Q: I always enjoy reading your column and am now writing for advice. For over six months I have been experiencing a recurring numbness and tingling in my fingers, toes, and just to the left of my spine under my shoulder blade that comes and goes throughout the day. For years I have had recurring headaches and stiffness at the base of my skull which I attributed to migraines.
My reflex sometimes seem stiff or exaggerated when I am typing or clapping. My right foot also seems stiff and swollen and makes a popping noise when I walk. Twice recently I had my left knee “lock” when trying to stand after sitting. I occasionally get blurred vision, auras and a tingling scalp which I have also attributed to the migraines.
I also sometimes feel woozy or clumsy when trying to walk. I have had a bunch of tests which showed I was low in vitamins B12 and D. We got the levels back to normal but the new symptoms continue.
I have also seen a neurologist who ordered MRIs of my brain and spine. The images of my brain were unremarkable but the MRI of my cervical spine showed “osteophyte formation at multiple levels and moderate foraminal stenosis, most notably on the right side at C5-6 level. My neurologist is unconcerned with the results, saying that the C6 nerve would only affect my fingers and that we should do nothing but wait six months to see if the symptoms go away on their own or get worse. She states the only other option would be to have a lumbar puncture to test for MS. I am concerned that the tingling signifies a problem with my CNS or spinal cord that might get worse if not treated.
Should I be concerned about the bone spurs and foraminal stenosis? I am a 33-year-old woman and except for the migraines and these new symptoms, I have always been in excellent health. Thank you in advance for any advice you can offer.
A: Osteophytes (bone spurs) may be an indication that a person has degeneration of the spine. They are not an uncommon finding in CT scans and MRIs. Spurs themselves don’t necessarily imply they are the precise cause of a person’s back pain. You may have been born with a small spinal canal. Other possibilities include Paget’s disease, calcium deposits on the ligaments that run along the spine, an excess of fluoride in the body, or a tumor. Foraminal stenosis refers to a narrowing of the cervical disc space caused by impingement of bony structures into the spinal canal. In the majority of cases, spinal stenosis causes symptoms to be worse on one side of the body over the other. Symptoms may include weakness, tingling, a burning sensation, and a pins and needles sensation in the arms and legs. As you have discovered, foraminal stenosis is diagnosed by an MRI or CT scan with myelogram.
Because pain medication often fails to provide sufficient relief and traction is of minimal benefit, many patients choose a modification of their activities or lastly, back surgery.
My recommendation is that you have a frank discussion with your neurologist. Determine if exercise, physical therapy, or even a brace for your back will help reduce your symptoms. Discuss whether acupuncture or chiropractic manipulation might be appropriate. While the latter two may not be recognized standards of care, they may be worth a trial. And, as you might have guessed, I’m beating around the bush to suggest you exhaust all options that include waiting the six months before opting for a surgical procedure. Testing for MS is reasonable and consideration might even be given to testing for Lyme disease that can present in unusual ways.
Additional information can be obtained by contacting the National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse at either http://www.niams.nih.gov or via email at NIAMSinfo@mail.nih.gov.
