Herniated cervical disc

[Shipp]

I am a 53 year old male. I have left cervical radiculopathy. My family doctor noted absent reflex in the left arm and ordered an MRI. She prescribed Lodine and I have seen a Chiropractor for spinal manipulation with no relief.
MRI CONCLUSION:
1. Left foraminal HNP C4-5
2. Right C3-4 bony spur
3.Mild degenerative disc disease C5-6
I am considering a percutaneous micro-decompression cervical discectomy with laser thermodiskoplasty. Do you have an opinion of the efficacy of this procedure? My symptoms seem to be coming from the herniation at C4-5.

[CCF Neuro[P] MD, RPS]

Dear Shipp:

In our experience, unless there is mechanical problems, such as pain with movement, numbness with movement, or frank muscle weakness, surgery is plus or minus with results.  A chiropractor is likely not going to have any effect on your problem as your problem is structural abnormality, herniation, and not alignment.  I think that I would first check with a good neurologist in the area and maybe a rehab physician who deals with spinal problems first.  Having lost reflexes (unless you family doctors is not good at eliciting them) you are in need of therapeutic intervention sooner than later.  What did the EMG show?  After getting everyone's opinion, make an informed choice.  Best of luck.

Sincerely,

CCF Neuro MD

[jo-ann Padula]

Dear Shipp

Please don't run for surgery.....I too have degenerative disc
disease, arthritis, bone spurs 4 herniations c3-4, 4-5,5-6,7-8...
I was operated on C5-6 and although it was sucessful in stopping
the unrelentless pain in upper right arm now i have very limited movement in my neck from disekomy and fusion (with titanium)
and still much pain from the other herniations.  My Doctors are
especially worried about the level above and below.

And whatever you do don't let a chicroprator touch you !  Listen
to these doctors...their advice is Great..i wish they were around
my area ..My prayers are with you.
May God bless....and don't forget offer up your pain for the conversion of sinners and for peace in this world....!!!
Jo-ann

[Dee]

Saw the statements about the chiropractor...I've been wondering...after having years of pain and stiffness from connective tissue disease, and more recently experiencing neurological type dysfunction including hyperactive reflexes right sided, right sided weakness, memory problems, increasing cognitive dysfunction, constant asthma problems, and tons of GI problems directly related to meds, I got tired of "learning to live with it" and being given more and more prescriptions and nobody really knowing what to do with me, I went to a chiropractor.  I have been going for about 3 weeks and I went thinking it wouldn't work but figured what could I lose I paid my whole out of pocket, insurance is now paying 100%, so what better time to give them a chance.  Two opposing problems...I do seem healthier since I started going and it might be a coincidence or maybe because they have helped me improve my diet and maybe the electrical stimulation/hot pack therapy and therapy type exercises are helping.....however....on
Thursday following a manipulation on my neck it hurt and he said it was ok to be sore....therapy seemed to make it feel better but got worse that night.  Thursday night through Saturday experienced unrelenting pain, had to take Ultram and even that didn't help much, couldn't move neck in any direction without pain, and horrible headache running up back of neck and head (all on the right side of neck and right side of head).  It scared me, I couldn't turn my head while driving except experiencing severe pain.  But woke up Sunday morning and the pain is gone, so am not real sure what to make of it.  My daughter was in a car accident and got whiplash and the chiropractor is who her pediatrician sent her to, so that made me think it is ok, and they are manipulating her too.  Xrays the chiropractor took of me showed bone spurs and disk degeneration on my neck and lower spine ( a year ago I injured my back and had bulging discs which was treated by orthopedic doc with steroids, meds and PT and the pain went away).
I have seen no real reduction in joint pain, but the asthma is under control for the first time since July and my stomach quit hurting since stopping Celebrex and some other meds.  I still am taking plaquenil and synthroid.  It scared me to have so much neck pain....but like I said it is all better now  I'm supposed to go back on Tuesday, and my kid goes back Monday.  What do you think?
Dee

[CCF Neuro[P] MD, RPS]

Dear Dee:

Sorry to hear about your pain.  It almost sounds like radicular pain, did the pain radiate or was it just extremely sore?  I see no problem going to the chiropractor however, is you have radicular pain, manipulation might be contraindicated.  I have also been trained in spinal manipulation and would not consider manipulating a radicular nerve process.  I suggest that if you neck bothers you again, that you see a neurologist.  A MRI might be beneficial to help diagnosis your problem.

