What's up with the pain in Arroyo's neck?

For the past two months, Pampanga Rep. Gloria Macapagal-Arroyo has had to be rushed to the hospital several times for a medical condition described as a "pinched nerve," reportedly causing her severe neck pain. The condition, known scientifically as multilevel cervical spondylosis, affects the upper part of the vertebral column called the cervical spine. According to Dr. Adonis Bernabe Gascon, chief of neurosurgery at the Asian Hospital and Medical Center, the condition usually comes with age, affecting half of people aged 50 and above and about 75 percent to 90 percent of people above the age of 65. Gascon said that some risk-increasing activities include smoking, diving, and high-impact activities. He added that the usual early symptom is a vague pain in the neck, while severe symptoms include shooting pain from the neck down to the arm. The pain in the former president's neck, Gascon said, could be caused by the dislodging of any of the elements encircling the spinal cord. These elements include bones, the cervical spine itself, intervertebral disks, ligaments, and possible new bone growth which could be likened to arthritis of the neck. In an earlier interview with GMA News TV's "News to Go," Gascon likened the spinal cord to a castle, with the spinal fluid acting as a moat that isolates and protects the spinal column. "The spinal cord shouldn't be in contact with anything. It is floating in the middle of the spinal canal," Gascon clarified. Gascon said that, when one of the elements gets out of place, the spinal canal —the hollow portion inside the spinal column— gets compressed, putting pressure on the spinal cord. While Arroyo's doctors at the St. Luke's Medical Center did not specifically mention the specifics of her condition, Gascon surmised that it could possibly be the intervertebral disk that has gotten out of place. According to the website SpineUniverse.com, intervertebral disks act as cushions that serve as the spine's shock absorbing system, which also allow for some vertebral motion. Gascon said that, as people grow older, the outer lining of the discs becomes brittle and ruptures, letting out the gelatin-like substance contained within the disk. "By statistics, the most common [problem element] is the intervertebral disk, which is pushed out of its place in what is called as herniation, where it extends and touches on the other surrounding elements," he explained. According to MayoClinic.com, a herniated disk could irritate and pinch nearby nerves, hence the common reference term "pinched nerve," which could cause numbness and weakness in the arm or leg, as what previously happened with Arroyo. Gascon said that the surgical procedure performed on Arroyo is called an Anterior Cervical Decompression and Fusion (ACDF), which involves removing the problem elements that make the spinal canal narrow in order to relieve the pressure on the spinal cord and surrounding nerves. "Kaya sila naglagay ng titanium cage and titanium plate [in the area], to replace the intervertebral disk," he added.

(Left) A CT scan image showing an example of cervical spondylosis, and (right) an x-ray image showing the application of a titanium brace and cage in the affected area. Image credit: Medscape.com

On Wednesday, however, Arroyo had to go under the knife for the second time after it was discovered that an infection in the operated area had dislodged the titanium implants. While Dr. Juliet Cervantes, one of Arroyo's doctors, told the media that the infection might have come from Arroyo's throat as the bacteria discovered were typically found in the pharyngeal area, Gascon said that the titanium implants themselves could have caused the infection. "Whenever you put foreign materials into the body, there is a risk of being infected. Of course, this is just an educated guess, but these are the more common complications that come [with the surgery]," he claimed.

An artist's interpretation of the pinched nerves in Rep. Gloria Macapagal-Arroyo's neck. Credit: Sixto del Rosario

Gascon said that it's possible Arroyo's doctors may use bone grafts instead of metal implants for her third operation, which is scheduled three weeks from now following intensive antibiotic treatment. "It's a safer alternative than implants. Doctors could take a part of the pelvic bone and put it in the area to keep it in place," he said. With the titanium implants now out of the former president's cervical spine, Cervantes said Arroyo would have to be fitted with an external fixation typically called a halo, which significantly reduces the movement of the head and holds the affected region in place, preventing further complications. — TJD, GMA News