysfunction nor significant MRI worsening during follow up over time.
  • Most asymptomatic patients that ultimately become symptomatic and need surgery for cervical spinal stenosis will develop warning or red flag minor symptoms early enough that they usually have no long term side effects from not having surgery done prior to symptoms.
  • Most patients with asymptomatic cervical spinal stenosis do not suddenly go paralyzed from their condition, unless there is a major impact injury that would likely injure even a patient without cervical spinal stenosis, but rather develop slowly progressive red flag symptoms
  • Medical studies on asymptomatic cervical spinal stenosis consistently support the role of observation vs prophylactic surgery.

 

When non-surgical observation only is the plan it is recommended that you avoid:

  • Sports and non sports axial load injuries
  • High-energy impact sports such as skydiving, downhill skiing, cliff climbing, football etc
  • Falls
  • Car, bike and motorcycle accidents whenever possible
  • Forceful Manipulation of the head and neck including physical therapist or chiropractic neck manipulation

 

The above is recommended in order to mitigate the increased risk of spinal cord injury in patients with cervical stenosis as compared to someone with a normal spinal canal.    Again people without cervical spinal stenosis have risks of spinal cord injury and paralysis with the above but those with cervical spinal stenosis have a statically increased risk of injury with the same force applied as compared to a person with a normal spinal canal.  Nevertheless, the same applies to breaking a leg or an arm from a fall in patients with osteoporosis versus normal bone.  We would not recommend putting casts on all the limbs of osteoporotic patients to prevent fractures from a fall!

 

Typically if non surgical treatment is the plan you will be followed up after a period of time with a clinical follow up visit +/- a follow up MRI at variable intervals for years to come and be advised to contact your neurosurgeon sooner if you develop any concerning red flag symptoms listed below.

 

 

 

 

 

 

 

 

 

 

Once patients develop symptoms and/or findings on exam then the condition is called “cervical myelopathy”.    Typically the MRI will show abnormal signal changes like the images above due to edema of the spinal cord in patients that are symptomatic from the cervical spinal stenosis.    This term is used to describe dysfunction of the spinal cord from many causes but in this case it is due to cervical spinal stenosis and the damage from the pressure on the actual spinal cord. 

MANY PATIENTS WITH SYMPTOMATIC CERVICAL SPINAL STENOSIS, MYELOPATHY, WILL HAVE LITTLE TO NO NECK OR ARM PAIN BUT RATHER ONE OR MORE OF THE NON PAINFUL RED FLAGS BELOW.

 

 Red flag symptoms to be aware of that might be indicative of cervical stenosis becoming symptomatic include any of the following:

 

  • Development of numbness and tingling in the arms and/or hands
  • Development of electric shock sensations that run down the spine or through the extremities with such activities as movement of the neck or coughing, sneezing or bowel movements etc. (Lhermitte’s phenomenon)
  • Development of pain running from the neck down one arm of the other or both.
  • Development of clumsiness or loss of dexterity with loss of fine motor movement of the fingers and of the hands. This may evidenced as problems buttoning ones shirt or developing problems writing with a pen or clumsiness typing with a keyboard.
  • Development of unsteadiness and clumsiness of gait while walking. This may present as stumbling when walking for no apparent reason. This is particularly noticeable when present during attempts to perform field sobriety testing, tandem gait testing or walking placing one foot immediately in front of the other while trying to walk a straight line
  • Development of significant weakness of the arms and hands that may present with inability and to normally use one’s hands and arms in the normal course of work and or play activities
  • Development of clumsiness and dysfunction and stiffness of the muscles of the upper or lower extremities (spasticity)
  • Development of urinary &/or bowel incontinence particularly associated with symptoms above is a typically a very late symptom. Isolated urinary problems would be uncommon due to cervical spinal stenosis and more likely related to urological/GI disorders. 

 

If symptoms develop or MRI findings worsen or findings on neurological exam appear then surgery will likely be needed. 

When needed surgery can be either an anterior cervical decompression and fusion surgery or a posterior cervical decompression with or without fusion or both depending on your anatomy.    

 

Hopefully your cervical spinal stenosis will never need treatment but please carefully read the warnings above and be mindful of the red flag symptoms discussed.  Please report to your neurosurgeon development of any concerning symptoms when they develop.  Do not wait for the follow up visit if these symptoms develop sooner.   Regardless, keep your scheduled follow up plan even if you have zero symptoms and are pain free!    

Any questions or concerns visit legacyneuro.com

Scott Schlesinger MD

Legacy Spine and Neurological Specialists

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Seizure First Aid

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Do I call 911?

Seizures do not usually require emergency medical attention. Only call 911 if one or more of these are true:

  • The person has never had a seizure before.
  • The person has difficulty breathing or waking after the seizure.
  • The seizure lasts longer than 5 minutes.
  • The person has another seizure soon after the first one.
  • The person is hurt during the seizure.
  • The seizure happens in water.
  • The person has a health condition like diabetes, heart disease, or is pregnant.

These are general steps to help someone who is having any type seizure:

  • Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.
  • Comfort the person and speak calmly.
  • Check to see if the person is wearing a medical bracelet or other emergency information.
  • Keep yourself and other people calm.
  • Offer to call a taxi or another person to make sure the person gets home safely.

