I happened to meet a young woman who had the misfortune of experiencing these symptoms. She was 37 years old, born to an Irish mother and a father from the Philippines. She never experienced any back or neck problems until her “Night of Hell.” She awoke from a sound sleep with the worst imaginable headache and arm numbness. She could not move her neck at all. Her partner drove her to the local hospital emergency room where, for some strange reason, the doctors were not impressed. They gave her a prescription for hydrocodone and sent her home. Two hours later, she presented to our emergency room in total misery.
The immediate concern was that she was experiencing a catastrophic intracranial event, either acute meningitis or an intracranial bleed. Neuroimaging identified the problem. There was a great deal of bone deposition coursing along the OPLL as it wove through its congested neighborhood. That evening, she underwent an extensive corpectomy of nearly the entire cervical spine. She was referred to me after her discharge from hospital. Although she was grateful to be alive and able to walk, she was still miserable because of the pain. She had already tried a variety of analgesics without much benefit. She was hoping that I could offer her “some kind of miracle drug.” Sadly, that would not be the case. We reviewed her films and I was amazed to see how much orthopedic hardware was required to stabilize her neck. No wonder she was so miserable, but unfortunately there was nothing I could recommend to lessen the pain. When I turned back from the X-ray viewer to my desk, I noticed that my prescription pad was just where I had left it. Untouched.
Dr. Helfgott is physician editor of The Rheumatologist and associate professor of medicine in the division of rheumatology, immunology, and allergy at Harvard Medical School in Boston.
