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Dear Dr. Roach: I am a 72-year-old woman, and I have developed painful burning and tingling in my feet over the past several months, to the point that I cannot sleep many nights. Unfortunately, I cannot tolerate gabapentin on an ongoing basis, and topical anesthetic creams only help a little.
I do not have diabetes, but I do have significant scoliosis since childhood. I was told by an orthopedic surgeon that the only way to stop the neuropathy from progressing is to have back surgery, which includes fusion, rods and spacers. He told me this is a 10-hour surgery, and although I'm not afraid of surgery, the recovery sounds horrific.
Do you think this is the best treatment for my neuropathy? I do have an appointment with a neurologist and a podiatrist next Monday. -- C.R.
Answer: I have only very seldom referred an adult with scoliosis to surgery, and I would be very cautious in your case. While it is entirely possible that the scoliosis is causing the neuropathy, you haven't told me enough to be sure of surgery, especially not a surgery like the one you are contemplating, which is a very major undertaking with a long recovery, as you say.
I completely agree with your planned visits. Your neurologist and podiatrist have complementary expertise to find out whether the neuropathy is really coming from your scoliosis. An MRI of the spine, as well as nerve/muscle studies like an electromyography (EMG) and nerve conduction, might be able to give more certainty on the underlying cause of the neuropathy.
Furthermore, if an alternative medication could be found to treat your symptoms (there are several other medicines), this would generally be preferable to a major surgery, in my view.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.