new member - mild symptoms but scary MRI

[dman777]

Hi everyone,

Can't say I'm too excited to be here, but it's great to have found such a helpful resource. Thanks to all who've contributed to this community as well as those who manage it.


My story, so far:

I'm 44, in fairly decent shape, no accidents or sudden back injuries that I recall, except maybe a random fall here and there while snowboarding a few years ago.

I started feeling some tightness in my left shoulder and intermittent arm pain about 3-4 months ago. Went to a GP, who chalked it up to a pinched nerve and sent me to PT. The physical therapist made me to some stretches and exercises to build up my neck and upper back muscles, but after a few weeks it seemed to only make it worse.

At the same time, I realized that maybe my bad posture while working can't be helping, so I set myself up with a standing desk, and started paying attention to how I sit and hold my head while working, using my phone, etc.

Since the PT didn't help, I went back to my regular GP, who ordered an MRI, and referred me to a physical rehab doctor.

While waiting for the MRI, my arm pain seemed to subside somewhat, and turn into more of an intermittent tingling in the hand and some mild dull pain in the shoulder.

Two weeks ago I finally went to see that rehab doctor who had the MRI results for me. I almost fell off the chair when he told me he better go grab the neurosurgeon who happened to be in the clinic at the time to come talk to me.

Turns out I have two cervical disc herniations. At C5-6, the disc is touching a nerve root, which is likely the cause of my left arm and shoulder issues. But the big surprise is a large herniation of C6-7, that appears to be pressing the nerve root on the right, but also putting some mild pressure on my spinal cord. I have no obvious symptoms from the herniation at C6-7 (yet?).

The physical rehab doctor and the neurosurgeon recommend that I have both C5-6 and C6-7 removed and fused or replaced with artificial discs, but primarily because of risk of injury to my spinal cord in the event of an accident or a bad fall.

Since them, I've gotten some more opinions, including from a very experienced and reputable spine ortho surgeon at the well known, university affiliated spine center here in Chicago. He does not advise surgery at this point, given them I have no weakness or numbness, or any other signs of neurological deficit. He thinks this may resolve gradually, but will be showing my MRIs to more spine surgeons at the center for their opinions as well.

My main concern at this point is how much real risk my (currently) asymptomatic herniation poses to my spinal cord. I've read that this "advice" that neurosurgeons typical give (that you're one fall away from paralysis) is somewhat unfounded, based on some studies and the prevalence of asymptomatic and undiagnosed herniated discs in the general population, compared to the actual # of reported spinal cord injuries. But, I also don't want to live with that risk, real of hypothetical, so I have to balance that against the risks associated with any spinal surgery.

I'll get some more opinions, and am doing as much research online as well, including by reading relevant medical journal articles. But, I'm preparing myself for what seems to be inevitable - surgery. And that's why I'm here, to learn as much as possible about options other than two level cervical fusion.

If anyone here has been down a similar road, I'd love to hear from you.

[Harrison]

Hey DMan, when you can, pls see:

http://www.adrsupport.org/forums/f58...-health-11053/

Let me know if you need help.

[dman777]

Thanks Harrison, done (I think).

[annapurna]

Zeeger's comment, said many time, is that surgeons should treat the patient, not the films. Of course, that argument is typically stated when the patient's pain is out of proportion high compared to relatively minor damage shown on their films. Your case would be the opposite. To some extent, it's about how you see your risks but it's worth pointing out that the pain and tingling is neuropathy, so you're not exactly symptom-free. Your pain level may be low but you do have symptoms.

If it was me, I'd do your research, find a surgeon you'd like if you did decide to go for surgery, and basically get yourself ready but not actually commit to the surgery until you're sure you're going to need it. Laura had L5S1 collapse and scheduled the surgery after that. For her first cervical disk, we scheduled the surgery when she started showing signs of neuropathy, more or less where you are now, and she found that the recovery was a lot easier. On the other hand, there's now non-surgical approaches that might halt or reverse very early DDD that you might want to look into if you don't feel like you're bad enough to commit to surgery yet

[DrewDotNet]

My main concern at this point is how much real risk my (currently) asymptomatic herniation poses to my spinal cord. I've read that this "advice" that neurosurgeons typical give (that you're one fall away from paralysis) is somewhat unfounded, based on some studies and the prevalence of asymptomatic and undiagnosed herniated discs in the general population, compared to the actual # of reported spinal cord injuries. But, I also don't want to live with that risk, real of hypothetical, so I have to balance that against the risks associated with any spinal surgery.

I've been in a similar situation for over a year.

Statistics are useful, as a general guideline, but may or may not reflect your case.

Some factors you should understand here:

1) Neuroplasticity (See Link) - The brain and spinal cord have the capacity to rewire themselves over time, in particular due to slow changes. We don't know exactly why, but some people are more "plastic" than others, and we tend to slowly lose plasticity as we get older.
One person can have a brain tumor the size of a tangerine, and be walking around just fine (some just live with it), and another person can have a tumor the size of a grape, and have noticeable impairment.
Extend the same principle to spinal cord compression....

2) Trauma vs. Compression - The former can cause permanent damage that the latter would recover from. Compression symptoms are more likely to relieve than trauma symptoms, although the longer compression is present, the more likely the symptoms may become permanent.
However, remember that Neuroplasticity factors in - some people will experience less symptoms due to compression, since their nerves adapt better to it, and subsequently will recover better.
Trauma recovery also depends on the patients' plasticity.

