I have a very large disc bulge with right central extrusion at my C5-C6 level. This is causing flattening in the right ventral cord. Even though the extrusion is on the right side, since it is in the central cord, it is causing pain, numbness and tingling on my left side. I also have severe burning in the left back of my neck and into the base of my skull. I feel like I can hardly hold up my head by the end of some days. I work at a stressful desk job and commute an hour each way to and from work. I have had EMG and NCV with only mild weakness at this point. The Mayo trained spine surgeon I have visited said I will need surgery, not an option, and it will be almost instant relief. The procedure he described sounded very simple and minimally invasive with a very quick recovery time. I have several other people telling me if I just suffer through it a little longer, it will improve on its own.
My questions are, does this ever improve on its own; is it really as simple as I've been told; and what risks do I run by not having it done?
It would be helpful if you could transcribe the radiologist's report of your cervical MRI here.
I'm not sure what's meant by "extrusion". Does he mean the disk is herniated and the nuclear material is spilling out?
As for the surgery being "minimally invasive", I guess that depends on what you mean by "minimally". I'm assuming that the surgeon intends to do an ACDF, where an incision is made in the throat, the disk pulled out, something (possibly donor bone) put in its place, and the whole thing "clamped" together. Is that what's planned? Or is he planning to come in from behind and do what's called a "microdiscectomy"?
As for this getting better on its own, there's one simple thing to do. GET A SECOND OPINION. RIGHT AWAY. Don't dawdle. In fact, you could set up a surgery date with surgeon #1 and get a date for a second opinion in the meantime. There's really no excuse for not getting at least two opinions, and the surgeons themselves know that.
As for it getting better on its own, I don't know. My understanding, however, is that you have only so long before you risk having the pressure on your cord create a condition called myelomalacia, which is permanent. I've been told six months, but I'm sure there's great variance. Certainly something the second guy can clear up when you see him.
Yes, that is what they explained is meant by an extrusion. They said it is identified by the mushroom shape of the bulge. The MRI says "disc bulge with superimposed right central extrusion at the C5-C6 level, which flattens the right ventral cord at this level. No abnormal cord signal is seen at this time."
So far, I've been to an orthopedic surgeon who sent me to the spine surgeon. When I attempted to go to physical therapy on my own,the DC who runs the physical therapy clinic refused to touch it and also said to go to a surgeon. The doctor who did my NCV and EMG refererred to it as a "very impressive bulge". Non-physicians are who say not to do it because it will get better on its own.
The orthopedic surgeon used the word huge, the pain dr used the word impressive, I don't remember the spine surgeon using an adjective to describe it. The procedure is what you described where they go in through the throat, pull out the disc, insert a spacer and screw it together with a bracket. Thank you for your response. It is greatly appreciated.
So, an ACDF it is. Pretty routine surgery, in spite of how drastic it sounds. Just get the best surgeon you can and don't worry about hurting anyone's feelings. You don't want someone practicing on you...
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Maybe I missed it but have you said how long you have had these issues?
And have you done every possible non surgical way to treat this with traction, physical therapy, injections, steroids, nerve pain medication and/or a muscle relaxer?
Usually if it isn't an emergency surgery needed (as in a week out from the MRI)...then a good Board Certified Neurosurgeon will recommend using every modality and giving it 3-5 months to see if it calms down or your symptoms go away.
And as WD mentioned, getting at least 2-3 opinions from Board Certified surgeons who don't know one another to see if they say they same thing about needing surgery.
So, if you have done all the treatments and gotten all the opinions you can feel more confident that this is the way to go.
Just my thoughts and what I have learned from my Neuro. I've had 3, two-level, fusions so I've been where you are...
On the other hand.... we see lots of people here who are in the anything-to-avoid-surgery camp. I think that if you have a disk bulge that a doctor describes as "huge" - and particularly if it is herniated - then you want to be very careful about spending a lot of time on alternatives that are unlikely to lead anywhere. From what I've been told, spinal cord damage becomes permanent if left too long. In fact, I'm a living example of that.
Still, I'd get that second opinion ASAP, and ask about alternatives. If the second guy disagrees with the first, go back to the first and ask for a rebuttal. Before my last surgery, I saw three surgeons a total of six times, and I'm glad I did.
Yep...it's all about getting those other opinions and then if all 3 Drs. are saying the same thing about surgery and you have bad nerve pain and loss of strength....then surgery is the next step.
I'm speaking about the 85% that can even have severe herniations..but if they aren't having nerve related issues...then going the non surgical route for awhile is recommended.
I have had 3 severe herniations for the last 6 years and my Neuro and I have been doing everything we can to avoid a 4th surgery. I trust him with my life...literally because he did my last surgery. We monitor my symptoms every 3 months.
If a surgeon tells someone that their surgery is elective and it's not necessary but it "may" help...that is when I would be questioning things...(not saying this is the case here...just a general example)
It's been going on for about 2 1/2 months and getting worse by the day. The first opinion came from the orthopedic surgeon. I tried to get an injection and the pain doc said I had to have an MRI first. Once it came back, the orthopedic surgeon didn't want me to do it until going to the spine surgeon. I tried on my own to go to PT and they said they won't touch it. I am friends with a DC who runs several physical therapy clinics and he said in his experience with back/spine patients, it would need surgery. He is actually the one who gave me the recommendation for the Mayo surgeon based on the PT he does on patients post surgical. The 3rd doctor I went to was the pain doctor who did the EMG and NCV. He also said I need surgery and that I'm already developing muscle weakness so not to wait much longer. The concern is that it is pressing on my spinal cord and waiting longer can cause permanent damage. 3 of the docs who said I need it (ortho, pain and DC) have nothing to gain from it. I guess I've been convinced, I'm just worried about it.
If you commute an hour each way every day in Texas you're already stressing your neck. (I've been there, y'all drive fasssssst) Sitting at a desk reaching here and there all day long is also stressing your neck. I hope you wear a headset and don't tuck the phone, it puts a lot of pressure on the cervical spine. I've never had a Dr. say the word "impressive" so it must be a spectacular bulge.
I had a 2 level cervical fusion and it helped a lot. I would recommend that you take as long as you need to recover (especially if you have disability benefits & don't have the added stress of salary loss) before you go back to work. This is not the time to be a soldier.
Driving and working at a desk are still going to be stressful. Don't make it worse by going back too soon.
Swallowing is difficult. There is a liquid form of most pain meds but you have to ask for them.