Back Pain, Chest Tightness, and Spinal Compression Symptoms

Lower back pain, chest tightness, dizziness, spinal compression?

Hello doctor, after undergoing an iliac vein catheter examination in early April, I began to experience discomfort in my lower back and buttocks.
The back pain worsened, and about two months ago, while stretching my back, I felt a "pop." Since then, I have experienced the following symptoms:
1.
In the upper and middle back, just below the scapula, on both sides of the spine (near the thoracic vertebrae), I easily feel swelling after walking a lot or going uphill.
Additionally, a slight touch to that area of my back (especially on the left side) immediately causes chest tightness, shortness of breath, rapid heartbeat, and elevated blood pressure.
My hands and feet feel cold, and I experience cold sweats in my extremities.
There is also numbness and weakness in my hands, depending on which side is touched.
2.
In the middle to lower thoracic spine, there is a section about 10 cm long that frequently feels burning, especially at night when I sleep.
3.
When applying heat to my left back, even a slight increase in temperature quickly leads to a bloating pain on the left side of my abdomen, which later causes several days of bloating and excessive flatulence.
4.
I have also developed symptoms of sleep difficulties, finding it very hard to fall asleep.
When I do manage to sleep, my heart rate suddenly increases, blood pressure rises, and I experience chest tightness.
Last month, I underwent examinations at the hospital, including cardiac catheterization and a repeat iliac vein catheter examination, as well as evaluations in urology and nephrology, which ruled out cardiovascular and iliac vein issues, along with problems from other specialties.
The rehabilitation department found evidence of ligament injury in my spine; however, treatments like microwave and laser therapy seem to exacerbate my condition.
Could this be a case of autonomic nerve injury or compression? I am unsure about how to treat it.
Which specialty should I consult next? Should I see an orthopedic spine specialist, a neurologist, or a neurosurgeon?

Mr. Zou, 50~59 year old female. Ask Date: 2022/06/18

Dr. Lai Zhaokang reply Neurosurgery

Hello, the preliminary assessment suggests issues related to the spine and autonomic nervous system.
It is recommended to consult a neurosurgeon (spine neurosurgeon) for further evaluation and to arrange for examinations.
Best wishes from Dr.
Lai Chao-Kang, Chief of Spine Neurosurgery at Changhua Hospital.

Reply Date: 2022/06/18

More Info

Your symptoms and history suggest a complex interplay of musculoskeletal and possibly neurological issues, particularly following your recent medical procedures. Given the array of symptoms you're experiencing, including back pain, chest tightness, and neurological signs such as numbness and weakness, it is crucial to approach your situation methodically.

Understanding Your Symptoms
1. Back Pain and Spinal Compression: The pain you're experiencing in your upper and mid-back, particularly around the scapulae and thoracic spine, could be indicative of spinal compression or irritation of the nerves exiting the spinal column. The "click" you felt while stretching may have been a sign of a sudden change in your spinal alignment or a minor injury to the surrounding soft tissues.

2. Chest Tightness and Autonomic Symptoms: The tightness in your chest, along with symptoms like increased heart rate, elevated blood pressure, and cold extremities, could suggest a sympathetic nervous system response, often linked to stress or pain. The fact that these symptoms are exacerbated by physical activity (like walking uphill) may indicate that your body is reacting to pain or discomfort in a way that triggers these autonomic responses.

3. Neurological Symptoms: The numbness and weakness in your hands, as well as the burning sensation in your thoracic spine, could suggest nerve involvement, possibly due to compression or irritation of the spinal nerves. These symptoms warrant careful evaluation to rule out any significant neurological issues.

4. Gastrointestinal Symptoms: The abdominal discomfort and bloating you mentioned could be related to referred pain from your back or could indicate a separate gastrointestinal issue. Stress and pain can also lead to gastrointestinal disturbances, including increased gas and bloating.

Recommended Steps for Treatment
1. Consultation with Specialists: Given the complexity of your symptoms, it would be prudent to consult with a spine specialist (orthopedic surgeon or neurosurgeon) who can evaluate your spinal health comprehensively. They may recommend imaging studies, such as an MRI, to assess for any structural abnormalities, such as herniated discs or spinal stenosis.

2. Neurology Evaluation: A consultation with a neurologist may also be beneficial, especially to address the neurological symptoms like numbness and weakness. They can perform nerve conduction studies or electromyography (EMG) to assess nerve function.

3. Physical Rehabilitation: Engaging in physical therapy can be crucial for managing your symptoms. A physical therapist can design a rehabilitation program tailored to your needs, focusing on strengthening the muscles supporting your spine, improving flexibility, and teaching you proper body mechanics to avoid further injury.

4. Pain Management: Depending on the severity of your pain, a pain management specialist may offer interventions such as nerve blocks, epidural steroid injections, or other modalities to help alleviate your discomfort.

5. Stress Management Techniques: Since your symptoms may be exacerbated by stress, incorporating stress management techniques such as mindfulness, yoga, or cognitive-behavioral therapy could be beneficial. These approaches can help you manage both physical and emotional stressors that may be contributing to your symptoms.

Conclusion
In summary, your symptoms suggest a multifaceted issue involving potential spinal, neurological, and autonomic components. It is essential to pursue a thorough evaluation by the appropriate specialists, including spine and neurology experts, to determine the underlying causes of your symptoms and develop an effective treatment plan. Engaging in physical therapy and considering stress management techniques may also provide significant relief. Remember, early intervention can often lead to better outcomes, so seeking care promptly is advisable.

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