Expert: Gerald Anzalone, D.C. - 1/14/2010

Question
I have had chronic neck pain for going on 14 years or so which finally went into my right arm and up into the right side of my face.  I have numbness in the tongue and face as well as ear fullness and clicking.  I have sinus fullness at times too.  I have wooziness, a feeling like having the flu with movement.  Even nausea.  I have seen many physicians and have had cervical laminectomies and foraminotomies as well as nasal septum surgery. I have seen many physicians and seem to stump them all.  I have had injections and just about every avenue has been crossed.  I now see a physical therapist who is leaning toward neck-tongue syndrome.  However, we don't know where to go from here for help.  We are trying a cervical collar which has only changed symptoms, not relieved.  Any suggestions at all would be most welcomed.  Thank you.

Answer
Ellen,

It appears that you have a complicated medical history, which has included multiple surgeries for in your cervical spine, with various neurological symptoms. Generally speaking, persistence or even worsening of symptoms post-surgically usually suggests a poor prognosis.

There is literature to support the use of spinal manipulation in treating a disorder such as the neck-tongue syndrome. However, assuming that a major contributing factor to your symptoms, if not the root cause, is an underlying neurological abnormality (of which the neck-tongue syndrome is one manifestation), also assuming that you have consulted with an neurologist and had any appropriate x-rays, MRI scans, or CT scans of your neck for your current symptoms to no avail, and given that you are almost certainly not a candidate for spinal manipulation given your multiple neck surgeries (unless the therapeutic approach utilized a non-forceful manipulation technique such as an Activator adjusting instrument), I agree that the physical therapy approach may be your safest venue at this time.

Acupuncture, like spinal manipulation, is another modality which may be of help in treating various uncomplicated neurological disorders. This is perhaps one other treatment venue which you might pursue. Like any other treatment, results from acupuncture or spinal manipulation for problems of this nature are often case specific; they may work well for one person, but not for another. Given the multiple neck surgeries you have had, your condition may be much more challenging to treat. Neurological conditions such as the neck-tongue syndrome, while rare, are usually the product of other degenerative changes of the spine (collectively and generically referred to as arthropathies), which may further complicate the best efforts to treat your condition conservatively.

The problems with which you are suffering can be most trying on your patience; your condition appears to be more than the usual musculoskeletal pain case. I can only encourage you to be persistent in finding the right practitioner who can properly evaluate your condition and offer reasonable and effective treatment options. I would also counsel you to be wary of any practitioner who offers and blanket promise to "cure" whatever ails you, especially if the treatment method involved has no evidence to support its use.

I wish that I could offer you a more concrete answer, but with the information you have given me, this is the extent to which I can offer an opinion. I hope that this helps to answer your question, and I wish you the very best of luck in your treatment quest.