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Cervical Disk Injury

Hello, I was recently  (30 days ago)(via an MRI) told that I have a Large herniated Disk in the C-5/C-6 area which is pushing paramidline on the nerve. I did it by exercising of all things. My symptoms are slight neck shoulder, and right arm pain with some minor weakness in the right arm. My discomfort is worse in the evening but is treatable with a small dose of pain med when needed. I have even noticed some improvement over the last week or so. I have had 1 neurosurgeon evaluation so far and he says that I need to have the Anterior Cervical Disk surgery asap to fix the problem and prevent further damage. I have a 2nd opinion in the morning. I am curious about the following:
1) Can I try a more conservative method instead of jumping into surgery? If so, what is reccommended? My family Dr. is backing the nerosurgeon and has no other options for me at this point.
2)Should I get opinions from other types of Dr.'s such as Orthopedic, or Osteopath, etc...?
2) Should I get the surgery if my 2nd opinion reccommends it as well? Or should I get a 3rd opinion? My 3rd opinion is in mid June. Is that too late to wait?
3) I am a career minded healthy 37 year old and am scared to have the surgery due to the risks involved. I'm worried about the surgery causing new problems and or not fixing the problem that I have. What are the success rates of this type of sugery?
4)Do you think I could find a surgeon who would go in Posterior? The front of the neck scares me because you have to pass by additional areas such as voice box, throat, ect...
5)If I had the surgery, what should I expect Post-Op?
6) How do you know that you have the best surgeon? What questions should I ask before surgery?
Thanks for your help,
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Avatar universal
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The symptoms and tests that you describe are consistent with a C5-6 radiculopathy (pinched nerve). A disc herniates out of the vertebral column and puts pressure on the nerves as they exit the spinal canal.  Many disc herniations will improve on their own without out treatment.  However, if you are having weakness, then you are running the risk of permanent weakness in your right arm.  Even with the surgery you will likely have some residual pain and possibly weakness.  I think getting a second opinion from another surgeon is a good practice, but I would not put the decision off too long.  Another test that might help you come to terms with the surgery vs no-surgery decision is an EMG to look for signs of active dennervation in your right hand muscles.  Anterior cervical discectomy is the standard of care and you should not worry about the technique, just find a good surgeon.  I would suggest that you go to a major academic center for an opinion, because they are the experts in the field and are not motivated by profit margins to do as many surgeries as possible.  The ACDF is a relatively quick procedure and the recovery time in the hosptial is short 2-3 days often, with longer periods of rehab (6weeks when you neck is stable enough).
I hope this has been helpful.
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Avatar universal
Hello , here is the latest as of my 2nd opinion with a Neurosurgeon this morning: First of all, I liked this Surgeon much better than the first one because he took his time and wrote down all of my questions and answered  them without rushing me. He first did a thorough physical check of my arms, neck, legs, and even my walk. (The first surgeon only checked my hand strength.) He then preceeded to review my MRI in great detail explaining each Cervical area. Luckily I only have one herniation and all the other disks look good. He recommended the Anterior Cervical Disk surgery. But he did agree that a Posterior approach without metal plate and fusion would also be an option for me as well. I like the Posterior approach because there would be no foreign bone/objects added to my spine with less risk to the throat, vocal cords, etc.... He also stated that some people can even heal on their own with no surgery.Now that's a thought.... Maybe I should wait a little while to see if my condition gets better or worse before jumping into surgery?? I had this injury for around 5-6 weeks so far.  At this point, I have a 3rd opinion scheduled in June. I may resume walking for now but no running. What do you all think?
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Avatar universal
A related discussion, swelling pressure at throat after cervical surgery was started.
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Avatar universal
I am 33years old and I  had a two level anterior cervical fusion C5-C7 with cadavor bone in Feb. of 05 a year after I was rear ended by a car going 45 while I was at a stop light.Shortly after my surgery I started to experience more pain so in Dec.05 I went for a mri and found that C2-4 were also now herniated and that the fusion didn't take. Also had a emg and found that I had nerve damage at C5.I had my second surgery in May 06.I now have C2-C7 fused.The doctor did a anterior and a posterior and replaced the previous metal plate and went all the way to C2.After the surgery I was having swallowing problems.The doctor first said it could be due to swelling.6 months later I was still having problems and went for a video swallow test (no answers ever really came out of it although they did see that my food was going into a little pouch and causing me to cough it back up) the doctor put me on neurontin this did help a little but still have some issues.Since both surgeries my migraines have gotten worse(I did have them before the accident)but now they are worse,weakness in the upper body,neck pain at the base of my skull to the shoulder blades. I also have tingling,pins and needles down both arms.Today I went to my pain doctor for an emg and found that I now have nerve damage at C7 in both sides and damage at C6 on the left side. I see him on friday to see what he thinks I should do.I to tried physical therapy and injections prior to both surgies only to have the PT work for a day at a time. Sometimes I wish I didn't have the surgeries as my pain is worse now and nothing seems to help.I believe for some people they have good outcomes but not for me but I didn't have a choice as I wasn't having much of a life. Not that I am now. All the doctors never really tell you how you may never get rid of your pain.My doctor says well I don't know why your still having pain.Well just because they fix you doesn't mean you will be back to your old self.....
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Avatar universal
Hi everyone,
On June4th I had a C4/5 anterior cervical decompression and disc replacement following an earlier fusion and cradle job over C5/6/7 It's early days but I'll keep you all posted on the outcome.  I'm to see my GP on Monday as the incontinance problems both bladder and bowel are still there. Through all my consultations I have always made mention of this tho nothing positive has come through! Would be grateful for any light to be shed on this?