3) Physical Therapy - The saying is "neurons that fire together, wire together, neurons that fire apart, wire apart." This is one of the big reasons why post-op physical therapy is so important for spine patients. Performing coordinated exercises stimulates plasticity by encouraging the nerves to work together and in coordination with the brain. It's not about the physical exercise, it's about the nerve exercise!
A well-designed and consistent routine makes a huge difference in your recovery.

A respected Neurosurgeon with 25+ years of experience explained to me that he's seen some patients exhibit no recovery at all post-decompression, and other patients still recovering function over 5 years after a spinal cord injury. It's very difficult to predict anyone's recovery.

The "standard guideline" is that most function is regained within 6 months or so, but your mileage may vary. Another reason why a post-op physical therapy routine is so important!

It's frustrating, but there is no exact answer to the problem you're trying to solve (If you find one, let me know!). Everyone's different.

In the future, research will likely find genetic and/or epigenetic factors, and potentially drugs/stem cells/gene therapy techniques to predict and enhance recovery.
A lot of this is beyond modern medicine. It's also very difficult to do this kind of testing for ethical reasons.

[dman777]

...for the insightful and helpful replies.

Annapurna - that's basically my plan, to do enough research so that I know what the course of action will be once the surgery decision is made (by me or my symptoms). Talking to a couple of surgeons known for their ADR work at Rush here in Chicago, and will likely set up a consultation with the Texas Back Institute. Also mildly considering Germany or Spain, but I'm very worried about potential lack of follow-up options once back in the US.

DrewDotNet - that's great info. Have you made any decisions with your situation, given all your research and time to consider all the options?

[Dema]

Dman, sorry to hear about your pains, and fully agree with Annapurna, to treat the patient/symptoms and not the images, and qualify that there must be conditions where the images are so severe they would require intervention. I have 3 cervical disc problems (C3-C6) with varying degrees of pressure on the cord (mild to medium), and about 5 weeks ago I was involved in a bad car accident (hit 2 trees and car rolled over and ended up upside down!) with the graces of God the spinal cord was not injured. That does not mean there are no risks, but I believe some surgeons use that expression (being a fall/slip away from being paralyzed) to rush people into surgery.
I recommend leaving surgery as last option, and give therapy some time, and please note you need to find a good specialized therapist, some have also recommended the McKenzie method, but seems like my condition is beyond therapy, and now I am hoping to recover from accident injures to get back to my cervical issue, which seems to have worsened since the accident.
Wishing you will be guided to what is best for you and to be pain free & go lucky again, in near future.

[Cheryl0331]

We are here for support; glad you joined us. I have had three level fusion c3/4 with roi-c c 4/5/6 with bone, plate & screws, now I have a two level adr with m6-c under that at c6/7/t1...I am doing much better since adr. just keep in mind no surgery can guarantee 100% pre surgery function. but I believe you will be better once you have them replaced. try adr first; you can always fuse later....hope to here your doing better soon!

[dman777]

Well it's almost a year since my surprise conversation with a local neurosurgeon, urging me to schedule a two level cervical fusion or disk replacement because of a large cervical herniation on my MRI, with what appeared to be some mild cord compression. My symptoms at the time were arm and shoulder pain, but nothing severe, probably like a 2 or 3, on and off, but the neurosurgeon thought there was too much risk of paralysis in case of a fall or accident, and insisted on getting me scheduled for surgery.

I said no thanks, and ended up finding 4 of the most reputable spine surgeons I could find, at very well known and respected spine centers, for more opinions. All of them had the same opinion - my symptoms were too mild to warrant surgery and the associated risks. One of them commented that they see this a lot - people with bad MRIs getting rushed into surgery by less experienced doctors, and/or those with questionable motives (covering their *** or financial). They all discounted the hypothetical risk of paralysis due to a fall or accident, especially compared with the risk of complications from any type of spine surgery.

Since then, I've stopped sitting while working (got a standing desk), made swimming and core exercise a part of my weekly routine. I've also become much more conscious about things that put strain on my body, and avoiding them.

The arm and shoulder pain gradually faded, for the last few months I hardly notice any discomfort, except some occasional mild tingling after sitting for a while (can't avoid sitting completely). Movements / positions that caused immediate pain or numbness a year ago, no longer do.

It's hard to say if I'm completely out of the woods, or if it's just a matter of time before pain returns, but I do think there are some lessons here:

1. Pain related to herniated discs can definitely improve with exercise and changes in posture, but it may take a while and require self discipline and potentially some big lifestyle changes.

2. MRIs don't tell the whole story, but many surgeons are very willing to use them as the only basis for spine surgery. Do your homework, and find the most experienced doctors for second opinions.

[Marbakes]

Dman,

I find myself in the same boat as you were...

I have mild symptoms. My MRI's look really bad and all the surgeons that I have seen suggest surgery, immediately. But I'm asymptomatic. My pain is at the 2-4 level but only sporadic.

My question for you is about the lifestyle changes that you have implemented. I am trying to balance the need for surgery against quality of life. I too have been told that I am one fall away from paralysis. I like to snow and water ski, ride my bike and I have been advised to stop. I am gaining weight because I am not as active too. So, are the life style changes that you have implemented affecting your quality of life?

I am considering three level ADR from C4-C7.

Paul