C6 C7 Herniation - Conservative Care or Surgery?

I am a 38 yo female with a diagnosis of osteoarthritis throughout my whole spine.

Last week Monday, I woke up could not get my head off my pillow. I was in excruciating pain on the right side of my neck, shoulder and pain going down my arm.  My husband came in after I called him and helped me get up to a sitting position.  Got me dressed and hauled me off to my chiropractor.  Every bump on the way there, hurt and I could not move my neck either way.  Chiro could feel inflammation at C6/C7 and extremely tight muscles and spasming muscles.    I did not have the strength to hold my head up while going down to a laying position, or getting up from that position - it was way too painful.  

He said I probably completely herniated that disk (that was already herniated).  He fitted me with a neck collar which I wore for about 3 days off and on during the acute phase.  Also going through conservative care of cervical traction, elect stimulation.  No Chiro manipulations yet, but I'm guessing this week he may do that.  He says 3 weeks of conservative care, then if not much better, will order an MRI.  The reason he's waiting is because I just had one in Oct/07 (they thought I had MS and were checking for plaques) and this is what that one said below.  Is this the right route I should be taking (conservative care)?   I am feeling a bit better, but range of motion is still not good, pain is "ok" on a scale of 1-10 I would say about a 4-5 but my right shoulder and arm are still in a lot of pain.  I was just curious of your opinion on this.  I have read in serveral places that any disk impinging the spinal cord requires surgery to be done to fix this problem very quickly - but no one seems to think it's a problem.  Thanks.

"**MRI Cervical Spine without Contrast.   The vertebrae are normally aligned.  Stature of the vertebral bodies is maintained.  Spinal cord is of normal morphology with exception of ventral impression on the cord in the left paramedian location at C6-7 secondary to moderate protrusion of the nucleus pulposus.   There is no evidence of tonsillar herniation, and the foramen magnum is normal in appearance.   There is mild/moderate broad-based bulging in the disk/endplate complex at C5-6, but this finding does not cause impression on the spinal cord, there is no spinal or foraminal stenosis at this level.

Impression:  Significant protrusion of the nucleus pulposus at C6-7, finding is positioned in the left paramedian location and causes mild ventral impression on the spinal cord.  It is also possible that this finding may impinge the traversing left C8 root.  Otherwise unremarkable MRI of the cervical spine."

[Kwan Yin Chong, MD]

You should see a neurosurgeon straight away as the disc protrusion at C6/7 could have been worsen. An updated MRI should be taken to see the severity of the protrusion.

[Zak_Han]

Conservative Care ,if six direction movement of youtr neck is fine.
if not,see orthopaedic doctor.

[spankyandrex]

Hi, not sure what you mean by six direction, but my Range of Motion is VERY lmited to the right and some to the left.  The Spurling test he does on me (pressure pushing down and turnig neck) is positive (painful).  So, I guess movement is not fine.  Can I expect this to get better even after conservative treatment - cause it's been two weeks already .  ALso, wouldn't it be better to see a neurosurgeon...since it's the cervical spine and I already have a disk compressing the spinal cord in the cervical area?  I don't know what difference there is between the two.  Thanks.

[JayDiddy]

Hi Spanky,

I am not a Doctor but I have had C3/4 and C6/7 fused surgically. I have a lot of info I could share later but it is 3:30 a.m. and I need to sleep but I do want to recommend that your situation at this point is too serious for a Chiropractor to handle. I would see an Orthopedist but even better would be a Neurosurgeon. Paralysis is a possibility if the problem is exacerbated and you don't want to take any risks with this type of injury that has progressed this far.

I wish you the best,

Jay

[Zak_Han]

I agree JayDiddy,coservative may be not good enough for your condition,Just may be.

Currently, a patient does not have to settle on a neurosurgeon who does "mostly brain surgery and a little bit of spine surgery" or an orthopedic surgeon who does mostly "joint surgery and a little bit of spine surgery." A patient today can seek consultation with either a neurosurgeon or an orthopedic surgeon appropriately trained in residency.

so ,anyway ,go to hospital....

[spankyandrex]

I would be greatful if you could share your story with me Jay Diddy.  THANK YOU.

