The new op to treat tingling fingers and numb toes | Daily Mail Online
As we age, the space around the spinal cord in the neck often narrows, causing pain, numbness or tingling. Daniela Thirlby-Smith, 42, an English teacher from Harrogate, North Yorkshire, had surgery for the condition in June 2012
Daniela Thirlby-Smith was diagnosed with cervical spondylotic myelopathy - where the bones and ligaments in the spine thicken, compressing the spinal cord
Just before Christmas 2011 I started to feel a strange sensation on my neck, as if cold water was trickling down the back of it.
It happened a couple of times a week, and my neck was constantly stiff. Then I started stumbling — I couldn’t feel my feet or the bottom half of my legs, so I needed to use a stick. I thought it was a flare-up of the juvenile arthritis I’ve had since I was four. Things came to a head when I couldn’t feel the accelerator in my car. It was terrifying, but I managed to drive to A&E.
They admitted me overnight and sent me for X-rays. A neurologist thought it might be multiple sclerosis, which affects nerves in the brain and spinal cord.
Thankfully it wasn’t, but I was told I’d need further tests. Over the next five months, while I had various other scans ahead of an MRI on my neck, things got worse — I couldn’t feel my hands or feet at all, so couldn’t cook, drive or even apply make-up. I’d stay in bed most of the time, totally dependent on my husband Steve.
After the MRI scan I was referred to neurosurgeon Deb Pal at Leeds General Infirmary. In May 2012, he diagnosed cervical spondylotic myelopathy — where the bones and ligaments in the spine thicken, compressing the spinal cord, the bundle of nerves that carry messages and sensations between brain and body.
Apparently it’s more common in older people, but my juvenile arthritis had accelerated the process.
Mr Pal said he could operate to remove thickened areas of bone and ligament. Usually, this means cutting through layers of muscle at the back of the neck.
But said he’d use a new method, avoiding the muscle so I’d have a faster recovery — although he did warn that the nerve damage already done meant that even with surgery there was only a 50-50 chance of sensation returning.
This terrified me, as did the thought of an operation. But by then I’d had to give up work. So I decided to have the operation.
Amazingly, it took only 40 minutes under a general anaesthetic in June 2012. When I woke up, Mr Pal examined my feet, prodding them with a sharp instrument — I could feel it!
And when Steve held my hand, I could feel its softness for the first time in months. It was overwhelming.
Because I'd lost so much muscle in my legs from lack of use, I was still wobbly and needed to have physiotherapy to regain my strength. But sensation had come back, so I could do everyday things again.
Now I'm back driving myself to work and living a normal life, able to feel my hands and feet. It's fantastic.
Deb Pal is consultant neurosurgeon at Leeds General Infirmary and Spire Leeds Hospital.
Around two thirds of us experience neck pain and stiffness at some point, and in older people this is often caused by arthritis of the upper spine.
Around two thirds of us experience neck pain and stiffness - and in older people this is often caused by arthritis of the upper spine
Cervical spondylotic myelopathy affects 75 per cent of over 50s to some degree, and half of these patients will have symptoms including neck pain and tingling in the fingers and problems with walking and balance.
In this condition, the spinal canal — the space in the centre of the spine's vertebrae — becomes narrowed in the neck, compressing the spinal cord, the bundle of nerves running from the brain to the lower spine that relay messages to the body.
In people under 60, this tends to happen when the cushioning discs between the vertebrae in the neck start to bulge, often referred to as a 'slipped disc'.
In older people, it is commonly caused by bones and joints degenerating with age, and ligaments — which bind bones to other bones — becoming thicker due to wear and tear. In some patients, the spinal cord is compressed by both things.
Cervical spondylotic myelopathy can result in weakness of the hands and loss of dexterity. It also results in difficulty walking and unsteadiness on the feet when pressure on the spinal cord occurs on the nerves affecting these parts of the body.
In around a quarter of the patients I see this progresses quickly, so within two to three months they've become disabled, even wheelchair bound.
Daniela is now able to drive herself to work and live a normal life after the operation
And if the nerve is pinched for too long, it can be permanently damaged, so people should see their GP for an urgent MRI scan if they have trouble with balance, dexterity or walking.
Once spinal compression is diagnosed, there are a number of surgical options. If bulging discs are causing the problem, we operate through the front of the neck to remove the disc.
If the damage is due to thickened ligaments, we operate from the back. The spine is made up of vertebrae stacked on top of each other like coins, surrounded at the back by thick layers of muscle. Usually, surgeons would have to strip these layers to access the bone to reach the ligament, which takes around 75 minutes and causes bleeding.
For elderly patients, this can mean a long recovery with neck pain. There is also a risk of weakening the neck, as the muscles may not heal properly. But thanks to a newer operation — cervical split laminectomy — we can leave muscle intact. Instead of cutting into it, we go through the spinous process — the spike on the back of each vertebra — as this is not covered in muscle.
This minimally invasive operation is quicker with less risk of weakening the neck, and less neck pain.
The operation carries risks including bleeding and infection, and a small risk — less than one in 300 — of temporary or permanent paralysis if the spinal cord is damaged. But without the operation, patients worsen anyway.
The operation takes around 40 minutes under general anaesthetic.
First, I take X-rays to check where the problem is, make an incision at the back of the neck, and use a very fine drill — a tool that has only been used for this surgery in recent years — to cut through the spinous process to reach the ligament. Using fine pliers, I carefully remove horizontal layers of thickened ligament until the spinal cord is no longer compressed.
I then close the incision in the tissue and skin above the bone with dissolvable stitches. This is a very simple operation which could help thousands of older people.
'All operations carry risks, including those from general anaesthetic,' says Adrian Casey, a consultant neurosurgeon at the National Hospital for Neurology and Neurosurgery in London.
'Any spinal operation also carries risks of nerve damage or damage to the spinal cord, which can result in paralysis in under 1 per cent of patients.
'The key is to refer patients quickly — if someone is already in a wheelchair there may already be damage to the spinal cord and the chance of a full recovery is reduced. In skilled hands this is a very effective operation.'
The operation costs around £7,000 privately and £5,500 to the NHS.