Neurology

[Cathy]

I am 42 and lead an extremely active lifestyle. I was swimming a mile everyday until I had extreme right shoulder pain and numbness and tingling in my rigth thumb and occasionally my index finger. This is in my dominant hand. Upon going to my HMO I was referred for an MRI. I have no clue what caused my diagnosis.I have moderate disc bulge at c5/6 with effaced ant. thecal sac and minimal cord flattening, some disc material extrude to neural exit formina Rt. greater than left. No other problems observed with c spine. This is the wet read. What is a thecal sac? I looked in a medical dictionary and couldn't find it. I have been referred to a nerosurgeon. (1) I do not want surgery if it can be avoided. What can I do to prevent permenent nerve damage to my right hand and arm? I am trying to learn to write with my left hand as I experiece the greatest numbness when I write. If surgery is indicated tell me more about a microdiskectomy. Is that the least invasive with the best prognosis. The question is what are my chances of geting full function back and what are the risks?  How long will recovery take? Would this type of surgery provide the quickest recovery. I certainly don't want to be a quadrapelgic after neck surgery! Am I paranoid-you betchah! Here is my most immediate concern. I am a teacher and I will be getting a dream job working with gifted students for twelve weeks. If I have to have surgery to regain hand function can it be postponed for three months? Are there things I can do to protect my hand and arm? By the way, I do have a medical background, so medical terminology doesn't intimate me. I took anatomy, neuroanatomy, physiology and all that stuff about 20 years ago. I did everything except finish my internship in OT.  If I don't know a word I can certainly look it up in a med. dictionary. That's not to say I'm by any means an expert. But, I do understand more than a total lay person does.
Thank you for your attention to my concerns. I have never been so terrified in my life!

[CCF Neuro[P] MD, RPS]

Dear Cathy:

I am sorry to hear about your problem.  As you likely know, without seeing the MRI myself and doing the neurological exam, there isn't much definite I can tell you.  Numbness in your right shoulder and hand may be caused by the cerivical cord changes, or it may not. The changes in the cervical cord at C5/6 are compatible.  However, the description does not sound like it should be giving you the trouble you describe (but everyone is different and I just can't tell).  I would not say that surgery is the initial course of action.  Most of us feel like surgery is the last resort when all else has failed and obviously you have yet to try other avenues. We usually recommend rehab with a rehab specialist and PT/OT initially.  I would see a referral to someone in rehab first.  Surgery can be curative or not have much of an effect, depends on the lesion and surgeon.  I would get a second opinion if surgery is recommended.  Swimming doesn't usually cause major problems with the C-spine and the type of changes you describe.  Talk to your neurologist before decisions are made.  Try the rehab route initially and see if that doesn't help things along.  

Sorry, I am not much help.

CCF Neuro MD

[Judy]

Hi Cathy,

The neurosurgeon will help you make the best decision about surgery. A word of caution. Avoid the mistake I made. The neurosurgeon wanted to operate on me - recommended it. I was scared because when my mom was put under general for a simple test - she died. Panicked - I tried the conservative route. Paid for it later when the disk really blew. Had surgery - great now in that regard. Not having surgery can be more riskier than having it. Be sure to understand the risks of surgery and the risks of not having surgery.

Also, a job is a job - don't wait if you need surgical treatment.

I've made both mistakes - putting job above health; thinking conservative is less risky - sometimes yes, but sometimes no.

Hope you make the right decision first time out.