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    Old 04-20-2014, 10:01 AM   #1
    kuan2
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    Cervical radiculitis steroid injection question

    Hello, I was wondering what others experience has been with dealing with cervical radiculitis.

    I understand I have a C6/C7 disk bulge that is pressing on the nerve on the left side.

    The odd things are that it's causing tingling/numbness in both hands/wrists.

    The orthopedist started me on a series of 3 steroid injections at C8/L1 .. I've had 2 and aside from the day of they haven't helped much.

    My question is, is this typical? I've read all the patient and provider centric information I can and it seems more common to do stuff like immobilization collars, traction and physical therapy prior to the steroid injections.

    I'm really hoping to avoid surgury (obviously) and don't know how to approach this with the doctor (the doctor is a combination pain specialist / orthopedist, it kinds of makes sense he'd try something like this first).

    (if it makes any difference, an EMG and nerve velocity study was done and came back normal .. though I was on a medrol pack at the time.

    Last edited by kuan2; 04-20-2014 at 10:14 AM. Reason: additional information

     
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    Old 04-20-2014, 01:22 PM   #2
    Heppat
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    Re: Cervical radiculitis steroid injection question

    I have been living with a spinal cord injury with chronic pain for 25 years. Somewhere along the line Orthopods started dealing with the spinal column, I really think that this is a mistake. My best advice to you is to get to a neurologist or neurosurgeon!!! ASAP

     
    Old 04-20-2014, 05:09 PM   #3
    ChuckStr
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    Re: Cervical radiculitis steroid injection question

    I don't know. I've dealt with orthopedic spine specialists and neurosurgeon spine specialists. I think the most important thing is the spine specialist part. I don't think I'd want a neurosurgeon that does only brain operations cutting into my spine. I think the best thing is to discuss the non-surgical options with your doctor. If you don't feel comfortable or they recommend surgery I'd get a 2nd opinion from another spine specialist. Personally, without significant weakness or spinal cord compression, I wouldn't have surgery but everyone needs to figure that out for themselves.

     
    Old 04-20-2014, 06:06 PM   #4
    kuan2
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    Re: Cervical radiculitis steroid injection question

    I'll look into a spine specialist if things look like they'll dead end with this doctor.

    I don't know what to expect on this stuff .. there is a good possibility this stuff will go away with a little work (from what I've read).

    As a little bit of background, I was treated for carpal tunnel 8 years ago .. normal EMG, steroids did nothing for the pain .. doctor was about ready to operate when I convinced another doctor to put me on a 30 day oral steroid regimine. During that time I did posture physical therapy, yoga and pilates hard that more or less fixed my posture and head position .. problem went away .. I still had to be careful with vibrating tools and such, but otherwise fine.

    .. about 2 months ago I damaged both rotator cuffs while shovelling snow .. posture went to hell from muscle guarding .. now all this spinal stuff.

    The orthopedist seemed to think I "simply" have an inflammation problem, hence the injections .. I just have no idea why they don't seem to be working.

     
    Old 04-21-2014, 06:36 PM   #5
    kuan2
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    Re: Cervical radiculitis steroid injection question

    Went to the doctor today .. his response was to proceed with the 3rd steroid injection and prescribe a 30 day course of muscle relaxers.

    I'm a little bit surprised, at least when I asked if it was normal to have a flareup a few days after the epidural injection, he answered no .. than proceeded to do the injection.

    Who knows, maybe the third does the trick. For tonight I'm not in much pain or numbness (of course the injection had a small amount of morphene (I believe) .. so that might make sense.

     
    Old 04-24-2014, 03:57 PM   #6
    kuan2
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    Re: Cervical radiculitis steroid injection question

    If anyone is following along, I start PT Monday .. so far the epidural steroid injection seems to have taken effect (where the first two did not to any real effect.

    I've started doing the range of motion exercises a few times a day (forward, backward, rotate side to side and ear to shoulder .. as well as trying to keep shoulders back and down (basically like doing an isolated part of my ashtanga yoga practice .. just completed through the day).