ps, This site is almost as good as therapy I thank you all

Longdog  UK
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Avatar universal
Just wanted to comment on this type of surgery , i had c6 and c7 disk fusion 6 months ago un fortuntly mine didnt turn out the way i expected, i have perment nerve damage , my hands stay numb all the time and its hard for me to sleep because im in alot of pain,im only 38 and i have spinal stenolis, the doctor told me i would be much better after i had the surgery but afterwards  i did feel better but slowly it got worse .
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Avatar universal
Guess the drugs are taking affect, and my eyes are fuzzy. Sorry I got your name wrong
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Avatar universal
Sounds like you will be a day ahead of me.  I will have ACDF with titanium plate on June 5th.  I'm very nervous, but I 've been so miserable I am looking forward to relief.

I caught the corner or my chair at work and fell.  It ended up a whiplash type injury.  I have had 2 MRIs. both showing large broad based protrusion at c5-6.  Thecal sac indentation and flattening of the ventral cord.

My symptoms began all from my neck to the back of my head and to my right ear.  I had a cerivical epidural which releived all symptom for one month.  When sypmptoms came back I was doing Phyiscal therapy with manual traction and pain was in the middle of shoulderblade.  Due to a lack of communication with my neuro pain management doc (he didn't return calls for a 2month period) it was from Nov 14 to Feb 15 before I had the next epidural.  By this dime the pain was stabbing in my shoulder blade and right wrist.  I also was having problems with pain in my fingers.  I had 2nd epidural in Feb and never got more than 40% relief.  I continued PT and it only seem to keep the nerves irritatied.  I swapped pain mgmt doc (fired the old one) and was sent for an EMG.  EMG showed nerve irritation in both arms and hands.

I was referred to a neuro surgeon and friend who works for a neurology group had to talk the doc into taking my case because it is worker's comp.  Neurosurgeon said surgery should have been done months ago.  My right hand sweels and I have lost all feeling in it other than the occasions where my right thumb fells as though it is being slammed into a car door.  Symptoms are now moving to the left side with numbness and pain.  I now longer have control of fine motor skills involving my right hand.  Rt hand and arm are weakened.  After workers comp denied first request for surgery stating that they needed a copy of the EMG (which they already had) summit with the surgery request and the 2nd MRI that the surgeon reqested because my last on was 8 month old.... comp did approve the surger, so I'll go for preop this Wed and have surgery next Wed.  LLWB  keep me posted on how you do.  I imagine I'll be going in before  you come out.  Even though I don't know you I will pray for you and your recovery..
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Avatar universal
Thank you for your prayers. Wow, you've been a long time getting to this point too. I will be glad to get this over with, as the headaches are getting worse, and if I hold my neck up, like looking over a steering wheel (I'm, vertically challanged) for very long, when I move it back down it feels like it's caught. I have to force it, then hear a LOUD pop. The pressure inside my neck feels awful. And my shoulders have started popping too. The left arm is getting a lot weaker. Even having trouble typing this note. Hope you all had as good a Holiday as possible and said a prayer for our soldiers. BBQ'ing a burger was the biggie for me. Spent most of rest of time on couch watching movies, or in bed.. Don't let worker's comp push you back to work too soon, or you won't heal right. Good luck to you all.
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Avatar universal
raz-- thought you'd never ask.
there are a ton of websites you can go to. here is a link to just one of em.
http://www.exrx.net/Lists/Directory.html
The idea is to get your hed over your spine and keep it there. one of the ways that happens is by strengthening the md back muscles and stretching other muscles (pecs, scalenes,scms etc) that pull your head forward and flexed. Way too many people develop problems (pain), have MRIS and nerve tests which invariably have "findings" and then blame those findings as the casue of their pain. Even if some of these findings ARE causing pain, many times they can be correctd if we use our bodies as nature intended---- one of these ways is to have good posture. Keeping your head over your spine is one way to exhibit good posture. See a website by Jolie Bookspan and buy one or two of her books. She saved me. I am pain free now.
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Avatar universal
My recommendations:

- avoid surgery if possible
- ask for further tests e.g. EMG for nerve damage
- find the best McKenzie-certified physical therapist
  http://www.mckenziemdt.org/faculty.cfm
- have the therapist do hand decompression
- improve posture, and do a therapist-approved progression of exercises
- buy the book "treat your own neck" by Mckenzie
- consider an inversion table to decompress late in the day / before bed

Body mechanics can have a whole lot to do with this. De-compressing the cervical column & the disks can be very helpful and some of the above steps can help.

Two other good books are:
- What to do for a pain in the neck - by Schofferman
- Do You Really Need Back Surgery?: A Surgeon's Guide to Back and Neck Pain and How to Choose Your Treatment - by

All the best.
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Avatar universal
I am a 41 year old femaile professional musician, recently dx with c-4 thru c-6 radicupathy.

Lugging guitars, and cases are no longer an option for me. I cna't even pick up my neices or nephews. Severe left shoulder pain, index finger of left hand tingling, it even hurts when I cough.

I found that it is worse at night, and releif only comes when I take a Norco 7.5 and prop my left arm with pillows. I take a FCelebrex daily for the inflammation.

I see the Neurosurgeon next week. Going in I will say that surgery is out. Not an option for a touring musician. I am not totally disabled by the pain, and I want to follow a treatment protocol that will alleviate the pain, and be best practice for me to heal.


Any advice on non-surgical healing methods, pain management, etc?

Thanks.
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Avatar universal
First of all I am a 46 year old aT-10 Para of 30 years...I had disc compression at C-5/6 and 6/7 with weakness in the arms and underwent surgery where as I had cadavair bone fused into these areas and a Titanium plate with six screws implanted on July 28, 07 and have been in severe pain since....saw a spinal surgeon with the Steadman-Hawkins group that took x-rays and saw that the fusion didn't take and is sending me for a CT scan as well as an MRI with 1mm cuts to confirm his findings. He stated that I will have to have undergo another surgery whereas he will go in through the back of the neck this time and insert two rods and pins. My questions are as follows:

1:) what is the recovery time from a surgery where he has to go in through the back of the neck?

2:) I lost about 30% of range from the first surgery, will I lose more with this one?
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Avatar universal
raz,

Your situation may be similar to mine.  Before opting for surgery, recognize that, depending on the extent of your condition, your symptoms may self-relieve and never recur.  In any case, consider all perspectives / alternatives in the context of your condition.

I have herniation and stenosis at C5-6-7 that manifested as an acute attack of neck/shoulder/arm pain last November (2006) lasting over a week, where the pain had become excruciating about 5 days after onset.  This was accompanied by a temporary but significant (about 50%) loss of arm and shoulder strength lasting a couple weeks thereafter.

I believe my symptoms may have been triggered when, about a couple weeks prior to the attack, when I had my neck in a contorted position while scooting myself under a barbell prior to doing bench presses, I felt a very sharp shooting pain across my shoulder blades, with residual pain lasting several days.... and then the acute attack of unbearable pain.  The underlying herniation and stenosis probably pre-existed.

Since that time (over 6 months now), I have been completely free of symptoms except for occasional bouts of mild neck/shoulder discomfort.  I've had no recurrence of weakness or numbness.  I am aware of nothing that I did to bring about this relief, although I'm physically active, which I believe promotes anabolism and associated growth and healing processes, so that might have helped.

Both of the specialists I've seen say that surgery is called for only if persistent weakness or numbness exists in arms, shoulders, etc., and that those symptoms are much more significant as an indicator of potential future neurological damage (if one ignores the symptoms) than occasional bouts of pain.