Dr. - I agree with you but I cannot get ANYONE to refer me to a neurosurgeon "right now".  And believe me, it's as though they have a gatekeeper getting in to see one at this hospital.  I have been complaining about my neck pain since Oct/07.  In fact, the neurologist said about my herniations "not important - I probably have one myself, doesn't require surgery-YOU HAVE FIBROMYALGIA!"  (I don't believe I have FM)  

He read my MRI reports and looked at my films too and it said just what I wrote above.  I am so frustrated at this point with everyone BUT my Chiropractor.  At least he knows enough to not manipulate my neck with adjustments and knows enough that I need to see a neurosurgeon not an orthosurgeon.  He's going to order an MRI probably next week if I remain the same (pain in neck and arm and range of motion diminished).  Do you think with Conservative Therapy, this herniated disk can just "go away"?

Thanks everyone for your time, I do appreciate it.
Sandra

[Ghilly]

I am not a physician, but as someone who has undergone an anterior cervical discectomy with fusion at levels C4-5, C5-6 and C6-7, my best advice would be to quit messing around with chiropractors and find yourself a good orthopedic doctor.  Unless you want to have frequent episodes such as the one you described above, going to a chiropractor isn't going to help.  Once you start to have these painful episodes, conservative treatment is not what you need.  I went through this for almost seven years except I was going to an osteopath for treatment and not a chiropractor.  I finally had enough and went to a pain clinic where I was examined by a neurosurgeon who said "this is a surgical neck.  I can fix you up in no time."  I got a second opinion from a doctor who told me the same thing, that I was a good candidate for the surgery and he felt it would be the end of my problems.  I went ahead and had the surgery and it worked beautifully.  Had I not had a myelogram before the surgery that resulted in me developing a condition called adhesive arachnoiditis as a result of the dye that was injected into my spine, I would be 100% today.  Even with my neck fused I have a wonderful range of motion with absolutely no pain in my neck.  It's only the scar tissue from the clumping nerves in my lower spine that is causing me all of the pain and numbness that I now feel in my legs and feet.  If I could do it all over again, I'd do it in a New York minute, but I would refuse the myelogram so that I could avoid the arachnoiditis, because that is incurable and I will now be stuck with it for the rest of my life.

Ghilly

[LLWB]

Definitely get thee to a neuro-surgeon. This is nothing to mess around with, it could cause paralysis. Chiropractors are not competent to be treating this severe a problem. At least get the MRI's done first anyway since he is willing to order them. I had C5-6 fused last summer. I have more range of motion now than I did before the surgery. Good luck, and let us know how you are doing,

[sonymarie]

r u serious?
go to the e.r so you can have another MRI, and then be admitted and scheduled for surgery- this is an urgent situation.  I would know because I had a c-6, c-7 discectomy and fusion 4 months ago due to a sudden injury i received from my martial arts instructor.  although my symptoms were a little different, you sound like you should go to the nearest emergency room.  

chiropractic care will make things worse for you, and you might end up in a very compromised situation.  i had my surgery within 24 hours of my injury.  although my situation was an exception to the rule of hospital insurance "approval", you can get around it all if your syptoms (symptoms) require you to take a trip to the e.r...let the rest take it''s course, because what the E.R docs will do is look at your MRI results, call in for a Neuro Consult, then transfer you (if necessary to another facility that has the resources needed for your situation) to an inpatient hospital bed to await a surgical consultation from a neurosurgeon.  Things happen faster if you are hospitalized- you won't have to wait a long time for approvals, and whatever.  Depends on what a neurosurgeon's decision is though- he or she might strongly encourage surgery right away- I would be wary of any surgeon who didn't!

You have to quit seeing that Chiropractor- it's important that you stop chiropractic treatment immedeately because you are at a very high risk for severe injury.  If you have insurance, your best option is to get a referal from your primary care doctor, and go from there.  Or- for faster results- get yourself to the emergency room and let things take it's course.  You'll be off work for a month, and no crazy activities for 3 months but at least you'll be out of pain, and ABLE TO WALK.