    Some limitation on range of motion going ear to shoulder and rotating .. I get to the point of feeling a stretch at around 50 degrees on one side.

    Still taking tramadol and flexoril at bedtime .. hands and neck are better, but still there enough to keep me awake at night.

    I did spring for the lovely "relax the back" cervical memory foam pillow $160 which should help .. I went from using 2 pillow stacked up to 1,. only to discover acid reflux issues which is quite annoying.

    Doctor's office is being a little annoying. I called to ask what the results were of an NCS/EMG (all normal) and had to argue with the staff to get the answers.

    (I'm a very technically oriented person and tend to research the hell out of things until I have enough context to base a viewpoint on)... In various internet readings, I've found some lovely quackery on CR .. specifically the vedic diet that gave instructions on proper guided meditations and the right level of ying/yang for your diet to clean various chakra .... makes no sense to me either).

     
    Old 04-25-2014, 07:02 AM   #7
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    Re: Cervical radiculitis steroid injection question

    In the early 1980s, a fellowship training program in the spine was developed to give an orthopedic surgeon advanced specialty....just like there are now orthopedic surgeons who only deal with ankle/foot or joint replacement, or Sports Medicine, there are those who have additional clinical training beyond the residency in the spine.

    The training is so similar to that of the neurosurgeon, who usually has no additional spinal training beyond the residency, that some medical schools are thinking of combining the two specialties into one, so there is just one program in the spine.

    On a different note, it is a good idea to ask for a copy of any tests that are done, images that are taken, etc. and start your own file on your spinal problems. If you make the request at the time of service, it eliminates several steps in acquiring this information. If you ever need to see a variety of specialists or have to deal with an insurance carrier, you have copies of MRIs, tests, etc. without having to go back, sometimes years later, to collect all this information.

     
    Old 04-26-2014, 05:43 AM   #8
    kuan2
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    Re: Cervical radiculitis steroid injection question

    Small question .. should I be concerned at all that the doctor is doing things out of typical sequence?

    Meaning he started me with the steroid shots before doing PT and before an MRI was taken (he never looked at the images for the CT from the ER).

    I start PT Monday and have told my rotator cuff PT people I'm taking a hiatus while I get that started (it doesn't help that the shoulder exercises were actively killing my neck and wrists).

    I'm also finding it "interesting" that around here, most offices offer the ACDF proceedure (if it comes to it), when from what I've read the miniminally invasive variety (only removing part of the disk and arthritic parts and no fusion) seems to be a much better way to go in terms of recovery and need for followup surgeries.

     
    Old 04-26-2014, 12:23 PM   #9
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    Re: Cervical radiculitis steroid injection question

    kuanyin2, you are right to question your doctor's choice on which therapy to use first. Steroids should not be the first, but more appropriate for the last, short of surgery. Steroids have a lot of side-effects, such as osteoporosis, high blood pressure, weight gain, and now, according to the FDA, possible loss of vision, paralysis, stroke or death.

    Physical therapy can help, so can yoga, Qigong, Tai Chi, meditation, massage, traction, radiofrequency ablation, etc. I would look for a new doctor, a pain manager-neurologist. They could have you follow a common protocol for your type of pain. I always get a copy of all doctor's visits, tests, labs, etc. for my own records, and if I need to change doctors, I already have the records and it cuts down on the amount of time between changes. The protocol I referred to is not anything I have seen written in stone. I just have had tons of experience due to cervical polyradiculopathy and lumbar spondylolysis. Logic should dictate here. Keep questioning what the doctor is trying to do to you. You know steroids are not the answer.

    Last edited by Administrator; 04-26-2014 at 02:39 PM.

     
    Old 04-26-2014, 02:57 PM   #10
    kuan2
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    Re: Cervical radiculitis steroid injection question

    Well, the steroid shots have already been completed .. got about 3 days relief out of the first two, than went to PT for shoulder and things kind of stopped working, hence why I stopped going to shoulder PT (I'm at the end stage for it anyhow).