Sincerely,

CCF Neuro MD

[Dee]

I'm sorry to bother you again.  To answer your question, yes the pain in the neck did radiate from my neck into my shoulder, primarily right sided.  What does radicular mean, I am unfamiliar with the term?  The severe pain has not returned...there is still an aspect of a duller pain, still radiating into the shoulder but not nearly as bad as before, and I have not needed any pain medication for the pain since Sunday.  Thanks for your help.

[CCF Neuro[P] MD, RPS]

Dear Dee:

Radicular pain is a term we use for pain arising from the spinal roots.  Usually it is caused by problems in the boney structures impinging on the nerve as it exits the spinal column.

CCF Neuro MD

[Sharon]

I have buldging disk C-3 through C7 confirmed by a MRI. I've had four weeks therapy and symptoms are worse, I have more pain in arms and more numbness in arms,hands and face. Also I have nerve pain in left buttock and down leg all the time now. My doctor is sending me to another doctor but he is not a neurologist. Should I go to see a neurologist? And is surgery advised if problem doesnt get any better. Very worried about this because I keep getting worse instead of better.  also I dont't want to live on medications.

                                         Thank you
                                                   Sharon

[CCF Neuro[P] MD, RPS]

Dear Sharon:

Bulging discs are not usually made much better by surgery.  Most of the treatments should be medical at first.  Unless the problem is mechanical (pain with movement that is located to a particular spinal root) then it is a **** shoot as far as recovery from the pain.  Four weeks is only a short trial of medical management.  Get a second opinion and try and find a good rehab specialist who will work with your neurologist.

CCF Neuro MD

[Sharon]

Thank you for answering me.  I just would like to know if I should see a neurologist.  My primary doctor doesnt think so.                            
                                   Sharon

[nancy]

I have been in pain since 1993 when an on the job injury left me with bulging L4 & L5. The pain has gotten so bad that I havent been able to work for over a year. My surgeon seems to be unwilling to do any type of surgery untill I can't walk at all.
I have pain 24-7 . I have been taking 500mg to 1500mg of Vicodin
a day and muscle relaxers for the past 5 years. I know that I am addicted but it has not gotten out of control because I cant take
more than 2 or 3 a day without vomiting, which is unbearable. The pain is driving me crazy. I get "stuck" often, unable to move without severe pain. I sometimes have numbness in my right leg and tingling in my feet, most of the time I have to walk taking short steps. At times my bladder and bowels feel like there going to explode. I am scared of surgery and want to wait as long as possible, but I HAVE to find a pain killer that works better
than what I'm taking now. Any advice would be greatly appreiciated. Email me at ***@****
       There are places on the web that say Advanced outpatient
Endoscopic discectomy is 90% effective, is this true? Is this the same as microsurgery?

[CCF Neuro[P] MD, RPS]

Dear Nancy:

I would see a pain specialist.  Viocodin is addictive and is likely the source of your bowel and bladder problems.  Micro surgery is a toss up and it depends on the surgeon and the lesion they are operating on.  I would also see your neurologist and see if there are rehab specialists in your area to help you manage your problem.

Sincerely,

CCF Neuro MD

[Jo-ANN]

Dear Nancy,

I know the pain sometimes is unbearable..( i too have multiple
herniations (cervical) arthritis, bone spurs etc-one surgery
under belt) but pain medication seems to actually make the pain
worse-it's true!  I take hydro-codiene a couple times a day for
a month or two and then get right back off it again because of
constapation problems, addiction and it doesn't solve the problem.  Get off the medicine gradually and use it only when
REALLY needed.  What helps me just as good is the over the counter NYQuil type medicine for nights that  pain kept me up-
but don't overuse that either.  Most of all remember that your
pain can be put  to good use-offer your pain up for the conversion of sinners-unite it with Jesus's on the cross.
Thank you med help for all your help and may God bless you this
holy season.  

jo-ann (***@****)

[CCF Neuro[P] MD, RPS]

thanks for the comment.

