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When do you know it's time for surgery? How bad should it get?
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When do you know it's time for surgery? How bad should it get?

I was diagnosed with DDD C6-7 in 1998.  I'm 43 years old.  Latest MRI says:Severe  degeneratiave disc disease, positional cord impingement ventral cord, which is flattened.  The disc below and above are starting to show wear also.  

I am doing physical therapy now.  I've taken Neurontin, which helped, but then symptoms returned. Had other rounds of PT in the past. My symptoms have always been the typical:  bad shoulder pain and muscle knots, heavy head feeling, aches.  I don't have shooting pains running down arm.  What made me go back to neurosurgeon recently was I am now getting numbness in my hands, especially my right.  It wakes me at night, too.  I have good grip strength, but I'm weak in the hand and arm.  Drop things alot. I get some shooting pains in back of neck.  This comes and goes, but it all affects my quality of life.  I have a desk job, and by noon time I'm quite uncomfortable.

Now that I have nerve problems, the dr. said if PT doesn't reverse the symptoms, I'm "borderline" for surgery, but would probably have good success.  My physical therapist acted like I shouldn't consider surgery until I'm in excruciating pain.  I don't know if I've "suffered" enough, or should I keep letting it go like I have been for 5 years?  I don't want to do permenant nerve damage.  If I have a cervical fusion now, do I have a better chance of the nerves repairing, than if I wait until it's really bad?  Can it improve on it's own, or is the degenerative disease always progressive?  

I'm just wanting to be conservative, but wondering if it's finally time for the surgery.
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Avatar_n_tn
When patients start to have clinical symptoms of weakness (objectively found on exam in addition to complaints of weakness) that is felt to be due to compression of the nerve by a protruded disc, we tend to be more aggressive and recommend surgical evaluation sooner rather than later.  If there is significant nerve compression (which is what it sounds like from your post) the longer you wait, the higher the likelihood that there may be permanent nerve damage that will be beyond repair.  Given that you;ve had severe DDD since 1998 and there has been no significant improvement, rather some worsening, it's unlikely that it will get better on its own. Get a neurosurgical opinion and have them evaluate your films and neurological exam. Let them help you decide whether or not surgery would be the way to go at this time. Best of luck.
6 Comments
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Avatar_n_tn
I know the pain you are suffering, back in oct. of 2001 I had a slip & fall accident, which caused a bulging disc at C5-C6 and a herniated disc at C6-C7. though my family Dr.said that it was just a muscle strain. sent me for 2 mos. of therapy, cortizone injection, nothing worked. so finally after 3 1/2 mos. of excruciating(spelling ??) pain, tingling,numbness & weakness on my right side, he finally sent me for a MRI. which revealed the problem. My mother drove me 3 hrs. to a neurologist in Pittsburgh, and he said the only option left was surgery. Well thanks to him, I am 90% pain free. I say 90%, cause now I think the bulging disc is cause me some discomfort. But I am so glad I had the surgery done and would do it again in a heartbeat. The pain was so bad that I  couldn't even lay down, I had to sleep in a recliner in a slight reclined position and on my left side. and the neurontin didn't even touch my pain.
My kids (ages 12&13)went through hell cause of my pain, though they we very understanding. I would seek a second opinion. you can't suffer anymore....
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Avatar_n_tn
What's confusing is that I'm not in the excruciating pain some people have.  I'm blessed in that area, but I can work around the aching and shoulder/neck pain.  It DOES change my quality of life, but usually comes later in the day and I just have to deal with it.

It's the numbness and loss of sensation that concerns me.  I think atleast if I WAS indeed in horrific pain, I'd have no question about whether it was time for the surgery.  I feel like I'm "on the fence".
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Avatar_n_tn
I have had three laminectomies and disectomies, involving L3-S1. The Dr. is now recomending a spinal fusion and bone graft of L3-L5.  Do I have to have 2 incisions for this surgery?  What about a brace?  How long do pts. have to stay in the hospital for this procedure, and how much pain should I expect and for how long?  I know I should of asked the Dr. doing the procedure, and will when I go in for my pre-op physical, I just wanted another opion.  Thank- you Sue
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Avatar_n_tn
had pain for years  in lower back    mri showed L4 L5 HERNIATED DISC  WENT FOR THE SURGERGY  FEEL GREAT  THE EARLY U GO THE BETTER U WILL RECOVER
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Avatar_n_tn
I had C-spine surgery in August2002. My MRI revealed pretty close to what yours says. My job irritated the problem; working at a PC 8 to 9 hours per day. Some days I could not even lift my head up in the morning. Every day became a struggle and since I have four daughters who need me, I decided to have surgery after finding a doctor I could trust. I had a bone graft (from cadaver) and a plate screwed into place. The recovery process was not fun, believe me. The collar was extremely uncomfortable, but I would do it again. I have so much relief and am able to do things now that I couldn't do for two years. I was back to work in seven weeks and am doing great. I no longer need any pain med, muscle relaxers and all of that I was living on prior to surgery. To me the risk is worth it if you find a trusted doctor who believes surgery is the best and only route to relieve pressure on spinal cord....the weakness will not improve and quality of life is too important at our age. I just turned 44 in Feb.
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