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Suggest Treatment For Symptoms Of Myelopathy

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Posted on Mon, 12 May 2014
Question: Hi Doctor, it has been a few weeks since we chatted; I hope this communication finds you happy and well. I wanted to provide you with an update of my situation and then ask a follow-up question. First the update, the pain in my neck, in relation to the pain I had 2 months ago is virtually gone. The pain in my deltoid is only intermittent and when I do have it, it is greatly reduced. There is no comparison between the pain I was having before and now. I have continued to swim and that, plus my neck exercises and getting reasonable sleep helps. I still have no motor function symptoms of myelopathy. My pain/rehabilitation MD., does believe I have slight symptoms of myelopathy such as a slightly positive Hoffman's, strength of a 4 in some areas and very slight hyper reflexes. I honestly wonder if I may have had all that for years? Whatever the case, there are still no issues with my hands, or leg/foot movement at all. In fact, I am very quick and agile for my age. During my last visit to my pain/rehabilitation physician I asked him if it was possible to establish a baseline of neurological function that we could then compare to in the future and he then scheduled an EMG exam that we will do in a week, or so. He also said the Neurosurgeon suggested a follow-up MRI in 4 months. My only concern is that recently, even with the pain going almost completely away, I am having tingling sensations in my muscles, calves, feet and hands in the last couple of days. I swam 2 miles three days in a row after taking a few days off, so I do not know if these sensations are just normal muscular reactions to fairly intense exercise, or something more. Up until two months ago, I would not have given it a second thought, I would have concluded they were normal muscle pains after a workout, now I find myself questioning various sensations I have as possible symptoms of cord compression. I told a friend of mine today, "until I have some small sign of impaired function I am just not going to dwell on this" and he agreed saying "if I sit still for 20 minutes I have tingling etc." My question is how do I know the difference between a sensation I should be concerned about and one I should disregard? Secondly, since we know I do have cord compression with an abnormal signal are there any other tests you would recommend to try and really pin point the effect this compression may, or may not be having? Thirdly, I am considering a second opinion from physicians ether at the Mayo clinic, or the Cleveland clinic. Would you recommend one of these facilities over the other and how could I insure I am getting the best physicians at ether of these institutions if I do proceed. Finally, I have not seen a Neurologist only a Neurosurgeon and my pain/rehabilitation spine center physician. Should I see a Neurologist to evaluate my numerological function?
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Answered by Dr. Vinay Bhardwaj (6 hours later)
Brief Answer: There is no perfect sign or measure, Any Clinic Detailed Answer: Hi there! Thanks for coming back. I wish I could tell you that there is one sign or symptom that you could look for which would mark the onset of true myelopathy. You are probably right about it already being present with the changes in reflexes. So now that you know you have it. its all about how the progressive deterioration affects you. ou know your reflexes will get more and more jerky and over time you will have difficulty doing fine motor tasks like typing on a keyboard or threading a needle. When these things start to bother you then THAT's when you have got to go to a Neurosurgeon. In the mean time, don't sweat the small stuff, tingles and phantom sensations will be the result of that irritation of the spinal cord and there's nothing you can do about it without surgery. The whole idea is to wait until the point that those sensations and the disability starts bothering you. All in all, its a gut call. You have to decide when the issue is causing you too much hardship. Mayo vs Cleveland? You'll get world class care in both places and the decision should be based on which is easier for you to get to for multiple follow-ups in the future in case you ever get surgery. So ease of travel is the only aspect I would use to separate these two institutes. I hope this helps. Feel Free to follow-up Vin
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Vinay Bhardwaj

Neurologist, Surgical

Practicing since :2006

Answered : 544 Questions

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Suggest Treatment For Symptoms Of Myelopathy

Brief Answer: There is no perfect sign or measure, Any Clinic Detailed Answer: Hi there! Thanks for coming back. I wish I could tell you that there is one sign or symptom that you could look for which would mark the onset of true myelopathy. You are probably right about it already being present with the changes in reflexes. So now that you know you have it. its all about how the progressive deterioration affects you. ou know your reflexes will get more and more jerky and over time you will have difficulty doing fine motor tasks like typing on a keyboard or threading a needle. When these things start to bother you then THAT's when you have got to go to a Neurosurgeon. In the mean time, don't sweat the small stuff, tingles and phantom sensations will be the result of that irritation of the spinal cord and there's nothing you can do about it without surgery. The whole idea is to wait until the point that those sensations and the disability starts bothering you. All in all, its a gut call. You have to decide when the issue is causing you too much hardship. Mayo vs Cleveland? You'll get world class care in both places and the decision should be based on which is easier for you to get to for multiple follow-ups in the future in case you ever get surgery. So ease of travel is the only aspect I would use to separate these two institutes. I hope this helps. Feel Free to follow-up Vin