CCF Neuro MD

[david]

I am a 32 year old male with mild HNP C4-C5 and moderate HNP C5-C6 (per MRI).  I was extremely active until approx. a year and a half ago when pain associated with running and jumping has forced me to slow down tremendously. Moderate to heavy exercise and job related stress trigger extended periods of pain and discomfort. I am trying to avoid meds although they have been prescribed. I am also hoping that the next 5 years will bring about surgical advances that will make surgery less of a crapshoot.  Are there any surgical procedures on the horizon that you can tell me about that might offer pain relief with less muss and fuss? Something less invasive and more effective?
    I would appreciate any help you can give?  If you can refer me to any med. journals that would be a great help also.

[warren]

I have radiating pain down the left side of the neck, and radiates down into my hand and fingers, burning sensation in my fingers feeling like someone is sticking needles in them.  I also have severe back pain which the doctor says is a herniated disc in the C5-6.  The neurosurgeon had recommended an anterior cervical diskectomy, and states that 90% of these surgeries are successful.  I want to know of anyone who has had this procedure, and want to know the recovery period, as the surgeon has told me that I would be able to return to work (as a correctional officer) in two weeks.  How successful is this surgery for these particular problems, and is it advisable to have it done.

[CCF Neuro[P] MD, RPS]

Dear Warren:

Without seeing the films and doing the neurological exam it is impossible to tell you.  If you have read some of the postings you would know that surgery is the last resort, and many times things are better and many times they do not change.  Alot depends on the surgeon, the lesion, the patient's adherence to rehab, and ....  

CCF Neuro MD

[Frank]

HERNIATED CERVICAL DISC:  My MRI Conclusion:C6-C7 broad Herniated Nucleus Propulsis; C5-C6 retrolisthesis*** and suspected cord gliosis from myelomalacia; multilevel spondylosis and uncinate process degenerative change; multilevel mixed spondylotic and soft disc disease--as described in the "body" of the MRI as follows: (***Grade 1 only retro.)At C6-C7, broad H N P superimposed on spondylotic change causes cord flattening and moderate central stenosis, bilateral uncinate process causes high grade neural foramen encroachment and mass effect on the exiting bilateral C8 nerve root complexes; At C5-C6 bilateral uncinate process spurring causes high-grade neural foramen encroachment and effacement of the C7 nerve root complexes bilaterally;anterior spurs, most markedly at C5-C6 and C6-C7.The high level chronic pain radiates across my left shoulder,down the left arm to the end of the left index finger, with numbness on the underside of that finger and mildly to a small part of the left thumb.

I am a surviver of three surgeries at my L4-L5, L5-S1 only AFTER ALL of the various modalities of rehab therapies offered at "world class" Pain Clinics did not solve the low back  problem.
Surgery,  then, for my L-spine and is now a "last resort" for my C-spine, BUT this begs a question.

I was told a chiropractic physian in my community had a very similar C-spine problem like mine described above. He tolerated the pain for an extended period of time, the amount of time not known by me.They tell me HE WAITED TOO LONG until he had to have "plates" put in his neck. By waiting, his muscles shrunk so significantly that he lost the strength and use of his left arm and hand. I have been told that I have lost 10% to 15% of my strength in my left arm/hand with only a slight measurement difference of left arm/right arm. My relentless acute pain episode started in July 1999 and continues to date, without a break.

(AT LAST) MY QUESTION IS: What is the "range" of time one can use medicines, epidural shots and non-invasive therapies and still feel comfortable that the risk of "loss of use" or atrophy is in the low risk probability range?

Perhaps with your answer you could refer me to further specific information related to my problem or to a location that I can research. Please accept my sincere appreciation of your expected reply.

[Joann]

To Warren,
As a 40yr. old I had anterior cervical diskectomy in July 1999. I had fission and plating.( C4-5 and C5-6) I had 2 reputured disc.I had neck/back pain. I also had pain and numbness in my left arm and  hand. I am still recovering. I began therapy at 6 weeks post-op. I began a work conditioning program. Thats really when I went down hill. I started getting awful headaches with much dizziness. My left arm & hand were still numb and painful. An E.M.G. showed carpal tunnel syndrom. I have large knots behind each ear causing much pain. I have quit the work conditioning and only doing therapy for the carpal tunnel & myofacial release for the tightness in my neck. All symptons are improving at this time. I also got T.M.J. from the surgery. They prop your mouth open and have your head in an odd position for the surgery. The T.M.J. also causes one to grind their teeth while sleeping. I had to get a tooth repaired and now wear a mouth piece while sleeping. I was told I would return to my job 2-3 month post-op. Its been 6 1/2 months and I'm a long ways from returning.

