C5-C6 & C6-C7 herniation with radiculopathy

    
      Re: Re: Re: C5-C6 & C6-C7 herniation with radiculopathy
    


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Posted by CCF Neuro MD (addendum) on July 20, 1997 at 11:13:38:

In Reply to: Re: Re: C5-C6 & C6-C7 herniation with radiculopathy posted by CCF Neuro MD on July 20, 1997 at 08:42:15:
  
  : : I was diagnosed with the herniations 3+ years ago but used various ways of coping from bio-feed back, visualization, relaxation etc. and vicodin or pain meds only when nothing else would help.  Well now I have gotten to the point that for over a year, I have not been without severe pain and finally returned to the neurologist who has been giving me nerve blocks approx every 2 weeks for the past several months.  I have severe psoriatic arthritis which I've been on methotrexate and prednisone now for 15 years.  Muscle myopathy due to prednisone etc.  My neurologist has suggested the nerves be cut to ellivate the head/face pain.  Loss of vision has also occured which improves somewhat with nerve block so hopes would be to alleviate vision loss also.  I have made an appt. at Cedars Sinai in Los Angeles CA to see Dr. Cooper (neurosurgeon) to see what he recommends but my neurologist said that the arthritis was too bad to do anything but cut the nerves.  I don't lilke the sound of this.  Can you shed any light on this for me.  A nerve cutting will not stop the arms hands feet etc. from going numb and having pain, will it?  I have severe esopogitis with terrible muscle spasms mimicking both heart attacks and asthma depending on where the spasm is occuring.  I've been hospitalized several times with these episodes and a heart cath was done so I know my heart is ok for now.  Dr. said that was probably the only thing ok with me though.  Can my neck problem also be causing problems with my chest pain etc?  One of my first signs of arthritis was in my thoracic spine when I was in my early 20's and I'm currently 49 but no MRI has been done in that area.  I feel it should also be checked because it is directly behind some of the severe pain I experience. They say it's not a common area for problems but I don't think I'm very common anymore. The last MRI on my low back (2yrs) ago showed multiple bulging disks but no herniation at that time but now I have a lot of numbness in the buttocks, front of thighs topo of feet and down shin bone along with a lot of pain.  I have the arthritis so sometimes I can't tell which is soing what but when the dr. pushes on my low back at all, I come unglued.  I have used a cane now to walk for several years and now am getting frightened as what may be ahead of me but no one seems to be talking.  Can you please tell me as you see it so at least I can ask the dr. some intelligent questions.  If you need further info of any sort, please e-mail me because I can sure use some help at this point.   Thanks so much...Cyndi
  
  : My e-mail which I forgot to post should you need it.  Thanks again and looking forward to hearing from you...Cyndi
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  Hello, Cyndi,
    Sorry to hear that you have been suffering from this condition for so many years.  In general, back problem can be very complicated and difficult to deal with especially when it is associated with other systemic illnesses.  First of all, the diagnosis has to be made clear.  The symptoms associated with disc herniation vary significantly depending on the degree and location of the herniation.  As you have realized, the wornings of nerve compression can be numbness, weakness and pain.  However, it is very important to make certain that the symptoms fit into the distribution of the nerve(s) that is(are) suspected being compressed.  There are several ways to find these out.  A full and detailed neurological examination is always the first step.  Then imaging studies are to be used to facilitate the clinical diagnosis.  Although your last MRI did not show significant herniation, since now you have developed new symptoms, you need to be re-eveluated to rule out compression.  
    The management of your condition has to be multidimentional.  In general, surgery is considered when the conservative measures no longer are helpful.  This should always be preceded by a CT/myelogram or MRI to localize the lesion and rule out other causes.  The relief after surgery has been documented in up to 85 to 90 percent in cases of pain due to lumbar disc herniation.  As far as nerve blocks, depending on different methods, it has been shown to be useful as a temporizing measure in some patients.  However, the data is controversial.
    As you can see, the management of back pain requires very careful evaluation before a surgery is performed.  I am sure you will be able to find such service in LA area.  If you are interested to come to Cleveland, or travelling through here any time soon, feel free to stop by at our The Center For The Spine.  We can provide you second opinion regarding the appropriateness of surgery, and discuss other treatment options available.  Please call toll free [phone] ask ext. 42225 for an appointment.
    This is provided for general medical education purposes only.  Please consult your physician for the diagnosis and treatment of your specific medical condition.
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Hi, Cyndi,
  Let me also make some comments about your question on cervical herniation.  The most commonly involved root levels are the seventh (in 70% of cases), the sixth (20%), and the fifth and eithth (10%).  Depending on the different root levels, patients can present as clinically distinct syndromes or a mixed picture.  Unlike herniated lumbar discs as above previously discussed, cervical ones, if large and cerntrally situated, may result in compression of the spinal cord.  The way to comfirm a centrally located herniation is to do CT myelography or MRI.
  Surgery is generally reserved for patients who failed conservative measures and have additional signs of a myelopathy, such as weakness, unsteady gait, or urinary/bowel dysfunction (incontinence).