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We answer all types of Neurology/Neurological questions about the brain, spinal cord, and peripheral nerves. Include your age, sex, current meds, and known diagnoses, upcoming/completed appointments, tests, or procedures. We are not physicians. We help explain medical terminology and give support.
Cervical Stenosis
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malyme posted:
A couple weeks ago I had a diskectomy and fusion at C4 to C7. The operation appears to have been successful (PTL!), but I have a couple questions about it.

The first is that some of my worst symptoms were in my head. I was having numbness of the face, and even once of my scalp as well, occasional poor control over my jaw when speaking, as well as headaches.

Now I understand that C4 is too low in the cervical column to affect nerves that would go to the face, so I assume that these symptoms must have been because of the stenosis of the spinal cord itself. I was also having lower body symptoms, but it's the head symptoms that I haven't found much information about.

It seems logical to me that if there's some disruption in the spinal cord it would affect information going up and down the cord. Is it common or possible to have head and facial symptoms as I did from the cervical stenosis? After the surgery there was a marked improvement right away.

Also, if it is possible to get these kinds of head symptoms from a cervical stenosis that I seemed to have, how bad could it get? I mean, I understand that from the neck down one could become paralyzed, but what about from the neck up?

Anyway, I'm glad that horrid ordeal is over with, although I still get some symptoms when I'm up and about for a while, but it's just been a couple weeks since the surgery, so I'm expecting that eventually I should be back to normal again. Nevertheless, I'd sort of like to know more about the head symptoms. Thanks for any help anyone might have to offer.
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susiemargaret responded:
hello, M --

i'm sorry i didn't see your post until now; i hope you are still following this thread.

the C1 and C2 vertebrae control the head and neck; C4 controls upper-body muscles. however, i am not a medical person, and so beyond that, i am afraid that i am not knowledgeable enough about the spine to answer your Qs.

there are two other people who sometimes answer Qs in this community, and i hope they will see this post. you might also get more info from the good people in the back pain community, http://exchanges.webmd.com/back-pain-exchange .

-- susie margaret
what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
 
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Lifes replied to susiemargaret's response:
A "high" injury at C1-C2 can cause high tetraplegia, like Christopher Reeves had. Above C1 is the brainstem-- the area that controls our impulse to breathe.

I don't have much expertise in spinal cord injury (well, except my own lol); I never worked exclusively in spine rehab. That said, however, although physicians / surgeons and nurses know anatomy, there's still a lot of guesswork about the spinal cord. For example, although even laypersons know that head trauma is "bad", physicians and surgeons still can't positively predict the outcomes for all head trauma patients. The brain, spinal nerves, and peripheral nerves don't cause the same symptoms in every person when these nerves are injured and none "heal" predictably.

However, it's logical that a "marked improvement" points to your pre-surgery condition as being a cause (even a partial cause) of your prior symptoms.

Each level of the spine innervates a particular set of dermatomes which is a patch of skin (which contain nerve endings). Dermatomes are, obviously, all over our bodies. The basic cord level to dermatome distribution has been mapped out, roughly (it's not perfectly exact). Although pictures show "lines" around shapes (for example, an area the shape of a half circle), these lined shapes may have some overlap into adjoining dermatomes.

Here is a diagram (halfway down the page) showing which spinal levels innervate which dematomes.
http://www.sci-info-pages.com/levels.html
The occipatal area (occiput) is the back of the head.
This image makes it a little easier to read the spinal numbering (C1, C2, and so on):
http://www.merckmanuals.com/media/professional/figures/MMPE_16NEU_206_01_eps.gif


Depending on where you felt the numbness in your head, it could correspond to a specific dermatome and therefore to a specific cervical level.

You might want to ask your doctor to explain your pre-op MRI. Ask specifically for him to point out where the most narrowing had been, how far it had extended, and ask him to point / name the cervical levels involved. You might also get a copy of your surgeon's post-op notes/summary to see what all was done. If you don't understand something, you can ask here.


I'm glad you are feeling better after the surgery. Give yourself time to heal properly and then see what's better or what is so-so.

Lifes
 
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malyme responded:
I'm replying here to Susie Margaret and Lifes.

I eventually figured it out - it was a matter of wording my Google search so the right information came up. Here's what I found out:

From C1 to C4 there's a sort of ladder-shapped web of nerves that come out from these vertebrae and return to the head. They seem to be on both sides (left and right) of the spine. This formation of nerves is called the "cervical plexus." You can do a Google search of this term and find out more about it.

