Lack of neuropathy puts doctors at odds

DEARDRROACH>>

I have weakness, numbness and the feeling of pins and needles in my hands, legs and feet. I have been diagnosed with both Sjogren’s syndrome and fibromyalgia.

I was working full time as a library assistant when my legs and knees collapsed a few times. I went to a neurosurgeon, who sent me for scans of my lumbar region. It showed no neuropathy, but a severe spinal stenosis and spondylolisthesis. He recommended lumbar surgery. But since I was not having pain in my buttocks or legs, he ordered scans of my neck and upper back too. Again, no neuropathy, but he is now recommending anterior cervical discectomy and fusion. He thinks this cervical surgery needs to be done before the lumbar surgery.

My rheumatologist, whom I have been seeing for over 10 years, maintains that the negative neuropathy test results indicate that the numbness I suffer from is related to my autoimmune illnesses, but the surgeon says that it means the numbness and other symptoms are being caused by the spinal nerve impingement.

Who do I believe, and what should I do now? I am 64 and had to resign from my job because the county would not extend my medical leave.

— B.R.

DEARREADER>> Fibromyalgia, a systemic disease of unknown cause, most frequently brings on widespread pain and fatigue, but it also may cause cognitive problems, psychiatric symptoms (depression and anxiety, in particular) and numbness and tingling. Although these symptoms certainly are real, the diagnostic studies may appear normal.

Sjogren’s syndrome, an autoimmune inflammatory disorder, also may cause pain, numbness and tingling through neuropathies. These symptoms may or may not show up on electromyography studies

Spinal stenosis is the compression of the spinal cord or a nerve root of the cord by the bones and other hard tissues. The EMG can diagnose this, and surgery is the only effective treatment when the degree of impingement is severe.

It is possible that you have spinal stenosis and spondylolisthesis, but you don’t want to go through major surgery expecting improvement if it is unlikely. However, to avoid missing neurosurgery if it’s necessary, visit a neurologist.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.