Cervical Disk Injury

[raz2206]

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,

[Forum-M.D.-SH]

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.

[loiskerr]

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

[DeniseMarie]

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.

[raz2206]

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?

[Justadad]

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

[raz2206]

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?

[tstex]

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 back, l-tricep, fl-orearm and slightly in the l-fingers.  I also had a mylogram that unequivocally demonstrated a herniated disc.  I also had a n-surgeon that was ultra-conservative and said "you need surgery".  I did not experience any one event that cause the pain.  It was cumulative and manifested one day while looking over my right shoulder while working on tractor at the weekend ranch.

To conclude, find a neurosurgeon that you can trust.  If they tell you or recommend surgery, ask them "why?" and make them explain. If they have a problem with that, you know what to do.  If you receive a qualified answer you can trust, then ask them their success rate for the type of operation you need, based on their previous patients with the same variables as you.  Surgical procedures on the neck or lower back for 20 yr old's will/can yield quite different results healing results than for 60+ yr olds...get an apples-to-apples comparison, and i mean fuji-apple to fuji-apple.  My surgery was April 2005 and it immediately took away the majority of the pain, i still have issues periodically, but i would do it again given all the same variables.

Good luck and keep us posted,
tstex

[raz2206]

Thanks for all the comments. Please keep them coming. I liked the 2nd Neurosurgeon better but he referenced that I have quite a few options which is sort of confusing but at least honest. He acutally came highly referred from multiple sources.  Where the other surgeon was so cut and dry that it had to be ACDF. My pain level is ok during the daytime and I take nothing at all. It's just that at night I'm exhausted and the weakness in my arm/hands, set in and I find that I need to take a low dose pain( 1/2 percocet) med to sleep. Other than that I'm very funtional so far. Though I dread if it should get worse that I am putting off the inevitable and causing more damage? But from some posts I've read, I may regret surgery as it may not fix my current symptoms and create new problems. Gosh, I just hate being in this situation at all. Summer's almost here in OH and I would really like to enjoy it. I guess it boils down to is the glass empty or half full when it comes to the view on surgery? I had a nice 1 hour massage today so maybe this will help with the stress of this decision.
Thanks again for all your input,
Rachel

[LLWB]

I too have a C5-6 herniated disc, causing severe headaches, weakness in left arm, wrist, hand, pain in shoulder. My neuro=surgeon, after extensive testing, recommended a anterior discectomy, replacement with cadaver bone, and fusion. My surgery will be On June 4th. My surgeon recommended it sooner rather than later, due to the progressive nerve damage. The likelyhood of full recovery is much greater the sooner the surgery is done. If left too long, the numbness in fingers, etc. is not reversable. I also have stenosis, so the surgeon will clean that up at the same time. It involves C3 thru C-7. I have been active all of my live, with hard physical labor involved. I now drive for a living. The surgeon assures me I can go back to this in one month. It sounds like you are active, and want to be. I have been living with this for approx 10 years now, and wish I had taken action sooner, as I'm now 60, and at that age recovery takes longer. Good luck. As to seeing more surgeons,  the likely hood of more conflicting opions  increases.  Ask your second dr about speaking with some of his former patients, and see if they are happy with outcomes. Good luck, whichever way you decide to go.

[bev62]

I had a two level ACDF C5-C7 in Nov 2006.  I am in more pain now than I was before the surgery.  I didn't have surgery until a year and a half after my injury.  I was being jerked around by several different doctors before they found out I had the herniated disk.  It's been almost six months since my surgery and I'm still not back to work.  I feel like if they had done my surgery when the accident happened I wouldn't be in this constant pain.  I know several people that have had this same surgery and they did great.  Good luck.

[jackk]

I have a herniated disc in my neck, C7, that has been causing me a lot of pain for the last 5 months in my back and right arm and also some tingling in my right arm, it

[raz2206]

Wow, it sounds like you are a few months ahead of me. Meaning... I'm hoping that I may be one of the few who might get better without surgery. I first noticed the arm weakness/tingling about 4 weeks ago. And have seen slight improvemements over the last week. So I'm taking this surgery decision week by week. I recently have stopped taking all pain meds too and am doing fine. But my fear is like you to see symptoms get worse like go into both arms and or legs. Yikes! My plan is the following: If I see an increase in weakness, pain, etc.. anywhere in my body after today, then I will most likely plan for a surgery 2 weeks out. At this time, I am more interested in the Posterior Disectomy because all of my other disks look good. That way there is not fusion or metal plate. I figure there is a 20% or less chance of re-herniation in my C-5/C-6 area per the Dr. What is your Neurosurgeon recommending? Did you get a 2nd/3rd opinion? Please stay in touch.. But if I were you, I would be scheduling surgery if it were affecting my legs for sure.
Raz

