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Neurology  (Expert Forum)
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Cervical Disk Injury
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MedHelp Member's Question

Cervical Disk Injury

by raz2206, Apr 17, 2007 12:00AM
Hello, I was recently  (30 days ago)(via an MRI) told that I have a Large herniated Disk in the C-5/C-6 area which is pushing paramidline on the nerve. I did it by exercising of all things. My symptoms are slight neck shoulder, and right arm pain with some minor weakness in the right arm. My discomfort is worse in the evening but is treatable with a small dose of pain med when needed. I have even noticed some improvement over the last week or so. I have had 1 neurosurgeon evaluation so far and he says that I need to have the Anterior Cervical Disk surgery asap to fix the problem and prevent further damage. I have a 2nd opinion in the morning. I am curious about the following:
1) Can I try a more conservative method instead of jumping into surgery? If so, what is reccommended? My family Dr. is backing the nerosurgeon and has no other options for me at this point.
2)Should I get opinions from other types of Dr.'s such as Orthopedic, or Osteopath, etc...?
2) Should I get the surgery if my 2nd opinion reccommends it as well? Or should I get a 3rd opinion? My 3rd opinion is in mid June. Is that too late to wait?
3) I am a career minded healthy 37 year old and am scared to have the surgery due to the risks involved. I'm worried about the surgery causing new problems and or not fixing the problem that I have. What are the success rates of this type of sugery?
4)Do you think I could find a surgeon who would go in Posterior? The front of the neck scares me because you have to pass by additional areas such as voice box, throat, ect...
5)If I had the surgery, what should I expect Post-Op?
6) How do you know that you have the best surgeon? What questions should I ask before surgery?
Thanks for your help,
Doctor's Answer

by Forum-M.D.-SH, Apr 26, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The symptoms and tests that you describe are consistent with a C5-6 radiculopathy (pinched nerve). A disc herniates out of the vertebral column and puts pressure on the nerves as they exit the spinal canal.  Many disc herniations will improve on their own without out treatment.  However, if you are having weakness, then you are running the risk of permanent weakness in your right arm.  Even with the surgery you will likely have some residual pain and possibly weakness.  I think getting a second opinion from another surgeon is a good practice, but I would not put the decision off too long.  Another test that might help you come to terms with the surgery vs no-surgery decision is an EMG to look for signs of active dennervation in your right hand muscles.  Anterior cervical discectomy is the standard of care and you should not worry about the technique, just find a good surgeon.  I would suggest that you go to a major academic center for an opinion, because they are the experts in the field and are not motivated by profit margins to do as many surgeries as possible.  The ACDF is a relatively quick procedure and the recovery time in the hosptial is short 2-3 days often, with longer periods of rehab (6weeks when you neck is stable enough).
I hope this has been helpful.
Member Comments (43)

by loiskerr, Apr 17, 2007 12:00AM
Hello, well I'm six months postop and I'm doing great. This is your only option. You can be parlized from the neck down if you let it go. In the front is the best way and my scare is in the fold so you can't see it. I let mine go for three years and couldn't walk before the operation. I couldn't believe the neck controlled the legs but it does. I was taking Aleve for years and when I got left side parlizisis I was sent to ER. My neuro said it's to bad you didn't fix it three years ago. He wasn't sure if I was going to get my legs back. But he did an outstanding job and I can walk six miles briskly now. (Three weeks after the operation) I had no brace or collor. Hurt like hell the first week as the nerves reconnected but after that I was great. Some stiffnes even today if I lift to much. Like laundry. But I would do it again in a second. I know someone else who is three weeks postop and is doing great too. He had two levels. So ask all the question you want I will respond. Lois

