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Does my diagnosis require surgery?
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Does my diagnosis require surgery?

I have been diagnosed by 2 neurosergeons in the same clinic recommending surgery. I am looking for a third opinion from a doctor who has not financial interest in my diagnosis. Do I need the surgery recommended below?

Surgery Recommended: Two Level anterior cervical discetomy and fusion C4-C5 and C5 – C6

Symptoms: 1. Positive Spurlings sign – sleep disturbances, feeling run down, ringing in ears, constipation, urinary frequency, stiffness, numbness in left hand, reduced strength in left arm, cold intolerance, heat intolerance, excessive urination, headaches, eyes  pain, muscle spasms, pain in neck, shoulder (front and back) and middle back

2. Two Level Stenosis secondary to primarily degenerative disc disease and marginal small canal. Slight degenerative disc in lower cervical canal.

3. Cord Signal Changes
Impression: Cervical myelopathy with cord signal changes

Tests: MRI of neck
XRAY, C-spine, flex & ext
XRAY, Thorasic

4. Radiology Report: There is some mild degenerative endplate signal change at C5-C6. The C2-C3 level is normal. C3-C4 level demonstrates mild asymmetric bulge, left paracentral. At C4-C5, there is moderate asymmetric disc bulging, left paracentral and lateral recess, with some effacement of the left lateral aspect of the cord. At C5-C6, there is broad-based disc degenerative bulging with some effacement of the ventral aspect of the spinal cord, in general, and narrowing of the spinal cord in the AP dimension. At C6-C7, there is mild disc degenerative change. At C7-T1, there is asymmetric disc bulging, left lateral, extending to the lateral recess without neural foraminal stenosis. The spinal cord has two levels of abnormal signal within it. The first is a or just subjacent to the C4-C5 disc level, with increased intrinsic cord signal and at C5-C6. There is some increased signal within in the cord also, slightly more prominent.

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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is nor can I recommend for or against surgery. However I will try to provide you with some useful information.

In most people, with time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications.

In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.

In your case, many of the symptoms you list are highly likely to be unrelated to your spine problems (like the fatigue, ringing in ears constipation, etc). However, many of your symptoms are likely related to your spine as well: the weakness in your arms, your head/neck pain. Importantly, your MRI shows evidence of not only arthritis in the spine (which is not necessarily and indication for surgery) but also what sounds like pressure on the spinal cord. Signal changes within the spinal cord signify that the bulging disc/arthritis is pressing on the spinal cord, and without surgery, damage to the spinal cord could occur. I recommend follow-up with your surgeons, with discussion of the risks and alternatives (if any) to surgery with them, as well as the potential consequences of not opting for surgery. Having them show you the MRI may be helpful for you to better understand what is going on.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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