It is hard for me to justify surgery in the absence of symptoms, so if your condition is similar, it is probably worth waiting before committing to anything drastic.

Here are some links that may be helpful.  I am neither endorsing nor disapproving the information herein, and some of the opinions are conflicting anyway;  just want to provide different perspectives aka "food for thought":

http://www.rebuildyourback.com/herniated-disc/surgery.php
http://www.biblelife.org/neck.htm
http://prolonews.com/degenerative_disc_disease.htm
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Avatar universal
    Just wanted to share some comments. I will be having surgery this coming Monday, 5/21 for a herniated disk & cervical spinal stenosis. My NS will fuse C4-5 to an existing fusion (3 vertebraes) which was done in 1996. I am quite concerned about having 4 vertebrae fused together. I've been assured that I will still be able to turn my head!
    I'm not concerned about having this surgery having been through this before.  I know what to expect and had great results previously. My choice in 1996 was to have my NS harvest the bone matter from my hip. I can tell you all that hurt more then the neck surgery! This time I have elected to use a cadaver for the bone fusion.
    I was in a neck brace for 6 weeks and went back to work two weeks after my surgery. I had to carpool with my DH and ended up having to work 10 hours a day before he was back to pick me up on his way home. I am older and wiser now, this time I will not work until my brace is removed and I feel strong enough to work.

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Avatar universal
Hello Everyone on this post. Sorry for the delay but I have good news to share. Since my last post, my favorite" 2nd opinion Neurosurgeon" offered me Physical Therapy for 2 1/2 weeks to see if it improves my condition. I'm happy to report that I am seeing "some" improvement. I am on a Cervical Traction machine for 20 minutes while laying on a heating pad. Then they do neck/shoulder massage for 10 minutes/ 3 days a week. No surgery planned anytime soon for me. I meet with the Neurosurgeon this Wed to review PT results. I will keep you posted.... As my PT said, a good Neurosurgeon will offer PT before surgery because 75% of folks heal in time or with PT even though it takes $$$ out of their pocket. And it makes for a better patient when it comes to surgery. You are in a better state of mind if you know that surgery was a last resort. He explained to me that a herniated disk is like toothpaste that has squirted out of the tube and you can not get it back in the tube right? So traction is trying to push it off the spinal cord/nerve to get you relief of the symptoms. If it works great, who cares where it goes.. But if it does not work then surgery will be the best option. I will you all posted...
God bless all of you that need surgery. Please keep the posts coming...
By the way, a friend of mine a had a double cervical fusion 2 weeks ago and she's doing great! 2 days later she felt much improvement while taking very little pain meds. That is very encouraging for me to witness.
Raz
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Avatar universal
Mike, can you elaborate on the Posterior exercises that you do? Or is there a website that I can check out? I am hunched over a computer much of the day.
Thanks!
Raz
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Avatar universal
Thank you so much for your reply. Helps to know what to anticipate in the recovery period. Sounds like you are doing great. I have read several scary posts that say they wish they hadn't had surgery, but my neuro-surgeon said it wasn't optional in my case or risk losing all feeling in my arm and hand. I think the more knowledge we have, the better prepared we will be. Again, thank you, god bless, and speedy recovery.
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Avatar universal
I am about 3 weeks into my recovery and I went back to work a week ago.  My fingers are still numb but the throbbing electrical pain went away immediately.  My shoulder and arm pain also went away immediately.  I am just now starting to feel a little bit of a cold ache in my wrist as my fingers are starting to become less numb... I hope those are related.  I can turn my head side to side pretty good now and can sleep well now.  Before I couldn't sleep lying down and was forced for the first 2 weeks to sleep in a recliner.  I cannot move my head much ear to shoulder as it feels very stiff however, makes since and I probably don't want to do that yet anyway with the metal plate.  My throat was a little sore for the first 2 to 3 days but nothing that caused me not to eat soft foods... But then again I was also on Percocett so I may not have felt it.  My problem is hoarseness without pain however, I do still feel like I have a lump in my throat but everyday it gets better and better.  I realistically would consider the month off since you drive.  The bumps seem to aggraviate it.  However, I am at 3 weeks now and I can now drive but I place a travel pillow/airplane pillow the c shaped ones behind my neck and it seems to do well.  I wore my aspen cervical collar for 2 weeks and when I took it off per the surgeons direction I did NOT put it back on and I am glad I didn't.  Part of healing is blood flow and movement and I feel really good now.  One step at a time.  Remember don't rush the healing but do get up and move around... walk everyday it really does help even though it is uncomfortable.  At two weeks I was completely off pain medication also.