First aid for generalized tonic-clonic (grand mal) seizures

When most people think of a seizure, they think of a generalized tonic-clonic seizure, also called a grand mal seizure. In this type of seizure, the person may cry out, fall, shake or jerk, and become unaware of what’s going on around them.

Here are things you can do to help someone who is having this type of seizure:

  • Ease the person to the floor.
  • Turn the person gently onto one side. This will help the person breathe.
  • Clear the area around the person of anything hard or sharp. This can prevent injury.
  • Put something soft and flat, like a folded jacket, under his or her head.
  • Remove eyeglasses.
  • Loosen ties or anything around the neck that may make it hard to breathe.
  • Time the seizure. Call 911 if the seizure lasts longer than 5 minutes.

Stop!

Knowing what NOT to do is important for keeping a person safe during or after a seizure.

stop sign with hand

Never do any of the following things:

  • Do not hold the person down or try to stop his or her movements.
  • Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
  • Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.
  • Do not offer the person water or food until he or she is fully alert.
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Too Much, Too Little, Just Right

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All too often a patient will come into clinic that has been very diligent with a fitness regime for years but despite preemptive health measures the patient will develop low back pain. It is described as a deep ache that is worse in the morning and/or night begins to interfere with the normal activities of his/her day. Seems like such a waste of time to put all the effort into staying fit then still having pain, right?

Often there is no specific injury and very little diagnostic grounds other than “facet hypertrophy” (described normally as arthritis in the low back) to support the claim of this pain. Chances are with most of these patients, arthritis did not develop in the last week or month. It is an accumulation of years of repetitive weightbearing and compressive forces to the spine that have brought about this change. The question remains, what can be done to improve this pain when you already believed you were doing all the right things to stay healthy?

In terms of treatment with patients that present with the history that I have outlined above; moderation becomes a recurrent phrase of emphasis. Other useful tools are variation and observation. Mixing up the cardio routine with a variation of biking (indoor or outdoor), swimming, and walking. If you have a gym routine for lifting weights or resistance exercises, try mixing things up by doing body weight activities or group aerobics. It may also be a nice change of pace to do a beginner’s class of yoga or Pilates. Moderation and observation are key parts to avoiding overuse injuries that cause setbacks.

There is current research to suggest that indeed there is a “happy medium” to activity. Too much activity can have as much of a negative impact on the body as doing nothing at all. Take home points:

  1. Use Variation in exercise choice
  2. Practice moderation with strenuous activities
  3. Observe how your body responds to activity and modify if necessary

If you are having setbacks due to low back/neck pain from too much activity or you find yourself sedentary and have no idea where to start, give us a call at 501-661-0077 for a consultation and evaluation at Legacy Spine and Neurological Specialists so that we can get you Back to Life!

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Bell’s Palsy

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Definition

Bell’s palsy refers to facial paralysis caused by a lesion or inflammation of the facial nerve. Symptoms resemble a stroke, with unilateral facial weakness. However, most facial weakness from strokes spares the forehead muscles. These are weakened with Bell’s palsy. Patients will have unilateral facial weakness that often causes difficulty with eyelid closure, dropping of the affected side of the mouth and reduced ability to wrinkle the forehead or the nose.

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Memory Loss

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Memory loss is a common neurological concern. Often, mild forgetfulness is due to stress, distraction, or even depression. Though patients can experience a little forgetfulness with aging, significant changes in memory or thinking are never only attributed to age.

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The Relationship of Neuropathy & Diabetes

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Arkansas is ranked 4th among the nation in adult diabetes rates. This is somewhat of an alarming statistic. There are different forms of diabetes but type 2 diabetes is the one I would like to highlight. One complication that can be associated with type 2 diabetes is neuropathy.

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Holiday Health Tips

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With the Holidays right around the corner, there are so many opportunities to over indulge, so here are some good tips to fight off those extra LBs and stay fit this Holiday Season!

Exercise: Its easy to skip out on your exercise during this extremely busy time of year, but here are some ideas to keep you motivated.

  1. Get outside

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Migraine Triggers

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Many migraine patients recognize specific triggers to their headaches. Migraine patients are more sensitive to certain substances in their foods and environments as well as changes to their routine. Too much or too little sleep, changes in exercise routines, and processed foods can worsen migraine headaches.Heavy, flowery scents or cigarette smoke are frequent triggers.

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Writers Cramp

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Task-specific dystonia, also known as “writers cramp” can occur in people who do repetitive movements.

It gets its name task-specific because classically, it only occurs during one specific task. It can be inherited, secondary to an underlying neurologic cause, or occur sporadically.

It is often initiated by voluntary movement with symptoms “overflowing” into adjacent muscles causing involuntary muscle cramping of adjacent fingers, wrist, and can include forearm. It can sometimes resemble a tremor. The most common task-specific dystonia is writers cramp, but this also frequently occurs in musicians due to the repetitive motions of playing an instrument. Treatments range from conservative measures such as occupational therapy and stretching to Botulinum toxin (Botox) injections of affected muscles if severely limiting function.

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