[CCF Neuro[P] MD, RPS]

thanks for your comments.

CCF Neuro MD

[jsh]

i was involved in a low impact collision approximately one month ago.  i was a passenger in a taxi cab and we were stopped at a traffic light when we were rear-ended by another vehicle.  I don't remember the accident because i was so intoxicated at the time, and there was no damage to either vehicle. about two days after the accident i developed intense pain in my neck and had numbness in my right arm. the insurance co. has refused to pay my medical bills because they say that there is no way that the accident could have caused my injuries.  i don't remember much about that night, but the accident is the only thing that i can possibly think of that could have caused my pain.  can an accident of approx. 5 miles per hour cause a herniated cervical disc?

jsh

[jsh]

i was involved in a low impact collision approximately one month ago.  i was a passenger in a taxi cab and we were stopped at a traffic light when we were rear-ended by another vehicle.  I don't remember the accident because i was so intoxicated at the time, and there was no damage to either vehicle. about two days after the accident i developed intense pain in my neck and had numbness in my right arm. the insurance co. has refused to pay my medical bills because they say that there is no way that the accident could have caused my injuries.  i don't remember much about that night, but the accident is the only thing that i can possibly think of that could have caused my pain.  can an accident of approx. 5 miles per hour cause a herniated cervical disc?

jsh

[Pamela Olsen]

I have a disk problem of the 5-6-7th. I have had this for problem
for 10 years, but it started at just the 5-6. I had another MRI on 5-19-00 and found out that the 6-7th was affected to and they both are herniate with possible fusion. The neurosurgen that I am seeing is saying that I am a candidate for surgery. I have read all the notes here and it dosen't sound to promising, but I have had this for along time and it affects me so bad that just getting out of a car, turning my head the wrong way, or just stretching in bed makes my neck go out, I mean I can't even move my neck. Are the success results of getting rid of the pain really that bad! I go to PT now cause my neck just froze up in May, and one year it froze up 4 times. I just feel that I can't go through this all the time, but if it's really that bad I might have secound thoughts. Do they really have to take a bone to replace your disk and put a plate and  screws in your neck? Thanks for listening. Pamela

[Now I know]

My reply is towards the comments of Chiropractors.  I was in a car accident in November of 1999. I have had all the symptoms and pains and annoyances. After being pushed and moved around between 3 different doctors, and Physical Therapy for 6 months,  Ultram Hydrocodine naprosyn and ibuprofen, Finally the 4th dr. a rehab/physiatrist gave me my options for my herniation of the L4 L5, and C3-4 C4-5 C5-6. Chiropractor, Pain management, Cortizone shots, Or Just deal with it ( since I WILL NOT have surgery ) I just finished up my 2nd visit with the chiropractor and I see a difference in the pain in my lower back.  Yes after the first visit I wondered if this was doing me more good than not.  But I figure after 7 months of "squat" getting accomplished What do I have to lose. Also in my dealings with the drs. and insurances You are going to get the run around, no one wants to "diagnose" the patients problem or order tests or etc. because then the insurance is going to "dock" them kick backs.  First and up-most thing to remember is YOU ARE THE EMPLOYER of these doctors. You are the one paying THEM.  I completly know better now that I am the one in charge of my health and body. NOT the doctors. It took me 6 1/2 months of complaining and trying to figure out what was wrong with my neck until Finally a MRI was taken of my neck and Wouldnt ya know it, I wasnt faking it, I just wasnt wasting their time, I did have something truly wrong , So who was wasting whos time here. I say, If you have tried the meds, the Pt the drs. I would definatly NOT do surgery for a mild herniation  or buldge, if you question it, just ask someone in your Pt facility that has had the surgery and see what they say. It will scare you to death about the surgery. Good luck all!

[susieq]

I have empathy for all you fine people out there with herniated discs. I also have a herniated disc at c6-7. I will be having outpatient surgery in Ca. in August. The procedure is called CED which means cervical endoscopic discectomy. The bulge will be sucked out with a scope-only 10% of the disc is removed and it is local anethesia. Has anyone here had this procedure? I have pain and weakness down my right arm. I have seen a chiro and done 8 weeks physical therapy without much success.