Graham Smith, 67, had an anterior cervical decompression procedure at Spire Hartswood Hospital to cure neck pain and a sudden lack of mobility in his right shoulder. Here, he tells his story…
I’ve had neck problems on and off for 15 to 20 years, but it’s always been managed by physiotherapy or just resting. In September 2012, however, I tried to put some curtains up and afterwards my right arm didn’t seem to be functioning as it should be. By the following morning, I realised I’d lost a lot of mobility in my right arm; we went out in the car and I couldn’t lift my arm up to pay a toll at the toll bridge, or to press the button for a ticket in a car park. I had no strength in it.
I went to see a consultant rheumatologist at the Hartswood, Dr Gendi, whom I’d seen before for various things. He sent me for an MRI scan on my neck, which seemed to show that I had some compressed nerves. As that was outside his field, he referred me to see Mr Jonathan Benjamin, a consultant neurosurgeon.
Mr Benjamin was really brilliant. He’s such a nice man: thoughtful and caring. He was understanding and just so normal!
The odd thing was that I didn’t have any pain; most people with neck problems get pain. I didn’t have numbness or pins and needles, either; just a total lack of mobility and strength. Mr Benjamin suggested that, as it had come on suddenly, we should give it a few weeks and see whether it would work its way out again. In the meantime, he wanted to do some tests, so he arranged a nerve test* to check how my nerves were operating. They seemed to be still alive.
*EMG and nerve conduction study
The next thing we tried was to put a pain relief catheter into the upper part of my spine to manage the existing neck pain. This helped the neck pain, but didn’t improve the mobility of my right shoulder. It was trial and error, eliminating things one by one, to see what would work. I also had physiotherapy throughout this time to try to keep the arm mobile and prevent the muscles from deteriorating; yet, although I could move my arm with pulleys both in the physio department and at home, I still couldn’t move it off my own bat.
I then went to see a specialist upper limb orthopaedic surgeon at The Hartswood, Mr Sunil Auplish, who requested X-rays and an MRI scan on my right shoulder. He said there was nothing wrong with the mobility of the shoulder joint and he also thought it was a nerve problem. I was very impressed with Mr Auplish, too.
By the end of November, by process of elimination, it was clear that there was no physical problem obviously causing my lack of mobility. Mr Benjamin had always said, right from the start, that he could operate on the nerve, but he couldn’t guarantee success because, as I had no pain, there was no obvious cause. He told me precisely what he could do; he could fuse the C4 and C5 vertebrae of my spine together, and free up the nerve, which had been caught up with debris from the disc and bone. He explained he’d be going to my neck vertebrae from the front of my throat. He also mentioned that possible side effects could be paralysis, difficulty in swallowing and voice box problems.
By Christmas, I’d pretty much decided to have the operation. My logic was that, if I didn’t have it, I’d never know whether it would have worked! Also, my right arm is my predominant arm, so I might become even more restricted in what I could do. My wife and I talked it through with Mr Benjamin and I booked in for 8th February. He said, if you change your mind and want to give me a ring, or to talk it through, feel free to do so. He was very thoughtful and caring.
I’d been more than three months without normal mobility and it made day-to-day life very difficult. I’m retired and my wife and I are usually fairly active but, inevitably, there were things I wanted to do that I couldn’t do. I couldn’t do anything in the garden; I couldn’t do things around the house; and it also hurt when I drove. Plus, because my shoulder hunched up when I tried to do anything, my wife had taken to calling me Quasimodo!
My wife and I decided to forget about it over Christmas, but I couldn’t help thinking about possible risks and side effects. I wondered if I should go ahead… after all, I had some movement in the arm, so was I really setting off on a path that I might regret? I rang Mr Benjamin up after Christmas and chatted it through again. Again, he said he couldn’t guarantee it would work, but was happy to give it a go if I wanted him to. I appreciated his honesty, as I was self-funded.
I decided to go ahead, but I got a chest infection two days before I was due to go in, and we had to rearrange the date. Eventually, I went in on the morning of March 8th for my operation. I had the operation at 9am and I was back in the High Dependency Unit about 12.30. The care from everybody at the hospital was excellent. The anaesthetist, who’d seen me in the morning to go through what she was going to do, came back to see me in the evening, on her way home, about 7pm. My wife had said to the anaesthetist beforehand, you will wake him up, won’t you! When my wife saw her afterwards, she gave her a hug and said a big thank you.
The next day, the physiotherapist told me what I should and shouldn’t do and watched me walk up and down stairs, just to make sure I was OK. Mr Benjamin came to see me at lunchtime and asked if I wanted to go home. I said, yes please… particularly because my wife has eaten my lunch! I was quite surprised; I’d only been in for just over a day and I’d been told I could be there for three days.
Part of the reason I was ready to go home early, I think, was that I’d already been up and about a bit. I’d had a prostate operation last July and Mr Benjamin had warned me that men of my age, after an operation, tend to have trouble going to the toilet to start with. That happened to me for the first 12 hours, so I’d been going backwards and forwards out of my bed to the toilet, which was directly opposite the HDU. That probably helped, although it didn’t feel like it at the time!
I don’t remember much about that first week at home, other than my throat was a bit sore from having the anaesthetic tube down there. The only problem I had was, about two days after the operation, I had difficulty in swallowing – even my own saliva – so I wasn’t able to eat or drink. Mr Benjamin had warned me about this and it was a bit frightening. By good fortune, the following day, I bumped into Mr Benjamin while at the Hartswood to have the staples removed from my neck. He reassured me it was just a bit of swelling from the operation and, sure enough, it went after a day or two. He also told me not to run before I can walk. It was good advice because, to me, I could only see a cut in my neck; you don’t realize what’s going on in the inside.
I had to go and see Mr Benjamin six weeks later for a check-up, and everything has been fine. I’m recuperating at home, and gradually getting more use back in my arm. I was warned it could take some time, because when you’re using muscles you haven’t used for a while, they ache a bit. It’s well on the mend, though. Driving’s fine now. If I’m going to the tolls for the Dartford crossing, I can pay the guy now; I’m starting to do things that I realise I couldn’t do before.
I’d recommend it to anyone thinking about it. I’m 67 and I didn’t really fancy spending the rest of my life with an arm that doesn’t work properly, particularly as it was the dominant one. I took a chance to a certain extent; you’ve got to weigh it up in your own mind, but I would certainly recommend it. Have a long discussion with your consultant or your neurosurgeon first, but I certainly wouldn’t hesitate to do it if I was in the same situation again.
Mr Benjamin really was first-class. I’d recommend him to anybody. All the consultants and hospital staff were most supportive. The anaesthetist was exceptionally nice; Mr Auplish was very helpful and reassuring; and the consultants who did the nerve tests and the pain relief were all excellent and very professional. I’m just very grateful to Mr Benjamin for what he did for me.
The consultant's view by Mr Jonathan Benjamin, Consultant Neurosurgeon
I’m ever so glad that Graham has had a good result from his surgery and that he was so pleased with his care from everyone at Spire Hartswood Hospital.
I think that the main message that comes across from his comments is how a difficult clinical problem can be solved when colleagues work together as a team. Most cases are straightforward and a solution is obviously apparent. In Graham's case, however, it was extremely useful to be able to call on the services of other consultants, both to confirm his nerve compression and also to rule out other problems: in his case, shoulder disease. I have to thank consultant neurophysiologist Dr Nizar Muhammed and consultant orthopaedic surgeon Mr Sunil Auplish for their expert input.
Arm problems can originate anywhere from the brain, down through the spine in the neck, to the shoulder, arm and hand. It took a multidisciplinary effort to sort this one out. Well done to everyone involved!