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large herniation of c-7 disk orthopaedic surgeon suggests ACDF C 6-7
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large herniation of c-7 disk orthopaedic surgeon suggests ACDF C 6-7

six weeks ago I awoke with severe pain in my right side and severe arm weakness. I went to the E.R. they gave me valum..no results, I went to my family  doc. the next day he thought it was tendonitis, and prescribed vioxx 50 mg a day.  THis did help, but i have slight numbness.  the pain is pretty well gone, I have been off all pain medication for 7 days, are strength has returned, but not all of it.  I had an mri and it did show a large herniation in the c-6 to c-7 area.  I do have a dull pain in the area of my lower shoulder blade. The numbness is severe when I look up.  My question is :  Is surgery needed? are there other ways to deal with this? I have read the posts and it is not looking like surgery is a definate cure all. I am 32 years old and in good shape.  I am an active person who has never been sick for an extended period of time.
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Avatar_n_tn
Dear Becky:

Sorry that your symptoms have given you such problems.  As you have probably read in the other postings, we feel that surgery is the last resort for cervical problems, unless the problem is due to a mechanical problem (such as severe compromise of the spinal cord, or abnormal vertebral fracture).  You are not alone in your symptoms as you probably have gathered from the other postings.  We feel the best thing to do is rehab with a rehab specialist and PT/OT.  This will help with giving you excercises to strengthen the muscles surrounding the column and ways to alter your habits of structural stresses from improper sitting, standing, and/or walking.  If this doesn't help, then the question of surgery should be answered.

I hope things get better.

Sincerely,

CCF Neuro MD
9 Comments
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Avatar_n_tn
Hi Becky,

I had the same problem in January of this year. I had slight tingling in my right index finger last year but I lifted a heavy marble coffee table by myself and apparently caused the C6-7 disk to rupture. The symptoms started about a week later and got worse. My thumb,index and middle finger were in varying degrees of numbness. My tricep muscle was virutally useless. The pain was severe throughout my right back, chest and arm along with constant cramping. My head was cocked down and I couldn't lift my head.

Before my condition got really bad, I first went to my GP who gave me a cortisone shot and some pain killers. When things didn't get better I tried a chiropracter who proceded to crack my neck and diagnosed that I had blocked gallbladder?? Whatever!!?? I went back to my GP and he sent me to PT and a orthopedic specialist. I had to fight my HMO to approve the orthopedic specialist. The ortho sent me to get an MRI which showed the rupture. I then went to three neurologists. The first wanted to do a spinal fusion at C6-7. The other two said to just relax and take it easy and avoid any exertion or strain. They explained that the ruptured disk material should be reabsorbed by the body with scar tissue forming at the rupture. They said that the pressure at the cervical disks is less than that of the lower spine so chances of recovery are much better. I was also using some strong anti-inflammatory prescriptions to help reduce the inflammation on the nerve root. I also used a soft cervical collar to keep my head stable.

Well it's July and I'm feeling great. The recovery took about about 4-6 months from the onset. I'd guess that I'm about 97% back to normal. The only symptom left over is slight numbness (more like a dull feeling) at the tip of my index finger. I avoid lifting anything heavy and I can feel the consequences in my finger if I do lift something heavy. I think slight numbness is a lot better than having your spine fused with the possible complications involved. One of the neurologists said that you should always give time a chance to heal your spine and only after several months should surgery be considered if things don't improve or get worse. Also, surgery should be considered only if the injury is debilitating.

Good luck, take it easy and give it some time to improve on it's own.

