Can cervical disc problems cause dizziness/lightheadedness?

[TexMich]

Hi Jacquie,

Really sorry about the severe attacks of vertigo you're experiencing. Not knowing the cause makes it even worse for you I'm sure. Have they found any medication that helps you during these? Without knowing the cause - it's most likely difficult to prescribe medication that's effective.

I was curious how they ruled out the cervical area of the spine as a source of many of your symptoms, including dizziness.

Are you seeing a neurologist, neuro-surgeon or orthopedic doc?

I'm not very familar with cervical back problems - but for lumbar problems- some posters here had MRI's which did not show torn or herniated discs- although they existed. A discogram - & other tests were necessary for some of these posters - to finally reveal the problem. It seems that those with Sacroiliac joint problems even had a tougher time determining their dx & had to be very interactive & persistent with docs to finally get to the source of their pain - must be difficult to dx or one of the last things some docs look for? http://www.healthboards.com/ubb/rolleyes.gif

The info below lists some of the symptoms of cervical issues - some of which you mention - & I've previously read that sweating, shaking, insomnia can also be cervical symptoms.

You probably have already done much research on Cervical spinal issues - but the following is info from Dr. Jho. I've seen his name on this board in the past - from one of the posters who was impressed with him - altho I'm not sure if he had any personal medical experience with him. We're not allowed to post web sites or email addresses on this board - they are very strict about that- but if you do a search from google - putting in "Cervical Dr. Jho" - the site I quoted the info below from may be of interest to you.
QUOTE:
TYPES OF CERVICAL DISC HERNIATION: Although the term "disc herniation or herniated nucleus pulposus (HNP)" has been commonly used for cervical disc disease, the displacement of the nucleus pulposus is not always the cause of cervical disc disease. Cervical disc herniation can be categorized into three different types: (1) a soft disc herniation that involves herniation of the nucleus pulposus through a tear at the annulus fibrosus, (2) a hard disc protrusion that is bone spur formation, or (3) a combination of both. When soft disc materials of the nucleus pulposus herniates out through a tear of the annulus fibrosus, it is called "soft disc herniation" because the herniated disc material is soft in its consistency. However, without a tear or defect at the annulus fibrosus, symptoms of cervical disc disease can still occur due to bone spurs (or overgrowth of bone spicules) developing over time at the edge of the vertebra which compresses the nerve root or spinal cord. This is called "hard disc herniation" because it is made of bony spurs. A combination of both conditions can occur as well.

CLINICAL SYMPTOMS: Symptoms can be categorized into three different groups. The first group of symptoms include neck pain, pain between wing bones, scapular pain, posterior head pain, difficulty in neck motion, and dizziness, especially when the neck is bent backward or turned to the side. These symptoms are thought to be produced by local compression of the ligaments and the surrounding anatomy. The second group of symptoms include pain along the shoulder, arm and hand, numbness in the hand and fingers, and weakness of the arm (radiculopathy). This second group of symptoms is produced by compression of the passing nerve root. The third group of symptoms includes numbness in the arms, torso and/or legs, difficulty in balance, gait disorder, clumsy spastic legs, and difficulty in bowel and bladder control (myelopathy). This third group of symptoms is caused by compression of the spinal cord.

TREATMENTS: Disc disease in the spine is one of the common problems that people experience. Treatments consist of conservative treatments and surgical treatments. Conservative treatments include physical therapy, chiropractic manipulation, nerve block, steroid treatment, pain medications, etc. When symptoms do not improve with conservative treatments, surgical treatments have to be considered. Current conventional surgical treatments fall into two different types: (1) anterior discectomy with bone fusion, and (2) posterior foraminotomy. Anterior discectomy and fusion will sacrifice the spinal motion at the herniated disc level. The posterior foraminotomy technique avoids bone fusion but often does not efficiently eliminate the herniated disc materials. In order to overcome drawbacks of the current conventional surgical treatments for cervical disc herniation, a new surgical treatment called “anterior cervical microforaminotomy (Jho procedure)” was developed by Dr. Jho. END QUOTE

There is also an interactive pain chart on the web- sorry I can't recall the web site- that shows which disc causes pain in which part of the body.

