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need alittle help with thoughts..

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Old 02-22-2010, 12:33 PM   #1
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need alittle help with thoughts..

Hi you guys. Im usually found on the MS board- but Ive got some questions that I was hoping you neck experts could answer.

Ive had neck pain for over 2 years in the C3 and C4 area of my spine. Since I also have MS, much of what was bothering me was written off as MS pain..including the numbness and tingling in my hand and fingers on the same side...

Because I have MS, I get MRIs 2x a year of my Cspine and brain....the brain is where all my MS lesions are, the Cspine has always shown SOME bulding of the disc at C3-c4, HOWEVER my latest MRi showed this in the report:
Moderate size central disc herniation at the C3-4 level which is abutting at the ventral cord and increased compared to prior study. No gross evidence of intramedullary plaques or abnormal enhancement.

Can someone tell me in laymans terms exactly what this means and if there is any possiblity that something- other then surgery will help? Ive had PT, that didnt help. Ive had steroid trigger point injections, they do take the edge of the pain off, but not,Im at a loss. Im terrified of chiropractors, and dont know if I should explore that route. Ive also tried accupuncture for the pain and it did nothing....this is the first time Ive read the word herination...before it was just "bulging"...Im guessing its getting worse?

Suggestions are definately welcome.
RRMS- dx 05

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Old 02-22-2010, 02:12 PM   #2
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Re: need alittle help with thoughts..

Hmmmm, you are having symptoms, you have tried a number of conservative treatments, so perhaps it is time you were evaluated by a neurosurgeon but you would need to find one that is also familiar with MS. The theme most here repeated is that nerve damage if left too long is not reversible. Just my thoughts....

Old 02-22-2010, 03:27 PM   #3
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Re: need alittle help with thoughts..

Your thoughts are appreciated, thank you. I do realize that permanent nerve damage is not reversible, story of my life! Having MS is also having permenant nerve damage, in different areas associated with the central nervous system. Since I have so many lesions on my brain and black holes are developing where there is no supporting tissue- this is just "one more thing" to worry about! Fortunately, I work 60+ hours a week, go to school on a doctorate level- nothing has slowed me down yet...but yes, Im scared to death of the thought of future surgery.

Tell me, can this be ignored? Besides the pain- is it debilitating in any way? Can it hurt me to "live with it"?
RRMS- dx 05

Old 02-22-2010, 07:38 PM   #4
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Re: need alittle help with thoughts..

Hello - There are people who do live with these kind of findings and do not ever do surgery. It really comes down to two things - 1) how you function with your symptoms, and 2) if your surgeron says it is beyond where you can wait. Surgery is not always the answer and sometimes depending the case - symptoms can persist. The other thing is with time sometimes these bulge/herniations will shrink back enough to calm your symptoms. However, you may have future flares. If the trigger point injections helped, maybe it would be worth trying the epidural type injections.

What it means is the disc in between your vertebrae at that level has degenerated and the inner gel like material has bulged out of the outer fibrous band that encompasses the disc. Your herniation is in the central canal where the spinal cord runs. C3-4 level can generate headaches and neckpain. Abutting means touching against the cord. The good news is there was no abnormal signal of your spinal cord - which is good because compression of the cord will usually cause abnormal signal. If there were no other cervical levels with problems you might be a very good candidate for minimally invasive surgery where they go in and pluck out some of the disc so it won't compress any structures. There are surgeons who do this type surgery as outpatient with a very tiny incision.

Old 02-22-2010, 09:09 PM   #5
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Re: need alittle help with thoughts..

Not an expert, but I would think that you need to consider the amount of impingement of the spinal cord. A small amount, you may have the option to wait, try other things if you want. But if you have significant impingement you should consider surgery.
I would think the more impingement you have also means more of the body nerve signals are blocked, including to/from internal organs. Also, if there is a lot of impingement a fall could possibly cause the impingement to bruise, if not hurt the spinal cord.

Having said that your report does say "Moderate size central disc herniation at the C3-4 level which is abutting at the ventral cord" and I see no mention of narrowing, which in my inexpert opinion means you have time to consider other treatments other than surgery, if there are any. In my opinion if there is a mechanical problem with the spine you don’t see a chiropractor. I stopped seeing mine when I was diagnosed back in 2003.
It is words like: "frank cord compression", "severe acquired spinal canal compromise" or "narrowed to critical values" I worry about. Your doctor might want to wait and monitor your future MRI's as you have them regularly. Although I have recently found out that a CT/Myelogram is the "best and most comprehensive" imaging for spinal issues. (“The Gold Standard”)

It is the numbness that I would consider to be the issue at hand and the item I would make your doctor explain to you, after you have educated yourself as much as you can.
Ask point blank “What percentage of your numbness can be attributed to the MS and how much for the disc herniation at the C3-4?” They make you quantify your pain level.
Then tell him/her that you can’t afford any nerve damage / loss on something that can be repaired.

Good Luck
Apr 03 C5 corpectomy C4-C6 strut graft with titanium
May 03 Heart Attack, Balloon Angioplasty & Stent implanted
Apr 2010 sched for ACDF and laminectomy & stabilize C3 (maybe C2) to C7

Old 02-23-2010, 03:45 AM   #6
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Re: need alittle help with thoughts..

Hi NP and Cliff. Thank you both. Ive been reading both of your posts in this board and appreciate that you both took the time to respond.

NP- your explanation not only makes sense, but also gives me hope! Yes, triggger point injections have made the pain manageable and yes, Ive considered eoidural type injections. In my MS office, there is a pain specialist who does these under fluroscopy and Ive been considering a visit with her to see what she thinks. She comes highly recommended. Im not sure what type of minimally invasive surgery is out there, but if and when the time comes, that sounds alot better then much of what Ive been reading about! Ill start looking into this as well.

Cliff- the whole thing is a catch 22. Because I have MS and that is a nerve disease as well, no one can tell me whether or not my numbness comes from MS or from the discs. In fact, I was dx with MS when I woke up with numb hands 4+ years ago. My primary doc thought it was a pinched nerve. I had a CT with Myelogram, which showed abnomalities, and a Neurologist was called in. Futher testing (MRI, LP, etc)showed over 50 lesions on my brain, which led to the MS dx...regardless, there is absolutely NO WAY for them to ever quntify where the pain is coming from or if any type of surgery will lessen the pain.

So the big question is can I live with this pain ? At one time, I was seeing stenosis on my MRIs, which no one seemed to worry about, they said it "ran in the family" and that "it was normal for a woman my age" (43). However, IM not seeing that on this, yes, I agree, that its a good idea to keep repeating these twice a year and see what happens.

Youve both given me great explanations for what I read on the report, thank you. and Cliff- dont ever get MS! I give myself injections 3 times a week, I read where you are a needle phobe. Thats something we MSers have to get over, and quickly- as all FDA approved meds are in the form of an injection!
NP, having read your history, I truly hope you have more good days then bad. I know what living in pain is like...youve both been thru alot!

Thanks again.
RRMS- dx 05

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