Spine surgery can help with shoulder pain

Q I am a 53-year-old woman and I have had pain and a feeling of tightness in my neck and my shoulder all the way down to my right arm and fingers since last November.

Now, the pain has become worse.

My whole right arm feels numb all the way down to my finger tips, especially my thumb, index and middle fingers. It feels like there is an electric current running through my whole hand.

By the way, I am left-handed.

When the numbness comes, my right arm will become weak. This numbness comes many times a day and it lasts for one to two minutes before going off. After five minutes, it comes back.

I was told to go for spine surgery.

What are the possible side effects from surgery? Is this spine surgery common in Singapore?

Is there a chance that the pain will remain after the surgery or is there a chance that it will affect other areas of the spine?

What if I leave it and bear with all the pain and numbness? What will happen as time goes by?

Will I become paralysed one day if I leave it untreated?

Is there any support group that I can contact to share my issue with?

Can keyhole surgery be done on the cervical spine? I have much doubt and many queries about my condition.

The doctor I saw did not say much, other than advise me to go for surgery.

A The most likely diagnosis for your symptoms is a condition called cervical radiculopathy.

A simple physical examination, neck X-rays and magnetic resonance imaging (MRI) of the neck should be able to pin down the diagnosis.

Occasionally, a nerve conduction study is needed to exclude other possibilities such as carpal tunnel syndrome.

The spinal cord is an extension of the brain that gives out a pair of nerves at every level as it passes the neck and the trunk.

There are eight pairs of nerves given off at the neck region, which is made up of seven small blocks of bone called cervical vertebrae.

The adjoining vertebrae are separated by a disc, which is a jelly-like material, in the front and two small joints, called facet joints, behind.

This tripod-like structure allows movement, particularly looking down and up.

It also props up space to allow the nerves to exit.

The last four pairs of these nerves at the neck exit to travel to the arms, forearms and hands.

Wear and tear of the tripod structure from poor neck posture in our daily activities result in the narrowing of the exits, thus compressing the nerves.

In most instances, the narrowing is mild to moderate and results in symptoms of pins and needles or shooting pain that runs down from the arms to forearms and fingers.

They are often self-limiting and resolve spontaneously. Most of these cases can be treated conservatively.

In about 1 in 10 patients, the narrowing is so severe that it compresses the nerves persistently and results in frequent symptoms which are disabling.

The patient may feel weakness as well, which is a sign of severe numbness or a result of permanent nerve damage.

In some instances, the wear and tear may also directly compress on the spinal cord, in addition to the exiting nerves, and result in clumsiness of the hands, becoming unable to use chopsticks or spoons, an unsteady gait, and urinary frequency or incontinence.

The symptoms involve both the upper and lower extremities.

This is called cervical myeloradiculopathy.

RISK OF PARALYSIS

Without surgical treatment, patients may become paralysed over time.

For patients with severe cervical radiculopathy, a frequent numbness or weakness on examination of the upper extremities may suggest that the nerve fibres to the particular area are being damaged. This damage may become irreversible.

As mentioned previously, cervical radiculopathy does not involve the spinal cord.

Patients with this condition will not become paralysed.

Without surgery, the patient may have weakness and numbness in the upper extremity concerned permanently.

Similarly with delayed surgery, the recovery of the numbness and weakness becomes less predictable.

This may have implications for people in certain jobs that require high precision in hand movements, for example, musicians, typists and seamstresses.

The aim of the surgery is to decompress the severely pinched nerve.

This type of surgery is frequently performed in spine centres in Singapore. It can be done either from the front or behind the neck.

The incision is often small (can be considered keyhole surgery) and requires the use of a microscope.

Most surgeons access the neck from the front to remove the damaged disc material and prop up the disc height again with either a plastic cage or ball-bearing.

Others access the neck from behind to decompress the facet joint that is pinching on the nerve.

The type of surgery is determined by the site of the problem (disc or facet joints), the expectation and surgeon's expertise.

You should consult your spine surgeon for an individualised treatment plan and information on a patient support group.

With prompt treatment, a good outcome with pain resolution is expected in most patients.

DR LAU LEOK LIM, consultant at the division of spine surgery at the National University Hospital


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