Bulging Cervical Disk

[JKuli10]

I have been advised be my doctor that I have a bulging cervical disk at the c5/c6 level.  In the MRI films he can see that it is pressing on my spinal cord.  He basically said that it is not large enough that I have to have the surgery, but based on my symptoms, he would recommend it.  He advised of fusion and the prestige disc replacement, gave me all of the details, answered the questions I had and then said it was up to me to decide if I want to do the surgery and if so, which one.  
As you can see in the symptoms I listed below, I have been in pain for a long time and it is getting progressivly worse, so I decided that I wanted to do the prestige replacement.  My insurance company (BCBS) has denied my claim and we are beginning the process of lobbying for approval.  In January my insurance will be changing over to Aetna and I have heard that they are currently approving the surgery for their policy holders.
My questions for you are, based on the symptoms below, would you recommend surgery?  If so, which one and is there any risk to waiting for January for the surgery?
Symptoms:
General neck and back pain and headaches since 1997
Numbness and tingling in neck and left arm and hand (mainly pinky and that side of my hand) started in October 97
Numbness and tingling also affecting right arm and burning sensation in neck and upper back starting Jan 98
I was sent to physical therapy for a suspected bulging disc and after 6 weeks symptoms increased so I was sent for an MRI
After seeing the bulging disc in the MRI I was sent for more Physical Therapy and Cervical Traction.  After 6 weeks no major improvement in symtoms except for a decrease in the headaches.  Typically after traction 1-2 hrs of relief and then a full return of syptoms.
I am currently taking lortab 7.5/500 at night to sleep and ibuprophen 1-2 800 mg during the day to get me through (1 at 8am and then another in the afternoon 2-3pm)

[Prem Pillay, MD]

There are several options for your problem.
If you looking for a non-surgical option that could "control" your problem then facet blocks, medial branch blocks together with more advanced physiotherapy such as aquaphysio (www.aquaphysio.com)  could be an option.
In the medium term, another option to consider is a non surgical percutaneous laser discoplasty or plasma energy discoplasty, which is done as a day procedure under local anesthesia. This can reduce pressure within the disc and the beneficial effects could last a few years. Again this should be supplemented with a high quality spine physio program.
If you are looking for a more long term solution, then artificial disc replacement is certainly a good option. This is provided there is no inherent cervical spine instability or osteoporosis.

sincerely yours

Dr Prem Pillay MBBS FRCS(C) FACS
Director of Neuro and Spine Services
Neuro Spine and Pain Center
Singapore

www.spine-neuro.org

[Daniel66]

I went to the doctor and after the getting the results of my MRI I have a buldging disc in c4 and c5. What is the difference between a bulding disc and a herniated disc? Can this be healed? What would be my best course of action? The doctor put me on a cycle of Medrol to reduce the inflammation. I have pain on my neck and my left arm. I have been losing strength on my left arm also and it's difficult for me to sleep. Can spinal decompression help? Please advise.

[usedtobeabletodothat]

Hi - I suffered an auto accident that left me with sore stiff neck that eventually traveled down the shoulder(underneath) , down the arm & into the hand leaving numbness that was sometimes at the pinli/ring, & sometimes at the thumb.  Almost always in the forearm.  Headaches are awful.  Very, very heavy head literally.  Tried 14 mths of conservative measures.  Traditional PT w/ traction for 6-8wks, then epidural & nerve blocks, followed by PTs who practiced integrated manual therapy.  Then gave into surgery & decided to go with the prestige cervical disc -vs- fusion.  I felt strongly against fusing the spine, because you change the mechanics of it's function & believe strongly that the adjoining levels will likely show problem with the extra stress the fusion would put on them.  However, I must say, that 10 mths after surgery I am nearly back where I started.  I'd make sure it is a disc & that they address the disc that is truly the problem.  I think I have scar or other soft tissues impinging nerve somewhere in the plexus....but I am not a doctor just an average jo who has had a little anatomy schooling.  Do know that after the disc is put in, you can no longer have an MRI in the future.  Still glad I chose arthroplasty over fusion.

[Cyndi2]

A related discussion, a second neck surgery ? was started.