Heidi2254MemberAugust 2, 2013 at 1:00 amPost count: 2
Would appreciate your advice, please. Have a good team w neurologist whom I saw for cervicogenic headaches since 2010 that have gotten much worse In past 5 months with right arm radiculopathy. I did not seek help until into 2 weeks of migraine and sleeping sitting up w propped arm and ice. Mri in 2010 showed herniation at c6-7’and 2 spaces above but ow that herniation and those bulges are pushing on cord and nerve root per neurosurgeon. Diminished reflex comes and goes. Better after first ECI and traction but worse again 5 weeks later. Was a labor and delivery and hospice RN which was tough re lifting (great jobs though) and now a manager so desk work. Have crohns so no NSAIDs and it is in remission. Pain is the biggest problem and lack of sleep w pain. Ice can help and lying flat. Neurosurgeon and neurologist think I may be heading towards posterior discectomy. Not familiar. He said because of scan and right sided sx I could perhaps avoid fusion. Also I am factor v positive and this is a vascular area. Heterozygous but took Lovenox for other surgeries. Experience? Md is aware. To be honest my goal is conservative care. But discouraged. For pain just Vicodin after work. Tylenol ineffective. Flector patch at times..Donald Corenman, MD, DCModeratorAugust 2, 2013 at 10:57 amPost count: 8455
I will assume that ECI is another way to say an epidural steroid injection. If you have had therapy (of which traction is a part of) and an epidural with continued significant pain, you are a candidate for surgery. If you have no significant weakness or cord irritation signs and you still want to wait, you can but the odds of improvement without surgery do drop somewhat.
I assume you have a new MRI as an MRI from 2010 is not appropriate to use for your current diagnosis.
A posterior decompression is useful for an extruded disc herniation where the fragment is lodged in the foramen and not under the cord. See the video under posterior foraminotomy to understand this technique. If the herniation is “pressing on the cord” as you note, I personally would use an ACDF to treat this problem. You can see this surgery also on the website under ACDF.
If you are factor V deficient, you can use factor V IV medications prior to surgery for normal coagulation times.
Dr. CorenmanHeidi2254MemberAugust 3, 2013 at 9:56 amPost count: 2
Thanks for your reply. In answer to your questions, my most recent MRI was in early June 2013 ordered by my neurologist who I saw for headaches and radiculopathy. She asked me to see neurosurgeon and to have two epidural injections a few weeks apart. Had epidural 6/24/13 and saw neurosurgeon 7/8. The neurosurgeon said to try traction w PT with no lifting greater than 5 lbs which I have done. I lost strength suddenly soon after that appt in fifth finger and the ulnar reflex decreased as well per PT. MD ordered medrol which helped along w traction for that symptom. Within 2 weeks the headache which had been helped by june epidural returned along w right radiculopathy. Had repeat epidural 7/31/13 and it took the edge off thus far but I am retain lay not pain free and am sleepless at night, often ending up in a recliner with an ice pack. I appreciate your opinion very much! HeidiDonald Corenman, MD, DCModeratorAugust 3, 2013 at 11:15 pmPost count: 8455
Traction is generally ineffective for disc hernations. In my practice, I recommend surgery for patients with weakness that have not responded to epidurals and physical therapy and have impairing symptoms. This sounds like you. If you are miserable, surgery has a very high chance of relieving your symptoms and making you comfortable. I cannot tell you which surgery without reviewing your imaging and performing a good physical examination.
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