Doc: Can stenosis be related to pacemaker implantation?
Dear Dr. Roach: I’m a 94-year-old male. Three and a half years ago, I was able to walk with a cane, until I had a pacemaker implanted. After the procedure, I was able to walk only with a walker, and not very well. Prior to the procedure, I had a CT scan that did not show stenosis, but I had a scan two years later that showed mild to severe stenosis throughout my spine. I’ve been told that the anesthesia could have caused my problem. Could that be true? Also, I’ve seen ads for laser surgery claiming that the surgery has a 1-inch incision and you can walk the same day. True?
Dear T.K.: I have never heard of someone losing function during a pacemaker placement, which normally is a short and straightforward procedure. It certainly is true that bad events can happen during anesthesia, but a pacemaker is usually performed under light (or no) sedation and using local anesthetics.
I don’t think the anesthesia has anything to do with spinal stenosis, which is a type of arthritis of the spine that leads to compression of the spinal cord or one of its roots. When someone suddenly loses function, like going from walking with a cane to having to use a walker, I would think about a neurological event, such as a stroke. A small stroke on top of existing arthritis of the spine could explain your sudden inability to walk with a cane. However, it’s possible that under anesthesia, you had a movement in your neck that did damage to a nerve structure.
As far as treatment of spinal stenosis goes, I would be very, very cautious about any kind of surgery. Back surgery should not be entered into lightly, and although in some people surgery may take away the pain and leave them walking pain-free immediately, that is not at all the experience I have seen with most of my patients. I certainly have seen people come from spine surgery (including laser spine surgery, which most academic institutions do not perform) with significantly worse symptoms and greater impairment. When contemplating surgery for my own patients, I generally refer to a very conservative surgeon who does not operate unless very sure he or she can help the patient, and even then we both caution that there are no guarantees from surgery.
Dear Dr. Roach: I am 83 years old and in good health. Last week I was watching television and suddenly had bright lights flash in my eyes. They seemed to move fast, from right to left. It went away after five minutes. I had a recurrence this week, but not as bad. I did not have any dizziness. Should I see a doctor, or is this something that just happens at my age?
Dear D.F.: This is not something that normally happens at any age, and you should see a doctor. My first thought is that of an aura that precedes a migraine. Going away after five minutes or so would be very compatible with migraine. Some people can have the aura of migraine without headache, and that could be what’s going on. However, age 83 is very unusual to start having migraines.
A retinal detachment may present with flashing lights. This would need to be evaluated right away. However, you should notice changes in the vision and an usually large numbers of “floaters” (bits of cellular debris that can obscure the vision). I would recommend a visit to your doctor.
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