Herniated disc and more - read my MRI - and where do I go from here?

[moogleslam]

Findings:
There is straightening of the normal cervical lordosis.  The cervicomedullary junction is within normal limits, and the cord demonstrates normal signal.  The vertebral body heights are well maintained.

C5/6:
Mild disc space loss is present along with a mild diffuse disc bulge with a small hard disc in the right lateral recess resulting in mild right neural foraminal narrowing.  The exiting nerve root and lower exiting nerve roots appear preserved, however.

C6/7:
Mild disc space height loss is present with desiccation of the disc.  A large right lateral disc herniation is present, which also involves the right lateral recess and results in a mild spinal stenosis.

C7/T1:
A small central disc protrusion is present with a minimal spinal stenosis.

So, there's my MRI.  My symptoms started about a year ago, initially, and for about 6 months, I just had right elbow pain, which I thought might be tendonitis.  About 6 months ago, I developed pain in my right shoulder and down my entire arm, including tingling in my hand, though the pain was most intense in my elbow and shoulder.

I have been going to Physical Therapy for about 5 months with no improvement.  Now that I've finally had an MRI, where do I go from here?  Surgery?  I'm a basketball player and want to get on the court again as soon as possible.  I feel I've already wasted so much time with Physical Therapy that hasn't helped at all.

Thoughts?

[BIGGUN69]

MY NAME IS GARY. I LOOKED OVER YOUR MRI REPORT AND IT LOOKED ALOT LIKE MY OWN BACK IN 2004. I ENDED UP HAVING A C5 C6 DISKECTOMY.WHICH STOPPED MY RIGHT ARM AND SHOULDER PAIN . NEEDLESS TO SAY THE DAY THE NEROSURGEON WAS RELEASING ME BACK TO WORK 9 MONTHS LATER HE TOLD ME THAT I HAD A BULGING DISC  WHICH WAS CAUSING MY LEFT SHOULDER PAIN AND THAT SURGERY HAD CAUSED IT.  I HAD A MRI DONE BACK IN MARCH AND IT SHOWED 2 HERNIATED DISC  BELOW AND 2 HERNIATED DISC ABOVE THE FUSION . HEY MAN CHECK OUT LASER SPINE INSTITUTE.COM/DISC .THINK REAL HARD BEFORE YOU LET A SURGEON TALK YOU IN TO A SURGERY LIKE I HAD THE PAIN RELIEF LASTED ABOUT A YEAR. I KNOW SEVERAL PEOPLE WHO HAS HAD THE SAME SURGERY AS I HAD AND THEY ALL ARE HAVING MORE TROUBLE OR EVEN HAD ADDITIONAL NECK SURGERY. ASK ABOUT A PROCEDURE CALLED RADIO FREQUENCY. THATS WHERE THEY GO IN AND BURN/DISACTIVATE THE NERVE THATS CAUSING YOU THE PAIN .I HAD THAT DONE IN MY LOWER BACK AND I HAVENT HAD ANY PAIN IN MY RIGHT LEG IN 5 YEARS . IM CONSIDERING THAT FOR MY LEFT ARM PAIN . AND ASK YOUR DR FOR A STEROID PACK IT REALLY WORKS WELL FOR A INFLAMATORY . GOOD LUCK

[moogleslam]

Thanks Christopher, I appreciate the response.

My update over the last few days is as follows.  

My D.O. sent me to a Neurosurgeon.  He evaluated me in his office.  I trust he did the tests you speak of.  He noticed no muscle weakness; his only finding was that when he did the tap above my right elbow to test reflexes, my arm did not respond as it did on the left side.

He looked over my MRI report and images.  He said the C6/7 disc is ruptured, not herniated.  I believe it is a lateral rupture, and if I recall correctly, looks to be pushing against my spinal column.  He explained that over time, my body might clear that out, but he presented surgery as an option also.  It certainly no longer seems to be the case that the disc just needs to go back in place, since it is ruptured, if I am understanding this correctly.

He was actually surprised I was functioning day to day as well as I am considering what he was looking at.

Seeing as I am in pain, and cannot do the things I normally do, surgery is where I am leaning at this time.

The surgical procedure and dangers were explained to me, and I was told to expect an overnight stay in the hospital, and at least two weeks out of work.  Many other things were also covered, but I have some additional questions that only came to me after I left the Neurosurgeon’s office.  I will certainly ask the Neurosurgeon these questions, but would like to ask them here also, in order to get another opinion.
1. After surgery, when I get to go home the following day, I am likely to be on my own.  Is this feasible?  Will I be able to get up, move around, cook for myself, shower etc without assistance?

2. How soon after I get home from surgery will I be able to sit in the recliner, at the computer etc?

3. How long after surgery can I expect to be back on the basketball court?

4. What is the risk in me returning to basketball once cleared to do so?  Is the risk greater than before the pain began, or should I expect it to be like playing basketball anytime.

5. Are there certain things I should do to prevent a reoccurrence?

6. If I chose not to pursue surgery, and instead chose for my body to clear the ruptured part of the disc and associated scar tissue out on its own, how long should I expect that to take?

Thank you in anticipation.

[Christopher R Newey, DO]

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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

The vertebrae (bones of the spine) have material between them to cushion and allow for mobility. This material may be squished out and when it does it is a herniated disc. It can be squished out centrally or laterally. In most people the pain associated with a herniated disc may resolve within 4-6 weeks. A minority of patients do not respond to medical/conservative management and require surgery.  Symptoms suggesting the need for urgent surgery include muscle weakness, loss of bowel or bladder control, loss of sensation, and progressive pain.

The findings on your MRI at C6/C7 seem to be the most significant based on the above report and your descriptions. It does seem that you have a herniated disc.

A test called EMG/NCS can be performed to determine the extent a nerve is being compressed or damaged by a herniated disc. This test is performed by neurologist at most local offices.

I agree with your initial plan of being evaluted by physical therapy. I would also obtain a consult to a neurologist for an EMG/NCS. You should try medical management prior to any operation. Operations do carry risks. If you fail medical management, a referral to a neurosurgeon should be obtained. You may also be a candidate for a referral to a pain specialist. I would discuss this with your primary care provider.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck, and I wish you the best in getting back on the court!