Peter
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Avatar_n_tn
Peter,

What kind of antiinf. did you take?  How large was your rupture?
Thank you for replying.  I am so scared.  Nothing like this has ever happened to me before.  I don;t have a lot of pain, mainly just in my elbow and the tingleing in my  fingers.  but when I wear the soft collar, My entire arm goes numb...about your head being cocked down...same here down and to the left.  I feel great when I am flat on my back.  My herination is quite impressive according to my DR.  He can't believe that I am not in severe pain.  HE sais that if iI don't have surgery soon, I will loose use of my right arm...but the arm is getting stronger not weaker.  I did go back on the vioxx yesterday. but not because of pain..just because I was hoping it would help the swelling of the disk.  Thank you again Peter.
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Avatar_n_tn
I have been through it all. The first fusion was C-6 and that collapsed. The next year the doctor fused C5-7. Now it has been five years and I have had no relief.  Last January the doctor did another surgery this time he cut into the back of my neck to clean out the fusions and try to release some nerves because I was experiencing numbness in my right arm and hand as well as pain in my neck and shoulders.  I now have more pain, numbness and discomfort then before the surgery.  I waited several years before I had any surgery.  I tried the chiropractor, PT, neuromusclar massage, everything possible to no avail. That is when I had surgery and it bothers me more now than before.  Just thought this might persuade you to keep resting and taking care of your neck now because the end result could be worse.
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Avatar_n_tn
Hi Becky,

Hey I really feel for you. I know what you're going through. I was also really scared. I'm only 37 and have a family with 2 kids. You have so many plans and things to do and then somthing like this comes along. You're pissed off, depressed, afraid of what may await you and constantly thinking "why did this have to happen to me?!".

My head was also cocked down and to the left because the rupture was on the right rear quadrant of the spine. I couldn't raise my head or tilt it to the right. I wore the collar as much as possible because with my head hanging down all day at work, the muscles in my neck and back would get very strained and tired. But with the collar on the pressure on the nerves was greater so I tried to find a balance and would also take the collar off and on.

I had a bad problem of even sleeping. I had to lay on my back with my chin at my chest. Sleeping on my sides was definitely out of the question. It was almost impossible to find a position where my head was tilted at the right angle. Eventually when I fell asleep I would move and wake up with severe pain and cramps. I was up almost every hour or two tring to stretch cramps out of my neck and back. One of the worst events was taking the MRI. They made me keep my head straight back. I was ready to scream after being in that position for a 1/2 hr.

I'm not sure how large a rupture, large is. I saw it on the MRI and I would guess that it was maybe a medium size rupture compared to another persons MRI that I was shown. A lot depends on where it is ruptured. You may have a large rupture that misses your nerve or a small one that hits right on the nerve causing great problems. Here's part of my diagnosis:

The C6-7 level reveals broads minimal, posterior disk margin bulge. Additionally.. there appear to be extruded disk fragments in the right neural foramen, largely filling the neural foramen.

IMPRESSION

C6-7: RADIOGRAPHICALLY, THIS IS FELT TO BE THE MOST ABNORMAL LEVEL REVEALING WHAT APPEAR TO BE DISK FRAGMENTS EXTRUDED INTO THE RIGHT NEURAL FORAMEN. CORRELATE FOR RIGHT C7 RADICULOPATHY.

I was taking anti-inflammatories and muscle relaxers along with pain killers.

VOLTAREN(diclofenac)-antiinflammatory
BACLOFEN- muscle relaxer
VICODIN-pain killer

I guess the theory behind loss of muscle use is that the rupture is putting pressure on your nerve and causing it to become inflammed. With extended pressure and inflammation, certain nerve cells may die thereby causing loss of muscle use. What is the time frame for that? Couldn't really tell you that and I guess it really depends on the injury. I would venture to say that you are somewhat lucky given that you don't have extreme pain meaning that the rupture is not hitting the nerve root with a lot of pressure. But I would say keep your head in a position that is most comfortable (thereby keeping pressure off the nerve) and taking the anti-inflammatories even though you might be feeling better. Just remember, even though you might feel better, don't think it's a green light to go ahead as normal. Give it time, lots of time.

Peter
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Avatar_n_tn
Thank you for replying..your comments have made me feel better.  Today is a pretty good day...no pain at all last night...slept through the entire night...numbness is down to a slight tingle in my index finger...unless I look straight up or bend over and keep my head level...I am taking anti-inflam. but no pain medicine...I have a ache in my neck  between my shoulder blades...but it is slight...I hope that everything continues to heal.  I haven't been lifting anything at all. Soaking in warm epsom salts seems to help also...Thanks again Peter, My surgeon had me convinced that surgery was the only recourse.  I went back to my family Doc yesterday, and he said I may be one of the lucky ones that won't have to have surgery...but that my life will have changed...no heavy lifting or straining..which will be hard because we live on a farm...but I am going to do what he says...I do have an appointment with a nuerosurgeon at a university hospital Aug 25.  I hope I am better by then...Thanks again Peter.
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Avatar_n_tn
Has anyone ever heard of this stuff? It is supposed to be a topical anti-inflamitory?

