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Neurology (Expert Forum)
Rehab/PT?Chiropractic for Cervical Spondylosis
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Rehab/PT?Chiropractic for Cervical Spondylosis
by AndyA, Jun 03, 2001 12:00AM
Hello,
I am a 41 year old doctor with MRI proven cervical spondylosis with a narrowed foramen along with a C6 radiculopathy involving the left side. I had acute onset of symptoms (pain in neck, posterior shoulder, and deltoid area with eventual parasthesias down the arm and numbness in the thumb) about 3 months ago. There was no inciting factor or injury.
I saw a neurosurgeon who felt that my symptoms would resolve in about three months. He did not feel that NSAIDS, PT, or for that matter anything else has ever been shown in studies to substantially improve the problem---except time. In the absence of significant disc disease, traction was not felt to be indicated. Indeed, I tried multiple NSAIDS without relief. Some Neurontin a psychiatrist colleague prescribed at HS has definitely helped me sleep at night.
At this forum and at other forums, professionals (neurologists, chiropractors, etc.) have felt that "rehab" or "PT" is extremely useful and indeed essential to a case such as mine. I like and have confidence in the neurosurgeon (who incidently was not anxious to do surgery initially). When I called back as he suggested (after patiently waiting 3 months in pain for this to resolve) his response was that I needed sugery (the surgery that he planned to do was a posterior approach--foraminectomy--no disc surgery per se as I apparently do not have significant disc disease).
There is no doubt that I have improved from three months ago. There are days however when I feel I am back 2 to 3 months ago with significant pain. I have never had a day that is without symptoms.
My question(s): Is it reasonable to wait longer--is it likely I will have complete resolution of symptoms? Is this the kind of thing I just accept and live with daily pain? Am I destined to eventually have surgery at some point in my life given the onset at age 41? I you feel rehab/PT/Chiropractic is useful and would be a good thing to pursue, which (a physical therapist or chiropractor) in your experience would be better?
Finally, I would never want to do any intervention to exacerbate the problem or injur my neck. I have concerns about chiropractic "adjustments" that might worsen the problem. Exactly what kinds of intervention from a PT or chiropractor can help this problem?
My sincere appreciation for your advice.
I am a 41 year old doctor with MRI proven cervical spondylosis with a narrowed foramen along with a C6 radiculopathy involving the left side. I had acute onset of symptoms (pain in neck, posterior shoulder, and deltoid area with eventual parasthesias down the arm and numbness in the thumb) about 3 months ago. There was no inciting factor or injury.
I saw a neurosurgeon who felt that my symptoms would resolve in about three months. He did not feel that NSAIDS, PT, or for that matter anything else has ever been shown in studies to substantially improve the problem---except time. In the absence of significant disc disease, traction was not felt to be indicated. Indeed, I tried multiple NSAIDS without relief. Some Neurontin a psychiatrist colleague prescribed at HS has definitely helped me sleep at night.
At this forum and at other forums, professionals (neurologists, chiropractors, etc.) have felt that "rehab" or "PT" is extremely useful and indeed essential to a case such as mine. I like and have confidence in the neurosurgeon (who incidently was not anxious to do surgery initially). When I called back as he suggested (after patiently waiting 3 months in pain for this to resolve) his response was that I needed sugery (the surgery that he planned to do was a posterior approach--foraminectomy--no disc surgery per se as I apparently do not have significant disc disease).
There is no doubt that I have improved from three months ago. There are days however when I feel I am back 2 to 3 months ago with significant pain. I have never had a day that is without symptoms.
My question(s): Is it reasonable to wait longer--is it likely I will have complete resolution of symptoms? Is this the kind of thing I just accept and live with daily pain? Am I destined to eventually have surgery at some point in my life given the onset at age 41? I you feel rehab/PT/Chiropractic is useful and would be a good thing to pursue, which (a physical therapist or chiropractor) in your experience would be better?