OK, concerning my back problem - it was sciatic pain (no back pain then) - constant aching/burning pain thru butt & calf pain. We tend to forget pain (altho we think at the time we never will) - but I recall mine was worse by the end of the day (after sitting at my desk for 8 hrs). MRI showed lft herniation of L5/S1 & bulging of L4/L5. My signature tells the 'rest of the story'! Years before the leg pain, I had slightly left sided internal pelvic/groin pain when sitting. That may have been IBS (colon's on the left) or early disc herniation pain. (I recall asking a doc yrs ago if that pain could be sciatica - & he said "NO. Usually sciatic pain is on the OTHER side") ???????? http://www.healthboards.com/ubb/dizzy.gif I hope he's learned since then that discs can herniate from more than one side. http://www.healthboards.com/ubb/idea.gif

As far as treatments for herniated discs - the general consensus is to try conservative methods first - before surgery as last resort. I've heard of some people being helped by Physical Therapy or the McKenzie method of exercises - positioning the disc material 'off' of the sciatic nerve I believe. Others
say the epidurals help- but some not til the 3rd one. Others say the epidurals were a waste of time/money/pain & didn't help. Others have tried nucleoplasty - still others - the endoscopic-micro-discectomy -which only requires a tiny entry point. Problem with that is there may be fragments or more extensive problems that cannot be seen thru such a minimal opening.

Microdiscectomy (a little more invasive than endoscopic microdiscectomy) is considered one of the less invasive/extensive surgeries - & has a high success rate. Certainly less invasive than fusion & ADR. Some people breeze thru the micro-d recovery time (as long as they follow post-op rules so as to not reherniate, etc.). Others have lesser recoveries - sometimes because they waited too long & suffered permanent neurological damage from the nerve being compressed too long. I believe I have scar tissue which is causing a few problems- but the constant leg & butt pain at least are gone. The groin pain when sitting & occasional zap of left/back side of calf pain appears occasionally - again- probably scar tissue related.

You probably already know this- but felt I should throw it in - 2nd & even 3rd opinions are important - both to help you feel secure in your course of action -& to ensure the best dx/care. Once a course of action has been chosen - of course - it's important to find the VERY best doc for the job. (just have one back!)

I know this was long - but I hope it helped with some of your questions. If there's something more specific you'd like answered- pls ask - I ck the boards less often these days (7 mos post op) - but I'll ck back in a few days.

Also, the Spinal Disorders board here is a good place to find more info on cervical issues if you haven't had a chance to ck over there - you may want to.

Best of luck - keep your spirits up - & please let me know if you're getting answers from your docs.

Laura

------------------
Mar 2003:Micro-Discectomy w/Hemilaminectomy L5-S1
Prior to that 4 mos of Sciatic pain; left side
Herniated Disc L5/S1
Bulging Disc L4/L5
08/20/03: At 5 mos post-op: Requested PT - (had to convince doc)Now completed 6 wks PT. Results: Back & abdominal strength MUCH better - to prevent future back injury. Stretching exercises help temporarily but next morning - incision area seems just as tight, same tugging feeling when leaning forward of pressure, restriction through-out post op. Concerned this is scar tissue adhering. Looking for appropriate Doctor to help me confirm this & appropriate treatment for it - if treatment's available. Continuing exercises @ home.



[This message has been edited by TexMich (edited 10-18-2003).]

[jvogle]

Hi Laura,

I really appreciate everything that you put in the posting!

I have not responded because I had the first epidural on Thursday. I did not react well to the medicine. I do not tolerate meds well. I had all sorts of problems including my blood pressure during the procedure. It went down to about 70/30. I have been so weak hardly could function without holding on to my husband. I am feeling just a little bit better but now it seems the pain may be coming back which is very discouraging.

Laura, I am supposedly going to one of the finest institutions for care in New York -- it is only second to the Mayo Clinic -- yet all these problems. 3 Doctors from there all with different diagnoses -- the first was inflammation of S/I joint -- injection did not help at all. Now annular tear of L5 disc and the last was a problem with the piriformis muscle. Unfortunately they all do have exactly the same pain symptoms. I briefly spoke to this doctor about discogram. When I go back to his office on Friday I will inquire more. I think that before I do anything else I more definitive diagnosis needs to be made especially since I am not responding well to the meds. And as you said I think I need to know absolutely sure what is going on before I proceed further. I am really upset and nervous. I am almost considering going out to the Mayo clinic but I am wondering if I will get the same -- no clear diagnosis. The only reason that I considered this last procedure was that a neurologist up where I live -- 60 miles north of NYC also said it was the L5 disc. The doctors who did the procedure was a physiatrist. I have seen 3 different neurologists -- and they are as divergent in diagnosis as the settings of a compass. And I have seen 2 physiatrists.
I have more MRIs xrays -- you name it I have had it. Some because of the dizziness, some the cervical problems and some the lower back issue.

Have you been able to work? With all that is going on I have not been able to. First I was self-employed but subcontracted so I have to be "fit as a fiddle" -- cannot work p/t or have other duties. I am having so much trouble with my disability carrier. My primary doctor felt I was getting better because the dizziness went away from awhile -- wrote that I was capable of p/t work and that is what they zoned in on -- not the 3 other doctors who said that I am currently disabled.