The other scary thing I came upon though is that at C4 a nerve, the phrenic nerve, that goes down to the body controls the diaphragm. There's a saying about this nerve that goes: "Cut 4, breathe nor more." In other words the person would die because of not being able to breathe. Yikes! I think my stenosis might have affected this nerve a bit, although I hadn't made the connection until I read about this phrenic nerve, but starting last summer I often felt sort of short of breath, although my blood-oxygen readings were often normal.

Man, that stenosis (now removed via surgery) seemed to have affected my whole body. I'm sure glad that hell is over with, but I know that fusions put strain on the rest of the spine that have to take over for flexibility, so I may well have future spinal problems too. But I don't think there was much choice that it had to be done. It would have been a lot easier to have had it done even just a couple months earlier though.
 
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RedBear2005 responded:
I'm a tad late to your party, but perhaps I can assist Susie Margaret in helping you.

Sensation and motor control in the face are controlled by the Trigeminal nerve system. This are the two 5th cranial nerves, and they branch out of the brain stem just below the skull. Although the Trigeminal nerve can be affected indirectly by cervical stenosis, I think most neurologists would look for somewhat different factors -- even if only to eliminate them. Facial numbness is sometimes an indicator that the trigeminal nerve or the facial nerve (which branches out just millimeters away) have become compressed by blood vessels.

Of you have had a marked improvement in your head and face symptoms following the spinal fusion, then my personal advice would be to let the whole spinal system stabilize for six months, before coming to any conclusions concerning the longer term. After that, if you continue to have numbness or pain in your face, then consult with a neurologist and get a full skull MRI done, in a 1-mm thin-slice procedure, performed both with and without contrast agent.

To protect you from harm, be advised that like Susie, I am not a medical doctor. I have been studying the medical literature of face pain for over 15 years as a technically trained layman and patient advocate for chronic neuropathic pain patients. It would be wise for you to validate any input you receive from me, with a consult to a qualified and licensed medical doctor.

You may follow up through my website at http://www.lawhern.org.

Go in Peace and Power
R.A. "Red" Lawhern, Ph.D.
Master Information Miner
 
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malyme replied to RedBear2005's response:
Thank you - that's helpful information. I haven't had facial pain, but numbness (including at least once my whole head), sometimes brief lack of control of jaw (especially when talking), tingling, and other symptoms that are difficult to explain - may have affected me cognitively somehow.

I'm about 3 weeks out now after my surgery and I think the bone is healing well, but I still have other limitations. Last Saturday I did too much and Sunday the facial symptoms started returning, so I spent much of Sunday laying down again - rather a set back for me, but also a confirmation that I really need to sort of lay low and give my body time to heal.

I agree that the whole nervous system needs to heal - that's just my sense about it. I have reason to believe that not only my head, legs and arms were affected, but also my g.i. tract and possibly breathing too. So after Saturday I'm really going to take it easy and listen to my body about what's needed.

Fortunately I'm on SSDI, so I have some form of income (such as it is), but I really do hope I can work again, at least part-time (I'm 50). But health comes first, so I won't push it.

The other complication, though, is that I have fibromyalgia, which benefits greatly by exercise, which I feel is not so helpful (or only in careful moderation) for the neurological healing. So it'll be a challenge trying to balance these two seemingly opposing issues until things settle down neurologically.

Thanks again for your helpful comments. Anatomy hasn't really been a major area of study for me before, and I'm just learning about things that might be relevant for me, so I appreciate your input. And, of course, I'm listening to doctors, as well as my body, but through all this I've also had to disregard some doctors and favor what my body is saying, which so far as served me well. Hopefully my new doctor-recruits will be more on target. (Two of my key doctors were unavailable through most of this ordeal, my neurologist said it was all psychological, and now I can't go to many of my doctors because they only take 1 medicare advantage plan and it's a local HMO. I'm reticent to switch to an HMO after my recent ordeal.)

I did have an MRI recently to rule anything going on there (it wasn't with contrast, though). It was done at a major university, and I think their MRIs are of good quality. But certainly if my symptoms persist we may need to do more testing/imaging.

Thanks again for your helpful advice - it's better advice than some doctors give, believe me!

Margo


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