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Neurology (Expert Forum)
When do you know it's time for surgery? How bad should it get?
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When do you know it's time for surgery? How bad should it get?
by dkidd, Mar 11, 2003 12:00AM
I was diagnosed with DDD C6-7 in 1998. I'm 43 years old. Latest MRI says:Severe degeneratiave disc disease, positional cord impingement ventral cord, which is flattened. The disc below and above are starting to show wear also.
I am doing physical therapy now. I've taken Neurontin, which helped, but then symptoms returned. Had other rounds of PT in the past. My symptoms have always been the typical: bad shoulder pain and muscle knots, heavy head feeling, aches. I don't have shooting pains running down arm. What made me go back to neurosurgeon recently was I am now getting numbness in my hands, especially my right. It wakes me at night, too. I have good grip strength, but I'm weak in the hand and arm. Drop things alot. I get some shooting pains in back of neck. This comes and goes, but it all affects my quality of life. I have a desk job, and by noon time I'm quite uncomfortable.
Now that I have nerve problems, the dr. said if PT doesn't reverse the symptoms, I'm "borderline" for surgery, but would probably have good success. My physical therapist acted like I shouldn't consider surgery until I'm in excruciating pain. I don't know if I've "suffered" enough, or should I keep letting it go like I have been for 5 years? I don't want to do permenant nerve damage. If I have a cervical fusion now, do I have a better chance of the nerves repairing, than if I wait until it's really bad? Can it improve on it's own, or is the degenerative disease always progressive?
I'm just wanting to be conservative, but wondering if it's finally time for the surgery.
I am doing physical therapy now. I've taken Neurontin, which helped, but then symptoms returned. Had other rounds of PT in the past. My symptoms have always been the typical: bad shoulder pain and muscle knots, heavy head feeling, aches. I don't have shooting pains running down arm. What made me go back to neurosurgeon recently was I am now getting numbness in my hands, especially my right. It wakes me at night, too. I have good grip strength, but I'm weak in the hand and arm. Drop things alot. I get some shooting pains in back of neck. This comes and goes, but it all affects my quality of life. I have a desk job, and by noon time I'm quite uncomfortable.
Now that I have nerve problems, the dr. said if PT doesn't reverse the symptoms, I'm "borderline" for surgery, but would probably have good success. My physical therapist acted like I shouldn't consider surgery until I'm in excruciating pain. I don't know if I've "suffered" enough, or should I keep letting it go like I have been for 5 years? I don't want to do permenant nerve damage. If I have a cervical fusion now, do I have a better chance of the nerves repairing, than if I wait until it's really bad? Can it improve on it's own, or is the degenerative disease always progressive?
I'm just wanting to be conservative, but wondering if it's finally time for the surgery.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Mar 11, 2003 12:00AM
When patients start to have clinical symptoms of weakness (objectively found on exam in addition to complaints of weakness) that is felt to be due to compression of the nerve by a protruded disc, we tend to be more aggressive and recommend surgical evaluation sooner rather than later. If there is significant nerve compression (which is what it sounds like from your post) the longer you wait, the higher the likelihood that there may be permanent nerve damage that will be beyond repair. Given that you;ve had severe DDD since 1998 and there has been no significant improvement, rather some worsening, it's unlikely that it will get better on its own. Get a neurosurgical opinion and have them evaluate your films and neurological exam. Let them help you decide whether or not surgery would be the way to go at this time. Best of luck.
My kids (ages 12&13)went through hell cause of my pain, though they we very understanding. I would seek a second opinion. you can't suffer anymore....
It's the numbness and loss of sensation that concerns me. I think atleast if I WAS indeed in horrific pain, I'd have no question about whether it was time for the surgery. I feel like I'm "on the fence".