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       Hello!
  
   I am a spinal injury patient, not a C-spine but a L-spine patient. I had looked for a new way of treatment for years, and had 2 lumbar operations and was fine for 3 years.  I was involved in a auto accident in 12/96 which left me partially disabled, and on pain killers, and lots of other medicines.
  I was watching The Learning Channel " The Operation" and  found a different way of surgery.  The doctor  who performed the operation was Dr. Stanton Schiffer M.D, Phd. Neurosurgeon out of San Fransico California.
  I e-mailed his office and within 4 days I received some encouraging news. Dr. Schiffer  wanted me to get a M.R.I. with Gadolinimum.  I talked with my family doctor and he agreed to order this.
   I fed-x the report and films to his office in Oakland,Ca. and I received a a call from his office 4 weeks later.  Dr. Schiffer  talked with me for 1/2 hour and told me I needed to have a "Disco-Gram" of the area in question. I  flew to San Francisco in 12/20/99, had this disco-gram which blueprints the disc  by injecting a Dye into it and inflates the disc. This finds the size of the rupture,or ruptures and Photographs it.  
   The results were I had 3 lumbar ruptured disks and most of the ruptures were in the spinal canal. L3-4 had 2 ruptures,
L4-5  was destroied,  L5-S1 was also ruptured.  With this info my insurance co. was o-k'd for a surgical Disco-plasty.
  I was scheduled for a Disco-plasty on all 3 discs.  This involves Laproscopic surgery to suction out the gel from inside the disc in effect shrinking the size and sucking the rupture back into the disc, removing the protrusion. Then a Copper wire was fed into the disc and was heated to 185 degrees to kill the center of the disc from making more Gel.
  After 6 hours of surgery and 10 hours at the surgical center I was released to go back to my hotel. I didn't feel any more pain from the operation, then iI did when I arrived, and wasn't even sore until the 3rd day. I was very sore then but this went away in 2 days.
  I returned to the office on 1-4-00 Dr. Schiffer told me that he did what he could, for now and lets see how I feel in 4-6 months.  I have been in contact with him about every 3 mo. I now take 40% less pain meds and muscle relaxers, and I can sleep better, and some range of motion has returned, and I now am able to drive longer and so on. This Doctor worked on me for 6 hours, with 3 incisions and only 3/ band-aids as surcical entry sites. After the main surgery my wife and I stopped for supper, and I wasn't in any pain from it at all.  
    Check into other means of surgery for pain relief. Dr Schiffer works on the west coast, but e-mail him and he may direct you to a Doctor that he has trained near your location.

    Doctor Schiffer has a Web site!
  
    Stantonschiffer@ drschiffer.com   This man is a Miracle  Worker

  I thought I would inform you about new ways to relieve a  pressure to the spinal cord, by new forms of surgery.
  Good Luck  in the future  
     Sincerely,  William Mueller   a.k.a.   ***@****
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Avatar_n_tn
At Present there are two doctors who perform laser surgery in the neck and lower back areas if you go to google and enter cervical laser surgeons you will get a response from the Bonati clinic in Orlando Florida. They have done 10,000 laser surgeries with a 93% success rate. There is also a doctor in California who does the same thing. Good Luck to all of you. It is expensive and you have to fight your hmo but its worth it. I was in a car wreck causing 10 discs to herniate 4 in the neck and 6 in the lower back. Pain pills will not eliminate the pain. Pain Clinics have a procedure to burn the nerve endings in the area of pain but the procedure is on going and not a a resolution to the problems. Recovery time is 2 to four weeks with a lot of ice packs and anti inflamitory medications. God Bless you all: jim
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