[jackk]

The two Doctors I

[raz2206]

I'm in the US and because I got hurt outside of work, I can see any DR. I want. I've seen 2 Neurosurgeons so far. They both reecommend the the front of the neck with bone and fusion too. But neither of them would use my bone, they prefer a cadaver bone. Kind of scary... I guess the reason why is because people have a hard time healing in the hip if they use their own bone. Just an FYI...The 2nd opinion said I could go the Posterior route with no fusion which is called a Microdisectomy/Foraminotomy. This sounds better to me at the moment. Boy since my diagnosis I sure have caught up on learning about problems with the spine. LOL.  Last night while sleeping I felt my other arm go numb and one of my legs was throbbing. And guess what? As of this morning I'm am not sure If it was real? Meaning maybe I was dreaming?? Cause I feel ok this morning. Strange... very strange....Stay in touch...

[tstex]

" What should I be doing overall while I wait for surgery? Should I be taking it easy or should I continue on as normal with the aid of pain killers?"

Jack, without knowing the exact extent of your problems, you can check into these inversion boards.  It is gravity and upright walking that takes its toll on the spine...the inversion board [you strap yourself securely-in] allows you to temprarily reverse gravitational pull.  It allows the spine to decompress and when the pressure is relieved, thus the pain. Just make sure you have the physical stamina to get in/off the board...i know a lot of people that use these and have had good results...'

good luck,
tstex

[papas_gurl80]

I am 10 mos. post ACDF. I saw several doctors and they all rules that surgery was the best option. The injury happened @ work(i'm a nurse) in November 2005. I felt pain in my neck and shoulers immediately. When I woke up the next day I couldn't now my head from side to side and I had a terrible headache that is still present today. I started in the beggining with seeing my family MD. We tried resting the muscles for 2 weeks, when that didn't work, therapy was perscribed. I went to therapy for months without relief. Did streching, moist heat, traction,etc, etc. Nothing helped. Took lots of muscle relaxants, pain meds and anti-depressants. Finally got to meet with my NS, he did x-rays and an MRI and found that I had to herinated dics @ c4-5/5-6. Surgery was set for 6/06. NS stopped all therapies d/t it was having no positive effects in my recovery. Had 2 level ACDF with titaniun plates for stability. I wore on collar after surgery. The headache is ongoing being the absolute worst upon rising. At 2mos. post-op the NS said that there was no reason for him to continue to see me. I felt very let down by him. My GP has followed me since. In Feb. I was found to be @ MMI and was released to go back to work. Shortly after that I was fired. It is hard in my feild to find another job when you fill out the forms and they ask about recent surgeries and why. I have applied @ our local clinic and hosp. without success. I have always worked in nursing homes and even then they drill me on the injury. My biggest draw back is the constant headache, weakness in my upper body, and the pain in neck at the base of my skull and down between my shoulder blades. I am waiting for the case with my ex-employer to be settled. I guess I'm asking if many of you out there still have the pain that I do? What did I do wrong?

[raz2206]

Sounds like some of us in the forum have had the surgery( ACDF) and some have not including myself. I am currently evaluating my symptoms daily to determine if they are getting worse or better before I make a decision on surgery. I have not had the headaches but I do notice some weakness in my upper body and little tingling/twinge in part of a leg here and there but that's it. I'm currently taking no meds even though I do have them if the pain would come back. It's strange because on a pain scale from 1-10, 10 being the worst, I am a 2. That's why surgery is a tough decision for me at the moment. But the weakness is very annoying and I'm more tired than usual at the end of the day so it is affecting my quality of life "some". I guess that's because the rest of my body is adjusting to accomodate my injury. There's seems to be alot of people who regret the surgery which is discerning.... But there are some folks who feel thankful they had it and wish they would have got it sooner rather than later. I live near 2 hours from the Cleveland Clinic and am pondering a visit there as they are one of the best clinics in the world. I am re visiting with my Neurosurgeon next Wed to ask some more pointed questions and to review how I am doing with my injury. For now, I am taking it very easy as far as my activity level goes. Just some light walking for me here and there as I do not want to take any chance of making my situation any worse.
Let's all keep posting and stay in touch,

[jackk]

Sounds to me that papas_gurl80 is getting the shaft. If you were clearly injured at work and are still suffering after surgery I don't see how anyone can fire you. Everything I'v read all say that some of the damage can be irreversible. I hope things get better for you and don't give up. Keep us posted.