[spankyandrex]

Hi Sonymarie, thank you for your post, I do appreciate it.  Yes, my neck is still in pain and my range of motion is horrible.  I cannot look up for any amount of time, it's too painful (hanging curtains, looking at chandeliers at Menards hanging from celing was horrible).  My Chiro is now doing manipulative adjustments.  He stopped traction and is just doing conservative care.  Right now, I can live with this.  My Chiro has been working on me for over 26 years and has done a wonderful job and I trust him compeltely.  However, the next time ANYTHING Happens to my neck, I am going straigh to the ER so I can get an MRI done immediately.  I can walk, I can live life, I am just in some pain most of the time.  As I said, I cannot get referred to a neurosurgeon, its like you have to be REALY REALLY BAD to get through the gatekeeper in this hospital to see a neurosurgeon and it's absolutely ridiculous.  So if the only way to get this done is to go to the ER, thant hat's what I am going to do next time this happens. I would guess it's not too far off.  

Thanks so much.

[spankyandrex]

Yes, I realize I may in fact have Fibro in addition to my C-spine issues.  The other day my husband asked "yay, why are you so tired all the time"?  I didn't know how to answer him. But I did answer him with "because I have Fibro - that's what the Dr.'s tell me", he said "oh, ok".  I am so darn tired EVERY DAY I can't stand it.  I would say I honestly have 1 good day in 7 if I'm lucky.    Anyhoo, my C-spine seems to be getting worse over time.  But is not AS BAD as that day I could not get my head off the pillow.  I was in bed last night laying on my left side watching TV and I could feel pain going down both my arms.  On my right side, it was down the back side of my right arm, on my left side it was down the front side of my arm into my middle finger.  My neck is sore and I'm in pain each and every day. I am so thoroughly exhausted either from the Fibro or fighting my neck pain every hour of every day.  I think I am going to call my Chiro and ask him to just go ahead and order the MRI and we can go from there.  He's already said he'll refer me to a larger hospital to someone in orthopedics if I need to be (which him and I both know we do).  

I cannot hyper extend my neck like for example, looking at chandeliers/lights hanging from the ceiling at Menards and the other day I was hanging my new valances in my living room, and I had to take breaks. I told my CHiro about this and he said that is going to happen with someone with disk problems in their C-spine. I won't be able to do things like I used to - like paint ceilings, tape trip up above my head, basically ANYTHING where I'm looking up.  Good thing I have a sit on my arse desk job and wait on customers, otherwise, I wouldn't be able to work.   The neurologist that diagnosed me with Fibro never even did the trigger point test on me. I realize that's not the "diagnosis marker", but geese, you'd think it'd be at least one of the most important ones.

I just don't know how much longer I can live with this constant gnawing in my neck - the achiness - the soreness, the stiffness.  One of these days I am going to get in an accident because my Range of Motion to the right is HORRIBLE.  When I talk to people, they look at me funny because I am looking at THEM funny cause it hurts to turn my neck to face them properly.  Every AM I wake up thinking "is this going to be one of those mornings I won't be able to lift my head off the pillow again".  

I am 38 years old - I just want this fixed.  I thought my MRI results would shout out at every Dr. that read them 'THIS PERSON NEEDS SURGERY ASAP!', but apparently they don't.  Even with a disk touching the spinal cord. I don't get it, I just don't get it.  

[DebinCO]

It's a difficult call. I've been told I need cervical fusion as well. I also have shooting pain in my left arm but it is nowhere near as bad as my left leg. Anyway...out of the four people I know personally who have had it, only two have had reduction in pain. The other two are in screaming pain all the time. So...at least in my case I'm opting NO on cervical fusion. And I'm still trying to deal with my own screaming pain in my left leg which has been diagnosed as "nerve damage." I've already had a lumbar spine fusion which went well...I've been told my pain is unrelated to the fusion. I have no back pain whatsoever: just my left leg with shooting pain all the way down to my ankle. I am getting desperate. I posted this info but as yet haven't received any good advice. Nothing helps...I don't know where to turn.

[DebinCO]

PS: I also agree with the previous poster who said NOT to see a Chiropractor. I'm sorry, I know some people believe they can cure everything from warts to cancer with chiro but, with osteo in the spine with probable cervical disk herniation, etc., I would rather go to a witch doctor in Haiti than see a chiro. Quackery at its best. You could end up paralyzed!

[jhn2356]

Has anyone considered depression instead of Fibro?  Many of the symptoms that you have described could in fact be depression maybe even caused by your neck pain.  Several years ago I had many symptoms that screamed autoimmune but all the tests done were inconclusive.  Now I am on Zoloft and am doing wonderfully.  