As most of us who have these awful problems we would rather be working -- at least I know I would -- I feel I have no life -- cannot do much of anything -- and I was so active. I'll let you know what happens after I return from the doctor. Have to go now because pain is really starting in again.

Jacquie

[TexMich]

Jacquie,

Wow, you've certainly been through a lot lately.

Looks like you've been doing all the things you can to get to the route of your problem(s) and still not finding your way out of the maze. Are you occassionally using ice (like laying back on a bag of frozen peas)(over your shirt for about 15 min at a time) on disc areas you feel are inflammed? Are you on Vioxx or an anti-inflammatory? Just brainstorming here- but throwing a few things out in case they may be of help ~

Again- I don't know if this is medically factual - but I've read (I believe on the Spinal Cord Disorders board of this board) - that with Cervical disc leaks - some leakage can get into the spinal canal & cause dizziness.

A few questions if you could answer:
What specific test did they do to rule out your cervical problems as a source of your dizziness?

Did an MRI reveal annular disc tear in the lumbar or did that 2nd neuro just assume? How did he determine it was the L5 - and not S1, or Sacroillioc disorder? (You may want to do a search on SI on this board- some SI'ers had SI manipulation & found relief - not much fun to have done - but helped some)

How did your problems start? Did they ever dx scoliosis or DDD?

On your disability case problems (sorry!) - do you have a case worker or lawyer who's working JUST for YOU on this? You may get some tips on disability info by doing a search on this board on 'disability'. OR - start a new thread with that in the 'subject matter'. Just brainstorming again - but - I don't know if it's best to discuss with your primary doc about your disability carrier problem & the other doc's disability dx - or not go into detail with him about that- but regardless-perhaps at least schedule a new visit w/Prim Doc for your situation on dizziness & have him write a new letter showing current dizziness dx & write a letter for your case worker showing 'recurring dizziness &/or unpredictable ongoing likely return of symptoms' (or whatever he feels appropriate) - then turn into your case worker with the other 3 docs letters who stated you're currently disabled?
Also- will the disability insurance (or your own insur) help pay for out of state medical care?

After all you've been thru to this point with testing, etc. - if it were me - I'd be very tempted to go to the best now. Mayo? That way you'd know you gave it your very best shot ~ not much more any of us can do than that? And you deserve that. They have a web site- & that may be a good place to start- to determine who to first talk to there - or contact by email via website - or however you prefer. Hopefully that person wld then be given a brief & consise history from you - as to 3 different neuro dx's, your symptoms, & the fact you physically AND emotionally need to get to the exact SOURCE(s) (may be a combination of probs) & then HELP for your constant discomfort & lack of quality of life. Somehow we have to make all people who can potentially be the 'door keeper' to the door of relief - feel enough empathy to really HELP - w/o us being mistaken for self pitying & over dramatic. I don't know how anyone cld mistake what you've endured tho, as an over dramatic reaction -but so many docs in these times just pat us on the back & go on to the next waiting patient- if it appears we are coping - but also if it appears we're overreacting (delicate balance I guess) Some seem to need to feel empathy with our pain as a motiviation to help. (My experience anyway - & some don't HAVE an empathy gene evidentally!) Back to Mayo- also explaining that you'll be traveling out of state & so will need much coordination for your planned visit. With a pleasant repretoir with this person - hopefully then, this person wld be able to best direct you in (a)which doctor to see - based on his experience & hopefully empathetic qualities. *or* (b) WHO to write there to coordinate this. It wld be ideal (since you'd be traveling out of state) - to be admitted (esp. since you evidentally need your BP montitored during any additional tests) - & stay a few days. Also ideally, prior to your hospital stay, the appropriate personnell would have ALREADY viewed your MRI's & other pertinent tests - along with your brief/concise letter/summary in outline form perhaps - showing your medical/pain/doc visits/tests/dx's by the 3 neuro's/prognosis history AND a few stmts on how this if effecting your quality of life & that you need help and direction as to what to do now. That you can't continue spending time, pain, money & possibility of wrong course of action on your body -unless you know it's on the correct dx & prognosis (espec. in light of the fact you've just gotten 3 conflicting ones)- and THAT'S why you're going to them - the best.