[raz2206]

Hey Jack, guess what? Last night I noticed some weakness in my right leg( thigh down) which is still there today. I was hoping I would sleep it off. This a new symptom for me. UGGG! So I'm heading back to visit with the Neurosergeon in the morning. Now that the weakness is progressing, I may be scheduling a surgery sooner rather than later.
I will keep you posted,

[Arachnoid]

Sorry that you are suffering so much. Herniated disks and pinched nerves can be exremely painful and debilitating. Hope you don't mind but it seems like you could use some help. Dealing with the W.C.B. can be difficult to say the least. However there are some things to know which you may already be aware of. Namely. They have to recognise the M.D. of your choice. eg. Your family doctor. When dealing with the W.C.B.  you need to have an advocate working on your behalf  like your family physician and for that matter any other doctor or specialist that you see. Believe it or not that is not always the case. I speak from experience having dealt with the W.C.B in Quebec for 35 years. It is bad enough to be  injured  at work but you do have rights and there is information easily available to you these days  at your finger tips on the internet. I am permanently disabled as a result of a work accident  and subsequent surgeries. I was only 17 when first injured requiring back surgery for herniated disc and again 5 years later for discotomy and spinal fusion L4-L5-S1.I have lived with chronic pain since that time and had to stop work at the age of 31. I now have Adhesive Arachnoiditis in my spine, Cauda Equina syndrome, Spinal Stenosis, and more recently diagnosed with herniated discs further up the spine in the Thoracic levels and in the Cevical spine as well. So I can empathise with your situation. I  went on-line last night and checked out The Workers Compensation Act for Alberta  which has lots of  useful information. If I can be of help to you I would be happy to assist. Best Wishes

[Maddogcanada]

Hello All From Brantford Canada. I am supposed to have a operation soon as i was diagnosed with the following.. C5-C6 This is the severley affected Level. There is an annuar disk buldge with a focal left paracentral protrusion that herniated both superiorly and inferorly almost to the level of the adjacent disk spaces. There is Severe acquired centra canal Stenosis and abnormal hihg T2 signal within the spinal cord extending from the level of the superior endplate of C5 to the Level of the midportion of the vertebral body of C6. There is Bilateral moderate to severe exiting neural foraminal stenosis as well at this level secondary to a combination of disc and uncovertebral degenaritive change. <-- This is from the Doctors MRI note. The Opinion is as follows. The Most Severe Level is C5/6 where there is a diffuse annular buldge with a left paracentral protrusion, as described above, that reults in severe acquired central canal stenosis with abnormal high T2 Cord signal indicative of myelopathic change at this level. There is bilateral moderate to severe neural foraminal stenosis at this level as well. "The Myelopathic change merits urgent referal"

Now my Symptoms are as follows..
1 - Numbness in my left and right hands
2 - Numbness in my lower body from the Mid-Section to under my Toes.
3 - I have to hold on the things in order to move around - example to go to the bathroom I have to pull and drag my feet up the stairs.
4 - Loss of sudden Bowel Trouble ie: Not knowing i have to go as per the NO feeling or ability to push to relieve myself as there is No pressure i can get to that area.
5- Un-balanced, walking like i have drank 100 Beers or the likes.

Now for the weird part - "I have NO NECK pain at ALL??. Why?? I am also a Type 2 Diabetic... Anyone have or had simular situation please reply ASAP as my surgery is for Tommorow at 10:30am at Hamilton Health Sciences here in Canada.

Thanks and for all of you i wish you all a brisk and speedy recovery...

God Bless You All.  

[Tpm419]

I also had a Anterior disc fusion with instrumentation. Had surgery on March 26th and now it's 5 weeks post op and I'm still in pain (more so then before surgery). I have very bad pain in the back of my neck as well as into the shoulders and across the upper back. My range of motion in my shoulders are very limited and I'm worried it may not return.
Anyone experience similar problems??

[mike1105]

your problems may be muscoloskeletal... have you tried postural exercises?? do you hunc over a computer all the time? my symptoms were like yours and i fixed them in 3 months w proper postural training/stretching.

[mike1105]

if it is only one disk, you may be a candidate for an artificial disc. there are some centers aroungd the country doing them-- they have only to this point been approved for one level. the bad disk is removed, the neves freed up, and instead of fusing two vertebrae, and artificial disc is inserted.