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Multi-level Cervical Disc Issues

  I've had symptoms of c8 radiculopathy for over a year (including an ulnar nerve transposition last January).  Also, I found beginning last winter that when I lie flat on my back without a pillow, the "ulnar" fingers and sometimes all the others tingle. In July it was diagnosed as a cervical disc problem, and I've been managing conservatively with occasional NSAIDs since then.  More recently I've occasionally had various fingers go numb at night (all fingers on both hands at one time or another).  A couple of weeks ago I found that both lower legs were a little wobbly; I could still walk normally but it required a little extra attention.  The lower body symptoms, mild as they were, indicated that it was time for an MRI:
  1.  Mild broad-based disc bulges are noted at c6-7, and to a lesser degree c3-4 and c5-6.
  2.  Small central disc protrusion is noted at c4-5.
  3.  At no cervical disk level is there evidence of cord compression or deformity.
  4.  Endplate irregularity consistent with degenerative change is noted at c6-7.
  I'm 48 years old.  It seems to date the only disc that is highly symptomatic is c6-7, but I wonder if the leg coordination problem is a cumulative effect of mild cord effacement at several levels.
  I can still manage conservatively but I find that I'm increasingly careful of my neck posture and I increasingly avoid vigorous arm exercise such as shoveling or raking leaves.
  I worry that disc bulges at four levels, even if most are not now symptomatic, doesn't leave me with good options if even one of them gets to the point of surgical intervention.  I understand that a single-level ACDF is likely to enhance difficulties at adjacent disks.  It seems I REALLY need to avoid surgery at all costs, because it's either going to be a domino series of single ACDFs, or a single major (4-level) fusion.  
  Is it really this bleak?  Are there options besides ACDF that would be less destabilising in a multi-disc case?  I live in a small town and the choice of spine doctors is pretty thin.  Should I consult someone at a major spine center soon, or wait till I have operable symptoms?  Who could best advise me on avoiding surgery entirely?
  Sorry for the length of this.  Thanks in advance for your help.
Dear Stephen,
Disc bulging is a common finding on MRI's.  One study states that 30% of patients have bulging discs on MRI.  Only a small percentage of these patients will require surgery.  
The key when considering surgery in the neck is to be sure the neurological symptoms and pain are referable to the level at which pathology is seen on the MRI.  For example, a large herniated disc at C6-7 protruding to the right would cause pain and numbness into the middle finger on the right due to compromise of the C7 nerve root.  There may or may not be some associated weakness of the tricep muscle on the right.  If the disc herniation is severe, the patient may have troubles walking and incontinence of bowel and bladder function.  In summary, the examination of a patient should fit with what is seen on imaging studies.
The MRI you describe of your neck doesn't sound too terrible.  You describe no compression of the cord, though there could be some compression on the nerve roots as they exit laterally.  Also, you have had an ulnar nerve transposition which complicates things a bit.  This would also involve some of the nerve roots in question.  To sort through this your physician, after a thorough neurological exam, may choose to order an EMG.  This may help to differentiate as to where the problem exists.
Remember that most bulging discs don't need surgery and that much of what is described on your MRI is from general 'wear and tear' on the spine over the years.  It is quite common.  
You may choose a second opinion to a spine surgeon to be sure of things.  If you desire, an appointment can be made to be seen at the Cleveland Clinic by calling 800-223-2273.  Ask the operator for the neurosurgery scheduling secretary.
Good luck.

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