by DeniseMarie, Apr 17, 2007 12:00AM
To: To razz2206
I had the exact same problem back in 1994.  I lived in the Chicago area and was fortunate enough to have a great neurosurgeon do my evaluation.  He told me up front about all the risks of having or not having the surgery, but in the long run it was my decision.  He did tell me that if I didn't have it done, I could fall or be in an accident and have permanent damage or be paralyzed.  He said that it's also a matter of "quality of life"...just how much pain can you deal with before it affects your quality of life and the people around you.  The risk is much less with one disk vs. more than one.  I had the surgery in 1994.  The doctor went in through the front, took some bone from my hip and fused C5-6.  It was the best thing I ever done.  I have been pain free since then and good mobility.  I had a GOOD doctor.  If I remember correctly, I called the AMA (American Medical Association) and asked for his credentials; where he went to school, how long he's been practicing neurosurgery...whatever you want to know.  They will also tell you if there have been any lawsuits against the doctor.  You can also do this on-line, but you will have to pay for the information.  I remeber asking my doctor how many of the same operations he performed and how many were problems.  He actually told me that only one he had a problem and that was a raspy voice afterward.  Do your research, then make your decision.  I thought it was well worth the risk.

by raz2206, Apr 17, 2007 12:00AM
Hi Lois, thanks for the quick reply. You give me hope that the the surgery will be a positive action to take. I will reply back to you after I get my second opinion in the morning. How is my medical situation similiar to yours? What procedure did you have exactly?

by Justadad, Apr 18, 2007 12:00AM
Hello raz:

How did your second opinion go? I have the same situation in c4-5 caused by a bone spur. As of now I'm doing just fine with little symptoms.

Thanks for your post

by raz2206, Apr 18, 2007 12:00AM
Hello , here is the latest as of my 2nd opinion with a Neurosurgeon this morning: First of all, I liked this Surgeon much better than the first one because he took his time and wrote down all of my questions and answered  them without rushing me. He first did a thorough physical check of my arms, neck, legs, and even my walk. (The first surgeon only checked my hand strength.) He then preceeded to review my MRI in great detail explaining each Cervical area. Luckily I only have one herniation and all the other disks look good. He recommended the Anterior Cervical Disk surgery. But he did agree that a Posterior approach without metal plate and fusion would also be an option for me as well. I like the Posterior approach because there would be no foreign bone/objects added to my spine with less risk to the throat, vocal cords, etc.... He also stated that some people can even heal on their own with no surgery.Now that's a thought.... Maybe I should wait a little while to see if my condition gets better or worse before jumping into surgery?? I had this injury for around 5-6 weeks so far.  At this point, I have a 3rd opinion scheduled in June. I may resume walking for now but no running. What do you all think?

by tstex, Apr 18, 2007 12:00AM
To: Follow-up to Raz
Raz,

In my humble opinion, you need to find a neurosurgeon [as with any doctor for any malady] that you trust and feel comfortable.

When i had neck issues, i asked some radiologist who they would go see if they had a problem?  There is a reason that many doctors all see the same neurosurgeon - they trust him/her.

I concur in getting a second opinion, or a 3rd if you have doubts about your prior consultations.  In my experience, the best doctors make their call by both your symptoms and their empirically driven diagnostic reports [MRI's, Mylograms, etc].  I prefer consulting with a very conservative physician, because when they say you need surgery, they mean it.  Your inclination towards wanting surgery, based on my opinion, should be when your pain becomes too much to handle and/or any risks from the surgery are the same or less than the current/sustained pain.

Even though i understand you are wanting to hear "i had the type of pain you had and the surgery you need i had and everything i now great", are only statistics.  There are many things to consider:  age, lifestyle, daily routines, genetics, degenerative disc diseases, what you did to get your injury, what you do post-op to prevent it from happening again, how much and often you perform repetitive tasks that involve the neck, ad infintum.

Unless your disc injury is severely trauma-based, then you should have time to decide, in my opinion.  My impetus to have a C7 laminectomy was driven by pure pain, such that i had to lean my neck to the right to open space in the disc to relieve nerve compression.  The pain was in the neck, upper left