Dear Dr. Roach: I had spinal stenosis surgery eight years ago, with great success. Two years ago, I had an MRI because I was having terrible pain again, and could have had more surgery, but the surgeon and I decided that I should carry on with medication instead because of my age. I am now 85 and in pretty good health, and I would like to know why I am experiencing burning in my leg. I know that numbness is common with this disease, but I can hardly stand this burning. Can you help me?
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D.C.
Spinal stenosis is caused by the hard structures of the back pressing on the spinal column or its nerve roots as they exit the spinal canal. Surgery usually creates more space for the nerve; however, the results of the surgery often aren鈥檛 permanent.
The process, usually arthritis, continues and gradually worsens, either in the same area as the surgery or in a new one.
The symptoms of spinal stenosis are numbness, pain and weakness.
The numbness is because the information from the nerves (for example, the nerves that go to the feet) is unable to reach the brain. Pain is caused by direct damage to the nerves, and weakness 鈥� usually the last symptom 鈥� occurs when the nerve is pressed so badly that the signals from the brain can鈥檛 reach the muscle.
Numbness can be just in one small area, or over a whole region of the body, called a dermatome.
The quality of the pain can be pins-and-needles, aching or burning. Burning is very common. Weakness is the most concerning of all, as it indicates the risk of permanent loss of muscle strength. Progressive weakness is a surgical emergency.
Treatment for pain can involve medications, especially the pain medications that are used as antidepressants (such as amitriptyline) and those that are antiepileptic (such as gabapentin).
Progressive pain that is unresponsive to medication is another reason to see the surgeon again, but unfortunately, it becomes progressively more difficult to operate and is sometimes impossible. 聽
Dear Dr. Roach: I had a stroke about three weeks ago. One night afterward, I heard a deep baritone voice and music, like church and Christmas songs. I hear it every night now. I can鈥檛 go to sleep without hearing it. Could it be part of the damage from the stroke? I have never heard of this.
K.J.
That must be very frightening. Hearing voices makes many people and most doctors worry about psychiatric disease; however, there are other causes, and you seem to have a rare one. Auditory hallucinations are the sensation of hearing things that nobody else can hear, and are an uncommon complication of a stroke, especially a stroke in a part of the deep brain called the brainstem. Less than one per cent of people with strokes have this complication.
The good news is that in every case reported in the largest study I found, the hallucinations went away within four months with no treatment.
Dear Dr. Roach: I have ridges on my fingernails that go from the cuticle to the tips of the nails. Is this something to worry about?
A.C.
Ridges in the nail that go vertically, like you describe, are increasingly common with age and not worrisome. Ridges that go horizontally across the nail sometimes are associated with medical illness, and are called Beau's lines. Many medical conditions are associated with Beau鈥檚 lines.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