Now Onto The Neck
I just had surgery on c6-c7 last week.  I woke up at 4am several weeks ago with pain done my right arm and into my hand.  That week I had just started seeing a chiro doc and had been adjusted twice before the acute pain down my arm.  I waited one day and ended up in the ER.  They didn't do a whole lot for me other than give me pain meds and they told me to make an appt with my family doc.  I saw my doc and she ordered an MRI, which showed the problem.  C6 and C7 herniation with probable nerve impingement.  She referred me to a Neuro doc (which you are right they are extremely difficult to get into ) he reviewed my MRI.  Next I received a call to schedule a surgical consultation with the Neuro (I was very leary).  Two weeks later I met with him and he could tell by just looking at my MRI EXACTLY where I was having pain.  He turned my husband around and pretended to draw the pain on him, which was right on.  He explained to me that I could try all conservative measures first, however, I would have the best recovery if I surgically corrected the problem with in 12 weeks of the intial acute pain.  At the time I visited him my pain level was maybe a 1 compared to a 91/2 when I was in the ER.  He explained that as well.  My nerve was dying.  I also had significant weakness in the tricep.  Trust me when I say that I was very leary of surgery, but when I was told the nerve was dying and my husband saw how weak my tricep was I knew at the moment I had to have surgery.  My saving grace was my Family doc and how quickly she made everything happen.  My recovery has been easier than having a C-section and I am only 7 days post op.

[spankyandrex]

Hi there.  Yes, I did have depression a few years ago.  But there was a reason for that and I won't go into it.  However, I do not have depression now.  I know what that feels like, believe me.  I am on Amitriptylin for my Fibro which is also an anti-depressent, but my Dr. prescribed it to help me sleep at night which I've been really having problems with over the past few months.  I do realize, and I do....that I may be down over the fact that I am feeling like **** all the time.  However, I am not clinically depressed.  Did I say, I'm not depressed?  LOL !!

Anyhoo, thanks for the note back to me, you gave me a lot of information to go on.  Geese, you really have good luck with your Dr.'s and you're right, you're saving grace is your family doc.  Unfortunately, mine is says "you have a little bit of a herniation there" and he says it should not be causing me this much pain and heartache.  Whatever.  Maybe I just need to take myself to a completely different clinic/hospital.  

Thanks so much!

[jhn2356]

Just a little thought..........do you have to have a referral to see a specialist?  I don't have the greatest insurance, however, I don't need to have a referral either.  In otherwards, I could just get my MRI records and make a call to a neuro or orthopedic doc, but I didn't have a need this time.  I do understand that these doc's are in high demand and you may have to wait awhile to get in, but at least you would have a foot in the door.  And sometimes, they even have a cancellation list they could put you on.  Once I saw the neuro doc and he suggested surgery, I could have had the surgery that same week, but I opted to wait two weeks, so that I could get my kids and husband in line first.  The doc I used says he works 6 days a week.  BTW, he said that once he opened me up, he saw how intangled my nerve was and asked me why I didn't tell him how much pain I was in and I explained to him the I only had severe pain went I had gone to the ER 5 weeks prior to surgery.  The MRI only shows the herniation not how pinched the nerve is.

Keep me posted.........

[spankyandrex]

Well, I guess I made a decision that puts me one step further "into that hospital" where the neurosurgeon is.  Right now, I am under the care of my Chiropractor for my osteoarthritis and herniated disks in back and neck.  I am also under the care of my primary physician for my Fibromyalgia.  I requested an appointment be made with a Rheumatologist in that hospital since I would like to be under the care of one physician for both of my diagnoses.  I don't need a referral either (whew!).  So, they will be calling me soon to set up an appointment time.  I think this is a good step in the right direction at least, because quite honestly, I cannot bring myself to believe I even have Fibro.  Perhaps I also need this Rheumy for a 2nd opinion on the Fibro as well.  THANKS for all your insight, I do appreciate it and I will definately keep you posted!  Have a great weekend!

[jhn2356]

Excellent decision........when it comes to my medical needs, I tend to be pretty assertive.  The left hand needs to talk to the right hand, if you truly have both of these medical issues.  I will say I grew up with a mother that had Rheumatoid Arthritis.  She had an acute case come on when she was just 39 years old.  It spread to all areas of her body, except her jaw and mid back.  She found an excellent Rheumatologist, but first she had to go through 2 or 3 of them before finding him.  He communicated wonderfully with all her doc's.

Best of Luck and yes please keep me posted!!!