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Neurology  (Expert Forum)
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TREATMENT: cervical herniated disk, bulging disk, ddd, djd, root damage
Answered by
Esteban Cheng-Ching, MD - Neurology, Internal Medicine
Cleveland Clinic Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury

TREATMENT: cervical herniated disk, bulging disk, ddd, djd, root damage

by mylove4logan, Jul 16, 2008 09:30AM
I'm 38/F
The MRI report showed:
*Herniated disc @ c5-6 with some mild bulges @ c4-5 & c6-7.
*Minimal arthritis.
*HNP (L) c5-6.
* (L) c6 nerve root damage.
*Mild  DJD-degenerative joint disease.
*DDD-degenerative disk disease.

My neurologist wants to do the Epidural Steroid Injection on C6-7.
My husband thinks I should just go to a chiropracter.  Is this too late for a chiro?  I think I'm better off sticking to my Neurologist.  Any opinions deeply appreciated!
Also, do you think my MRI report is bad news??  
Are there any limitations that I should not do??  (Lifting over certain pounds, etc.)??  
Anything else I can do at home to ease the pain in my neck, shoulder, tingling in my thumb & couple other fingers, and massive headaches?  My neck movement is limited.   Started approx. 4-1/2 months ago.
I'm on Tramadol & Neurontin, prescribed by my nuero.  I also take Ibuprofen 800mg when needed.  Heating pads.  Memory foam pillow.
Please help!!
Terri

by Esteban Cheng-Ching, MD, Jul 21, 2008 01:19PM
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 take a history and examine you, I can not tell you what the cause of your symptoms is. However, I will try to give you some information.

Regarding your MRI report, it is not very common to have multiple areas of degeneration and herniated discs at 38 years of age, unless there is an underlying cause like arthritis, or osteoarthritis.  However it is very important to know the severity of the damage, and this sometimes is under or overestimated in the reports.
Sometimes the MRI reports gives a lot of information that may not be clinically significant, and so some reports may say that there are multiple areas of herniated discs and degeneration, but they may not comment on the severity and this is something that counts. It is important to actually see the images in order to say if they are significant or not, and just based on the report, I cannot give you a more specific information without seeing the films. But I can say that at age of 38, DJD is not common.
Based on the severity of the herniated discs and DJD, patients with more severe disease should avoid lifting heavy objects or doing movements that may produce pain. Depending on the severity, other therapy may be needed, and so more severe cases sometimes require surgery. Surgical intervention is usually reserved for patients who have a very severe problem, evidence of neurologic symptoms or signs on examination, evidence of spinal cord compression or nerve compression, or no improvement with other treatment options.
Usually patients with herniated discs  and DJD of mild to moderate severity will benefit from physical therapy and exercises, and different rehabilitation and physical therapy programs will have recommendations regarding this, and I think this is very helpful.  Medications are used to help relieve the pain and the uncomfortable sensations, and so the medications you mention are part of the therapy.
I don’t work with chiropractors, but this is just my personal practice, and I don’t send my patients to chiropractors. I cannot give you an advice about this.
Neurologists, depending on their training and their practice, as well as depending on their experience, may consider trigger point injections. As the cervical area is enclosed, difficult to reach, and close to important structures, this should be performed by an experienced neurologist.
I think one of the important things you should discuss with your neurologist, is why do you have DJD and herniated discs at your age. This may warrant further evaluation if your problem is significant.
If your symptoms worsen, if you have numbness and tingling, weakness, or problems with urinary and bowel incontinence, you should seek medical attention sooner. I think you should discuss your problems with your neurologist, and see what he thinks.

As I said previously, without being able to get a history and examine you, and without being able to see your images I cannot give you more specific recommendations. I hope this is helpful.





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