Lastly, if I may ask, are you on an anti-depressant?
a) Chronic long lasting pain is KNOWN to cause depression. There are so many anti-depressants nowdays that can really help lift one's spirits. If you're not on them - you may want to speak to your Pri care doc or gyn or whichever doc you feel most confident with (expertise-wise) about which one they'd suggest for you.
b) Emotional pain: worry, pain & stress is KNOWN to make your physical pain worse. A vicious cycle occurs -pain, then worry & stress - then more pain etc etc etc. I hope you are pampering yourself with whatever lifts your spirits thru this tough time. Sounds like your husband is supportive & empathetic - which is a great help. Sometimes it's hard for our spouse's to understand if they haven't felt the pain. Comedies, happy old movies, favorite music, reading, watching nature - anything that brings peace of mind. Yes- you'd like to feel more productive and work - but we have to know our CURRENT limits - but do everything we can to get back our lives - which is obviously what you've been trying to do - http://www.healthboards.com/ubb/t_up.gif Even if our future doesn't hold running marathons- there is a more pain free - & happier life ahead - and then we can make our adjustments & find the high road. We CAN deal with whatever hand we're dealt - IF we know we've done all we can to improve that hand. It's so much easier, as you know, to appreciate even the smallest things of beauty & worth in life- when you aren't distracted with constant pain. So, you deserve this time to get better - and not feel badly about things you have NO control over.

Jacquie, best of luck to you - hang on sweetie!

Laura

------------------
Mar 2003:Micro-Discectomy w/Hemilaminectomy L5-S1
Prior to that 4 mos of Sciatic pain; left side
Herniated Disc L5/S1
Bulging Disc L4/L5
08/20/03: At 5 mos post-op: Requested PT - (had to convince doc)Now completed 6 wks PT. Results: Back & abdominal strength MUCH better - to prevent future back injury. Stretching exercises help temporarily but next morning - incision area seems just as tight, same tugging feeling when leaning forward of pressure, restriction through-out post op. Concerned this is scar tissue adhering. Looking for appropriate Doctor to help me confirm this & appropriate treatment for it - if treatment's available. Continuing exercises @ home.

[This message has been edited by TexMich (edited 10-22-2003).]

[jvogle]

Hi Laura,

I hope I will answer all the questions you posed and comment on your suggestions etc.

I have more MRIs than you can imagine and bloodwork also and catscans, xrays you name it! It was based on the same set of MRIs that one said DDD, another S/I inflammation, one piriformis muscle syndrome and 2 were leaning towards L5. The DDD was on the L5, the annular tear also -- not sure what the one neurologist
felt. I was too sick with the dizziness to really care. I first did the S/I because I had not gone to anyone else. When It didn't work that is when I started to go around -- since more drs seem to point to the L5 I went with it. My pain in that area seems to have diminished but it could be also I am not moving around alot due to the dizziness -- it is just so awful. I just feel wiped out all of the time. I have a low grade temp -- not sure why. The dr. is ordering more bloodwork to see if I picked up something.

I would not be surprised if I am a little depressed not being able to do anything. Also as you so rightly indicated there is so much anxiety. I am a person who wants to know what is wrong and then get it fixed. I owned my own business and had a great life and now relegated to staying in the house months on end except for drs. I am just too sick to do anything.

About meds like anti-depressants. I do not have a high tolerance for meds. I think the steriod -- they used Kenalog is giving me problems. But because of all the problems prior to the injection -- not sure if it is that or something else. So I am trying not to take any more meds -- they will possibly do more harm then help. I just try to believe there is a light at the end of this tunnel.

I know that there probably is more testing that can be done but I am also allergic to iodine dye and the way I am feeling I do not think I can go through any more tests. I am supposed to have a 5 hour glucose tolerance test and I cannot even do it -- just too weak to sit there.

Tomorrow I go back to the doctor in the city -- that is an all day affair -- my husband has to take off from work to drive me. Thank god he gets 5 weeks vacation.

Just to add to the stress his company is changing insurance carriers dropping UnitedHealth Care and Blue Cross and going to Aetna. And neither my doctor or Hospital for Special Surgery is participating -- now that is very stressful.

I called Mayo -- 2 year waiting list for a physical. You have to have a diagnosis otherwise. Since noone can agree with what is going on I would have to wait two years!!! They say people go and stay in hotels waiting for cancellations!!! Imagine that!. I think NY has some pretty good doctors and hospitals so I will try and deal with it here. The only huge problem is that not many doctors in this area are with Aetna. You have to have a fortune just to cover medical. Between the hospital and doctor for the caudal injection it is over $3,500 -- that is expensive and currently it was covered with my insurance.

And my husband's company doesn't have their act together about medical and open enrollment. My husband use to work for Con Ed they had to sell their plant and it was bought by Entergy. They do not have a clue about how to roll out a new medical benefits plan. I know what I had and one cannot make an informed decision as to which PPO plan to select because they cannot tell you the differences and we only have another week to make a decision. As you said I am sure none of this is helping me one bit.

the disability carrier sort of backed down. I am trying to work with them. How can anyone know when I can work when there is not a clear diagnosis.

Anyway I am starting to feel very tired so I will end now. But thanks for all of your suggestions and when I feel a little stronger I will do the search you suggested.

Jacquie