how serious is my problem?

[crazysunny11]

my mri report says 1 discal bulge,central anular tear at C5-C6 with no neural compromise. 2 small posterior marginal osteophytes,discal bulge, broad based central and left paracentral at C6-C7 with thecal indentation,pressure over left exiting root. i am suffering from pain in neck and headche and unable to get a sound sleep

[Lama Chahine, MD]

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 what the implications of your MRI findings means exactly. However I will try to provide you with some useful information.

The vertebral column is composed of several small bones. The bones in the neck and upper back are termed cervical bones, or C. C5-C6 is the area between the 5th and 6th bone (if you were to count from the skull down). There is a material that cushions the space occurring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones; this is called a herniated disc, or bulging disc. The disc may push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself. It sounds like you have a herniated disc at the C5-C6 level, and some arthritis with a herniated disc at the C6-C7 level, and that there is some pressure on the nerve as it exits the spine at that level.

In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. 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 ibuprofen), 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.

Your headache is likely related to your cervical problems. Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.

Continued follow-up with your neurologist is recommended; there are several treatment options that can help you through the most painful part, and if continued pain or other neurologic symptoms occur, further management options would be available as well.

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