[Cbuck]

#5494

I am faced with a decision and need advice. I have a herniated disc at c6/c7 and after 7 weeks of upper back/shoulder/neck/arm pain and several meds. chiropractor visits etc ..i was finally able to sedan Ortho. who is recommending surgery b/c of possible nerve/muscle damage in my right (dominant) arm. I am 38 with a 6, 4, 2 and newborn at home. Is surgery my only option?

[Donald Corenman, MD, DC]

#5495

Surgery may be important now but you need to know of other potential treatments. I assume you have weakness of your triceps muscle along with wrist flexors (bending your wrist down to the palm side) on the side of the herniation. If you have no motor weakness- then surgery is less important than if you do have weakness.

If there is only pain with paresthesias (pins and needles) without weakness, you would be a good candidate for an epidural injection (see website). If you have weakness of the above noted muscles, surgery is more likely to be needed with an exception. In the neck (unlike the lower back), the nerve roots can recover more completely without surgery as they are shorter and more resilient. An epidural injection could also be used as long as the C8 and T1 nerves are not involved (these nerves are more persnickety and do not heal well). If you would be willing to take the small risk that with an injection, the pain would improve but the weakness might not, an epidural injection could be considered.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Cbuck]

#5496

Wow! Thanks so much for the detailed information. That’s more information in one post, than I have received in over a month and a half of pain.

So, the areas of pain that I have changes daily. Sometimes it is in my upper right chest, then the underarm of my right arm, then the wrist, then mid-arm, right back shoulder, neck. And, that pain varies in intensity. Today, for example, I am feeling paresthesias that you described in my right arm and fingers (which is not normal). I’ve had less pain since I started taking Lyrica on Jan. 11…it has tremendously calmed the nerve pain. Before Lyrica, I couldn’t get comfortable at all and no meds were helping. I also would wake up in the middle of the night and soak in a hot bathtub to get some relief. But, Lyrica has made me able to function in the day to day basic tasks.

My MRI determined that I had a herniated disc in my c6/c7 disc. The surgeon seemed like he was going to go the alternative to surgery….”shot” route until he tested the strength of my arm. He pushed down on my left arm and I was able to resist. But, when he pushed on my right arm (3 times) I couldn’t resist his pushing. It was then that he determined that I was “in a whole other category” and needed surgery to prevent permanent or worse damage.

He told me after that visit to go home and do my “research” and “homework” on Anterior Cervical Diskectomy and Fusion and to let him know what I decided to do. I really don’t want surgery unless there are not other options. But, I don’t want to spin my wheels with shots, other doctors, etc. if it will only eventually lead to surgery anyway. So, I called him back and asked him if there were any other options and if we could try other methods before surgery. His nurse called me back yesterday and said he really thinks surgery is your only option, because of the possible nerve damage. So, I am scheduled to meet with him again next wednesday to look at my MRI’s and hopefully have him explain in detail why he think surgery is the only way.

[Donald Corenman, MD, DC]

#5501

I can understand your reluctance for surgery but with your significant symptoms and motor weakness, surgery may be your best option. The weakness is what has your surgeon’s attention. Motor strength deficit is worrisome as even with surgery, strength may not fully recover when the nerve is decompressed. It is true that the cervical nerves have better recovery potential than lower nerves (lumbar roots) but with weakness and no surgery, there is a risk that the nerve may not function normally.

If you want to take that risk and still try to reduce the pain and paresthesias, an epidural is the next step. This injection has a good chance to reduce symptoms but will not help to return motor strength. The danger is that you will feel better but still have weakness that might not improve.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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