Finally, I would never want to do any intervention to exacerbate the problem or injur my neck. I have concerns about chiropractic "adjustments" that might worsen the problem. Exactly what kinds of intervention from a PT or chiropractor can help this problem?
My sincere appreciation for your advice.
Doctor's Answer
by CCF-Neuro-M.D.-RPS, Jun 03, 2001 12:00AM
Dear Andy:
I am sorry that your having neck pain. If you remember the NEJM article several months ago which showed that osteopathic manipulation and medications but not chiropractic manipulation was useful in back pain? The numbers were pretty good and if you believe the stats, osteopathic manipulation was actually better than the other modalities. We have seen PT/Rehab work fairly well. Some of the treatment is adjustments of lifestyle, carriage of the body, lifting techniques, sleeping techniques, etc. The problem with surgery in a foramen problem is that the healing process also includes an inflammatory component (the healing process itself) which can induce osteo changes in the area of the foramen and in itself induce foramen closure and nerve compression. It is not a good situation either way. We think that the surgical option is the last approach. But each case is unique. Multiple inputs are usually best, including multiple neurosurgeon inputs, neurologist input, and rehab input. Neurontin works well for neuropathic pain as you have found out. I hope that things work out. I am sorry that I am not giving you more formative answers.
Sincerely,
CCF Neuro MD
I am sorry that your having neck pain. If you remember the NEJM article several months ago which showed that osteopathic manipulation and medications but not chiropractic manipulation was useful in back pain? The numbers were pretty good and if you believe the stats, osteopathic manipulation was actually better than the other modalities. We have seen PT/Rehab work fairly well. Some of the treatment is adjustments of lifestyle, carriage of the body, lifting techniques, sleeping techniques, etc. The problem with surgery in a foramen problem is that the healing process also includes an inflammatory component (the healing process itself) which can induce osteo changes in the area of the foramen and in itself induce foramen closure and nerve compression. It is not a good situation either way. We think that the surgical option is the last approach. But each case is unique. Multiple inputs are usually best, including multiple neurosurgeon inputs, neurologist input, and rehab input. Neurontin works well for neuropathic pain as you have found out. I hope that things work out. I am sorry that I am not giving you more formative answers.
Sincerely,
CCF Neuro MD
I'm very interested in learning more specifics about what kind of PT, etc. you've considered. If you know of good references (esp. websites) that detail what works, what's a waste of time, and what's dangerous for cervical injuries, could you post them here? I've been told by my doc. I should get physical therapy (I posted my description a few days ago), but what it should be has been pretty vague.
Thanks,
nor
It is more likely than not that you will decrease the compressive aspects of your spondylosis with engaging in active strenghening of you extensor muscles of your neck.Simply put,It could be said that your body is laying down bone in order to compensate for weakness of neck muscles that maintain the anit-gravitational forces. This is best done with a computerized machine that shows you at what areas or range of motion you are weak. It is manufactured by Med-x and there are many locations across the country in hospitals and rehab centers if you look on their web site.
The doc
I am a chiropractor. Chiropractic is a conservative approach applied by a highly trained individual. The difference between a osteopathic manipulation and the chiropractic adjustment is the difference between the professionals applying them and not the editorial veiwpoint of a magazine. Get a refferal for the name of a competent Chiro, visit them and get a opinion. We are caring professionals as you are.
Good Luck
Physical therapy of any variety is unlikely to change the pathology. However, an experienced practitioner near you should teach you pain management techniques, evaluate your posture and working positions, look at the pattern of muscle tightness and/or weakness, evaluate the joint mobility. The goal is to alter the mechanical environment around the pathological joint thus reducing the neural irritation. A good practitioner should be able to assess how irritable the neural structures are and avoid exacerbating the pain I would suggest that simply launching into high thrust manipulations would be quite likely to aggravate your pain. A better approach can be through correcting the muscle dysfunction