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Neurology (Expert Forum)
cervical disk herniations
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cervical disk herniations
by zk, Mar 21, 2005 12:00AM
On my mri of the cervical spine report is written the following "FINDINGS: There is posterior disc herniation at the c5-6 level.This ceates moderate canal stenosis and extends posteriorly to come in contact with the cord.Findings efface the anterior thecal sac and cause cord compression.This is a somewhat broad based disc herniation and also appears to effect both neural foramen.At c3-4,there is a very small posterior central disc herniation which does not create significant canal or foraminal narrowing.The remainder of the cervical disc in intact.The posterior elements are maintained.The paraspinal soft tissues appear normal.IMPRESSION: LARGE POSTERIOR CENTRAL DISC HERNIATION AT C 5-6.VERY SMALL POSTERIOR CENTRAL DISC HERNIATION AT c4-5." I had arms and legs EMG/NCS which was normal,but I still have total nubness in my thumbs (not in both hands at the same time),other fingers and hands in general for several minutes upon awakening in the morning.During the day I do not have total numbness in my fingers and hands,but my palms (skins) do feel differently.There is a different feeling (spasms,tiredness) from elbow to hands during the day,heavines on the back of neck,spasms in feet,sometimes total numbness in feet when sitting and sleeping in chair for prolong time. 1. Are the above symptoms(especially total finger and hand nubness for a couple of minutes upon awakening in the morning) caused by c 5-6 disc (bulging,protrusion) herniation? 2.Do I have to have c5-6 disc surgery and when is surgery indicated(by what symptoms)? 3.I talked to one neurosurgeon and he said that he would do surgery only when there is progressive weakness in arms,but not for numbness.Do you agree? 4. What is the likehood (in %) of these 2 herniated discs causing paralysis from neck down to feet (A) if they are not operated on and (B) if they are operated? 5. What should I do to prevent these discs from getting worse,for example should I stop fast walking on treadmill,watch how I position my head during sleep,carrying groceries etc? 6. Can I have cervical endoscopic discectomy or even microdiscectomy for the above discs as opposed to traditional ACFD?If no why not? 7. What's ACFD surgery success rate,for instance does nubness go away after surgery?If no why have surgery? 8.What's the difference between protrusion and extrusion discs and are protrusion discs considered herniated discs?BTW I am average 50 year old male.Thank you
Doctor's Answer
by CCF-Neuro-M.D.-PW, Mar 23, 2005 12:00AM
1) Certain neck positions, such as extending the neck back can narrow the space for the spinal cord that is already narrow from the disc and create some symptoms - it may be somewhat position dependent - MRI remember is taken when you are flat on your back and the space available for the spinal cord may be misrepresented
this may be why you have symptoms when you wake up and why the EMG is normal
2) I cannot give you a definitive comment on whether you need surgery without seeing your scans - your neurologist or neurosurgeon should be able to answer this. Usually surgery is indicated if you have a neurological deficit or symptoms such as weakness of the arms or legs or changes in bowel or bladder function. Also if there is severe pain, or problems with daily functioning, or if there are disc fragments in the neck (which does not seem to be the case with you). Otherwise treatment is conservative.
3) again the severity of a neurological deficit will influence surgery - weakness is worse and more lifechanging than numbness - it is a big operation.
4) I cannot give you an exact % it is diffeent for every body and I do not really know your case. usually it is a slow process if it gets worse, but if you did develop sudden weakness in the legs or loss of bladderfunction, seek help right away.
5) you should try to continue your daily activities. Just check with your doctor before you have for example an anesthetic etc so they are aware
6) probably not, because you have a broad disc bulge and a small focal disc bulge is required for the above procedure
7) surgery can prevent symptoms from getting worse, it may not reverse symptoms already there - this cannot be predicted prior to surgery usuallu unless the deficit is severe (in which case it is unlikley to resolve)
8) extrusion is when the extruded disc base is narrower than disc bulge, protrusion is when the base of the protrusion is wide - both essentially descriptions of the same thing, a herniated disc, extrusion being worse than protrusion
good luck!
this may be why you have symptoms when you wake up and why the EMG is normal
2) I cannot give you a definitive comment on whether you need surgery without seeing your scans - your neurologist or neurosurgeon should be able to answer this. Usually surgery is indicated if you have a neurological deficit or symptoms such as weakness of the arms or legs or changes in bowel or bladder function. Also if there is severe pain, or problems with daily functioning, or if there are disc fragments in the neck (which does not seem to be the case with you). Otherwise treatment is conservative.
3) again the severity of a neurological deficit will influence surgery - weakness is worse and more lifechanging than numbness - it is a big operation.
4) I cannot give you an exact % it is diffeent for every body and I do not really know your case. usually it is a slow process if it gets worse, but if you did develop sudden weakness in the legs or loss of bladderfunction, seek help right away.
5) you should try to continue your daily activities. Just check with your doctor before you have for example an anesthetic etc so they are aware
6) probably not, because you have a broad disc bulge and a small focal disc bulge is required for the above procedure
7) surgery can prevent symptoms from getting worse, it may not reverse symptoms already there - this cannot be predicted prior to surgery usuallu unless the deficit is severe (in which case it is unlikley to resolve)
8) extrusion is when the extruded disc base is narrower than disc bulge, protrusion is when the base of the protrusion is wide - both essentially descriptions of the same thing, a herniated disc, extrusion being worse than protrusion
good luck!
Member Comments (3)
by Complaining Pain, Mar 22, 2005 12:00AM
To: zk
Hi, I'm sorry to hear about your pain. I have some of the same problems with waking up completely numb on the left side, I have a herniated disk at the l4-5 at Severe S1-2 levels. I beleive the posterior protrusion means the disk is slipping towards the back and the other toward the front. But I find with my problems the neck pain and numbness does have to do with the herniation in any part of the disrupted area of your spine. Try the tempurpedic wedge and if possible the pillow. Roll a towel under your back with light heat and use the tempurpedic pillow. I was a runner. I find now NOT to RUN. Yoga and light walking on your treadmill with a proper waist belt has worked for me to keep circulation going. GOOD LUCK and I hope you find some answers soon. I also find to increase circulation when you wake up don't panic when you feel the pins and needles and you start to crack and pop. Use the technique for physical therapy and open and close your hands and if you can I find squeezing a stress ball gets the circulation going faster. If you have any tips on a better way to get the blood flowing while you sleep please let me know, I've been this way for almost 5 yrs.
by zk, Apr 02, 2005 12:00AM
Are you going to have surgery? Do you use incline (and what) on treadmill when you walk?If no why not?Thanks