I will keep looking back...
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Avatar universal
About your anterior discectomy. Mine is scheduled for June 4th. I have ruptured disc at C5-6, with stenosis at C3 thru C7 My dr plans on cadaver bone plus fusion. How sore is your throat? Or are you just hoarse? I drive 8 hours a day as a courier, and the dr says I will be back to work in a month.is that realistic? How long were you in the hospital. I have loss of strength in my biceps, numbness in fingers. Did you have that and did it go away?  Very concerned, as I'm a widow, and I have to work. Was hard enough to get the month off for the surgery. Also, my headaches are almost constant, and my eyes seem to be getting fuzzy, expecially by the evening. Is this normal? I have lots of questions, and don't see my surgeon again until 2 days before surgery. Would appreciate any answers you can give me.or anyone else! Hope you're healing well. God Bless
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Avatar universal
Reading all your questions and comments have been helpful to read as I just had anterior cervical disk removal with fusion C6/C7on 4/2007.  I had major pain in my neck on 3/24... figured it was a normal neck pain as I have had for 10 years.  Only this time it was different... 3 days later I had left hand finger numbing and tricep pain and along the left shoulder.  I couldn't deal with the nerve twitching and eventually a feeling of electricity throbbing feeling throughout my arm and hand.  I had two opinions from neurosurgeons which both said nerve damage was major and the spinal cord was being compressed per my MRI which did show significant protrusion with the nucleus more than 1/2 way out of the verterbrae.  They recommened doing the surgery before a month goes by as the healing of the nerve may be affected otherwise.  I did traction at a wonderful physical therapy which relieved the pain temporary until I could get my appointment... Surgery and recovery seem to be doing ok... I will keep you posted however my voice is VERY hoarse even 3 weeks later... has anybody dealt with that?  They said 1 to 2 days but I haven't seen anything about 3 weeks later... I do still feel a lump feeling in my throat but contribute that to perhaps swelling still?  Anything from anybody?  BTW I am happy to answer anybodys questions you may have and as a note... anterior approach did scare me however not having to lay back on the incision was nice and the scar is healing nicely... you would have to know to see it.  Again any help on my hoarseness?

Until later -
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Avatar universal
Hey raz, your not alone in this world of uncertinity. Ive just had my 4th cervical operation and Im miserable. To start off, ill give a brief history of me. At 23, I ruptured c6-c7 and wound up having the anterior fusion. At 25 years old, c5-c6 blew out and had another fusion with bone from the hip and into the neck. From there I was fine until I slipped on the floor and injured c4-c5 at 32 and because of the prior operations the inexperienced Dr decided to place titainium rods for stablazation from c4-c7. I have been in pain ever since. Two years later at 34, under the knife again for repairs and to fix c3-c4, (the screw at c7 was in too deep or something to that effect) a more experienced Dr removed the hardware from c4-c7 and because of the amount of scar tissue and damage already done, the best route to take was to fuse the remaining vertabra from c2-t1. Titainium rods were then placed from C2-T1 as well. At this point they flipped me over and entered thru the front and cut out the front halves of c4-c6 and placed a cage inbetween the vertabra and then placed plates over c3-c7 to protect the caged area. I am in more pain now then ever and I was told the only thing they could do for me now was to fuse my skull to C1-C2. I told myself Id never go under the knife again, however the pain I live in everyday is getting to be unbearable and Ive put a gun to my head a few times thinking that it would end my problems. everytime I do think along those lines, I find a reason to go on. Anyway, I feel your pain and if you need any advice or support I'll do what I can to help you out. I am currently seeking a top notch Neurosurgen to get an opinion as to what else can be done to help get rid of at least some of the pain I'm in. I have no problem flying to another state to get a new evaluation with a highly rated Dr. If you have any knowledge of any excellent Drs, please pass the info along. You can contact me (anybody can for that matter) at ***@****. Goodluck with your situation, Scott
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Avatar universal
your problems may be muscoloskeletal... have you tried postural exercises?? do you hunc over a computer all the time? my symptoms were like yours and i fixed them in 3 months w proper postural training/stretching.
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Avatar universal
if it is only one disk, you may be a candidate for an artificial disc. there are some centers aroungd the country doing them-- they have only to this point been approved for one level. the bad disk is removed, the neves freed up, and instead of fusing two vertebrae, and artificial disc is inserted.
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