    I'm at least hopeful the "neck school" pt will be more effective .. I'm not on pain meds or antiinflamatories right now .. just a muscle relaxant and have managed to stretch my neck to full range of motion .. so I'd like to think this is a good starting point.

     
    Old 04-26-2014, 03:00 PM   #11
    kuan2
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    Re: Cervical radiculitis steroid injection question

    From what I remember, he started me on the injections first because the EMG was normal and he thought the shot would be a good first step

    (funny thing though .. I didn't have much neck pain until he started doing those .. now I have neck pain, but only on the side he injected into.

    For reference, this doctor is a orthopestist / pain specialist.

     
    Old 04-27-2014, 07:21 AM   #12
    dumbo27
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    Re: Cervical radiculitis steroid injection question

    Quote:
    Originally Posted by kuanyin2 View Post
    Small question .. should I be concerned at all that the doctor is doing things out of typical sequence?

    Meaning he started me with the steroid shots before doing PT and before an MRI was taken (he never looked at the images for the CT from the ER).

    I start PT Monday and have told my rotator cuff PT people I'm taking a hiatus while I get that started (it doesn't help that the shoulder exercises were actively killing my neck and wrists).

    I'm also finding it "interesting" that around here, most offices offer the ACDF proceedure (if it comes to it), when from what I've read the miniminally invasive variety (only removing part of the disk and arthritic parts and no fusion) seems to be a much better way to go in terms of recovery and need for followup surgeries.
    The fusion happens naturally by your body. When they remove the disc the Doc has to put something in the gap to support the neck. After a few month's the part that was put in fuses with the top and bottom of where the disc was replaced.
    I had the acdf over a year ago, I wish the Doc would have given me any and all kinds of shots instead of the surgery.
    Good Luck, Paul

     
    Old 04-27-2014, 09:32 AM   #13
    kuan2
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    Re: Cervical radiculitis steroid injection question

    I just wonder why the ACDF seems to be the most common one, when for "simple" single level removal of the parts impinging the nerve would make more sense. I'd probably pay for it out of pocket if I come to need surgery and my insurance won't cover it. Does anyone know if microdiscectomy is typically covered and/or is considered a routine operation?

    (at least judging by the glossies around a couple of spine surgery places)

     
    Old 04-28-2014, 01:56 PM   #14
    kuan2
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    Re: Cervical radiculitis steroid injection question

    For anyone following along .. went to first PT today for the lovely Spurlings maneuver and all over poking an proding.

    Interesting thing was, the area of focus was a "deep neck flexor" in the front .. as in he wants me to work on thoracic mobility more than cervical (which is fine, aside from the fact that those vertebre are among the least mobile).

    Exacerbated the hell out of my wrist pain, but that's more from needing to do what amounts to an updog/cobra position.

    PT guy was very professional, though he seemed much more comfortable with the idea of surgery than I am.

     
    Old 05-02-2014, 08:43 AM   #15
    kuan2
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    Re: Cervical radiculitis steroid injection question

    Interesting when the PT guy sees my CT report and doesn't see anything to bad ..

    At least, this is the first person who has actually laid hands on flesh to see what's going on with each nerve root/branch and figuring out what specific movement causes what.

    The results were -- interesting, at least the basic treatment plan is to fix head position and posture by strengthening "deep flexor" muscles (muscles on front of neck) and making my thoracic spine segments more mobile.

    "Interesting" in the sense that the exercises prescribed are very small movements (chin tuck) and some of the physical motions / mobilizations essentially consisted of an upper body reverse hug and going "crunch" at various angles and positions to loosen that area up.

    Results feel -- odd -- at least I have to actively concentrate on keeping my posture .. the manipulations make it very easy to slouch because things have been lengthened and stretched that haven't moved in awhile.

    (FOr reference, I did yoga quite a bit before this all came up, and I'd do an up-dog/cobra position that ws essentially overextending my lumbar and cervical spine with stuff in the middle not flexing very much.

     
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