Disc problems

[tjs1974]

Hi,
I had an MRI of the cervical spine after having neck pain, spasms, which go down the left arm into the fingers.  Heres what the MRI SAid

Mild desciccation and flattening of interverteble discs particularly at C5-6.
A Posterior Bulging of disc material at C3-4 C4-5 and C5-6
A Mild hypertrophy of unconvertebral joints at multiple levels

I have had this problem for almost 5 months now and have had physical therapy, spinal injections and nerve blocks, which none seem to help.  I haven't been able to work or enjoy any activities due to being in chronic severe pain.

they didn't want to do surgery on me three months ago.  Do you think it is appropiate to have surgery considering the conservative treatments do not work?  If so, what kind of surgery is usually done for this problem?  All help is appreciated.

[CCF-Neuro-M.D.-PW]

I cannot give you a formal medical opinion over the internet unfortunately,as this site is purely educational

In most cases, symptomatic disc disease settles down with the correct conservative (non-surgical) treatment.

Surgery is mainly done to prevent permament neurological damage if there is evidence of same. Surgery is usually not an answer for pain, which in many cases does not come directly from the disc but from the muscles, ligaments, soft tissues etc around the neck and back - surgery cuts into all these tissues and this 'trauma' and healing can make pain worse.

An EMG can sometimes help provide objective evidence of nerve damage which could guide a surgical opinion, (as well as the neurological examination, which if showed muscle wasting or weakness in the affected limb, would indicate nerve damage)

I cannot comment directly on the MRI, but there does not seem to be an urgent indication for surgery based on teh MRI report - urgent indications for surgery are compression of the spinal cord on MRI or a broken off disc fragment, or symptoms of spinal cord compression like inability to walk or pass urine - the MRI report (although I have not seen and scan and corroborate this) does not indicate that there is any nerve compression.

Good luck

[mike1105]

you may want to have selective nerve root blocks to isolate and identify the specific nerve root(s) involved. usually this can be determined clinically by which fingers are involved. nerve studies may or may not help the diagnosis. if there are specific nerve roots being pinched (which may or may not show up on you MRI as "foraminal stenosis") you can search for a neurosurgeon who does minimally invasivde foraminotomies through the back of the neck, leaving discs intact.

[mike1105]

your problem also may be totally muscular. lost people do not realze that nerves travel through muscle and when muscles are tight, nerves get pinched. you may want to look into postural problems as the cause, or myofascial issues. check out John barnes website on myofascial release.

[tjs1974]

Thank you very much for your help Mike.  I also found out I have tendanitis in my left shoulder.  It makes me wonder if most of my pain has been coming from the shoulder and not the neck?  If a shoulder X Ray showed Tendanitis, is it appropiate to have an MRI on my shoulder?

[cino]

I wrote a comment on the forum for bulging discs C5/6, but I would like to comment that since the age of 17 yrs old, I have had chronic disc problems.  I am now 53 yrs. old.  At the age of 17, I was told I had the spine of a woman of 40 yrs old.  Now, I am told I have the spine of a woman of 70.  I have 5 bulging discs...C2/3 - C3/4 - C4/5 - C5/6 - C6/7.  I have nerve damage on the roots pressing on the spinal cord. There is narrowing of the lateral canals with calcified posterior bulge of the disc annulus significantly encroaching on the central spinal canal and impinging on the spinal cord.  The spinal cord is markedly reduced and the narrowing is severe.  There is significant compromise of the spinal cord at these levels.  I also have a bony spur in the centre of the anterior aspect of the central spinal canal extending down behind the superior C5 vertebral end plate.  I have chronic severe headaches, at times like a train is going through my head, pain in the neck, shoulder, arms, legs and now the past 6 months dizziness.  I have seen 2 Neurosurgeons, both which say there is nothing they can do for me, I have seen chiropractors, accupuncturists, physiotherapists, muscular skeletal specialists, and pain specialist, all of which say they cannot help.  I am waiting to see a Neurologist in July 2006.  I live constantly on pain aids, including tables, heat packs, massages, etc....with no avail.  The Neurosurgeon has told me that this is degeneration from having my whiplash at the age of 17, and that my discs will bulge down every disc in my spine.  I already have 5, starting on the 6th.  I am also now very dizzy, and even sitting at the computer writing this now, is very painful, as I cannot sit for more than 15 - 20 minutes without having to stand up.  I have not slept for more than 4 hours for the past 6 years, and I have severe pain down my legs, which makes it difficult to lay down, and I need to turn from side to side all night.  I have tried sleeping sitting up, but the neck is too painful.  I heard of injections to shrink the bulges, but I have not read enough information on this. I work full time, but may have to give up my job, as I cannot stand the pain much longer.  Is there anything to help this pain? To relieve bulging herniated discs?  To relieve the bony spur?  If the neurosurgeons say they cannot help, is there anything out there for help?

[tjs1974]

Hi Cino,
I'm very sorry to hear what you are going through.  I completely understand how you feel as it can be extremely frusturating.  I had two spinal injections from a physiatrist.  It seems to be helping a little and they put me on neurontin.  I was originally taking 300mg at bedtime but the Dr now has me on 300 mg 3 times a day for a total of 900mg a day.  I heard that is a pretty common dose.

When you said you went to a muscle skeletal specialist, are they similar to a pain Dr?  What kinds of things do they do?  Have you been to the Cleveland Clinic or Mayo Clinic?  I heard they are very good at getting to the bottom of things,  There has to be someone out there that can help you.  I would insist to the Dr's that you are tired of being in pain and not feeling good and to please refer you to someone that can help.  I have confidence that someone out there will be able to help you. I wish you all the best with everything and hope you are feeling better soon.  If you have any questions Cino, please feel free to ask.

Todd

[Kimmer01]

For some reason, the Dr.s always surgery isn't the answer. Sometimes I think that they just want to keep you coming back for the steady income. I am on so many drugs to try and control the pain, and this approach stinks. After so long your body becomes immune to the meds, then you have go through the process of finding another one, something stronger, and that can become very costly. Even with insurance.
I was rearended in Dec 1997, and finally in Mar 2001 I finally found a surgeon that would fix the problem. Once opened up, they found bone fragments (splinters) in my ligaments. These did not show up in any of my MRI's of X-Rays. He went in thru the front of my neck, and removed C4-5, and C5-6. I spent one night in the hospital. Two weeks later, I was mowing my lawn, and feeling better than I had in years.
All I can say is keep plugging along, one of these days you'll find someone that can and will give you back the quality in your life.

[lesterh]

Having gone to the Dentist , & waking up the next morning , I was anable to lift my left arm. I could not lift it one tiny bit. There was no pain.I have gone to 2 neurologists & 2 neurosurgeons . After having 5 MRI's , 2 cts, 1 xray, & 1 conduction test , they are unable to say what caused the arm to go dead. 1 neuro surgeon says it is multifocal motor neuropathy, & is not curible. The other neuro- sugeon said that my arm would not go completely dead overnight from multifocal motor neuropathy. My 1 qestion: Can MMN happen overnight & cause my arm to go dead??
Although nothing definitive showed in the MRI's, 1 neuro-surgeon thinks that surgery might help with a 50% chance or less of any improvement.
Five months have passed & in the mean time my right arm has weakened? My 2nd question: Do you think the risk of surgery is worth It.?
I know you can't answer the 2nd question completely without seeing any of the tests, but if you can give it your best shot it will be much appreciated.
                thanks
                 Les