<3 weeks symptoms so far but worsening motor weakness - what are my options?
 

Thanks so much every1 who has contributed to the wealth of information here on this forum. I have been on this website for last 8 hours.
I am a new victim of disc herniation, 35 yr old male, 2.5 weeks h/o neck pain with rt arm pain, with weakness at Rt wrist extensors (4-/5) and biceps(4/5), MRI - C5-6 Right parasaggital disc herniation, protrusion type, extending into neural foramina. Pain is adequately controlled with meds at this time, but weakness worsened from initial power of 4+/5 at the said muscles. How much more can I wait to continue trying conservatively at this time? This is the first time I developed this, no prior history of disc disease. other cervical discs appear fine, no DDD reported on MRI.
I am scared, confused and sad after having learnt many of the pros and cons of every approach and the experiences of many with good and others with no so good outcomes.

!
 

poonav,

Welcome to the site. There is a ton of information on here and it can be very confusing. You first have to decide what you are willing to live with then find out what option is best for you. There are other procedures that can help you in the short run but will probably just delay the inevitable. The ultimate, at least here in the states that they still teach is fusion which has something like 60-65% chance of sucess initially but could lead to further disc deterioration or ADR which so far in the short run has a much better success rate and is thought to prevent further adjacent disc problems. So, what is your tolerance to risk? For me and others on here, fusion was not the answer and we went with ADR. Talk to people and read and research. Ask your doctors tough questions.

Good luck

Mark

Thanks Mark for beautifully summarising on the current state of treatment choices. My main concern at this point of time though is that are there good examples of people with C5-6 disease who have worsening motor weakness in the dominant arm and hand, who opted for conservative approach in the acute phase and actually did make good recovery?(like it is said that many disc herniations resolve/ improve without needing surgery.)

Of course I understand that my case is in the grayer zone since i have possible progression of my neurological symptom ie weakness of my right arm - I am not sure till what level of weakness should I wait hoping to recover before i really decide on getting it fixed surgically?

Nerve compression pain or disc pain?
 

Poonay,

I think the big question here is what is your pain generator---the nerve that is being compressed by the herniated disc, or the disc itself?? If it is just nerve pain (which is suggested by the arm pain & weakness), then a simple Microdiscectomy (outpatient procedure that takes about 30 minutes, you go home that day) could do the trick. They make a small (1 cm) incision, use a small endoscope to get to the disc, and then remove the bulging portion that is pressing on your nerve and causing the symptoms. However, if the disc is degenerated as well as bulging and the pain is coming from the disc itself, a Microdiscectomy will not work. The disc needs to be removed, and as Mark said you then have a choice between fusion or artificial disc replacement.

Rather than worry and fret, why not go see a spine surgeon or neurologist and get a professional opinion? Your first step is to find out the exact cause of your pain, then you can determine how to treat it. Until you do that, everything else is just conjecture.

Good luck,

Welcome!
 

Welcome to our humble global forum. You’ve received some thoughtful, succinct replies from Mark and Charles, so I hope this motivates you to keep going; researching, seeing different doctors, asking questions and sharing. It is a journey, as many here can attest.

When you can, please:

- see this topic, a very important one: ADR Risks, Complications, Disqualifications;
- add a signature, as in mine or others in this topic, that describe your spinal situation;
- tell us a bit more about your spinal health, e.g. traumas or disease;
- research other options for non-surgical options – have you started yet?

Thanks for posting. And don’t forget that even though you are going through a tough time, you are helping others by asking and sharing. So don’t be shy!

:wiggle:

Sorry that you're in such pain.

I agree w/Charles that you must determine your pain generator(s). If you feel pain on your cervical spine/back of neck, then maybe (and I don't know cervical stuff at all) a discogram is warranted, along w/facet injections to rule out the facets as pain drivers which means that an ADR wouldn't help you vs. fusion (if you have a positive/painful discogram). Hopefully you can get away w/a disectomy. My best, Allan

all of u guys r awesome, i am really greatful to everyone here with all the valuable suggestions, i will be posting in detail soon about my visits with ortho-spine doc and other details of my case. and Rich - will add my signature soon - i have to run now. thank ya all, keep ur suggestions coming.
god bless every1!

Title: Re-Introduction

Hello Mark,Charles, Rich, 'ans' and the forum

I really appreciate all the valuable and important suggestions - enabling me better understand my situation and making me smarter in my questions to my doctors to help them help me.
I have already seen a neurologist, a neurosurgeon and today I met an Ortho-spine as well. I have seen these 3 specialists in that sequence.
To again put it in perspective, my symptoms of right sided neck pain (back of neck) started 3 weeks ago, initially mild pain for 4 days with sudden worsening to 10/10 pain on 5th day, with myokymia of right arm muscles and minimal weakness of the arm. (The pain in my arm has never been as bad as the 'spasms' in the back of my neck.)
Neurologist - seen on 6th day of symptom onset - MRI done - C5-6 disc herniation - suggested conservative Rx with steroids/ anti-inflammatories/ vicodin/ heat - helped in pain, did not notice much difference in weakness.
Neurosurgeon - seen after 2 weeks of onset - I was a little weaker in my right arm than before - agreed with conservative Rx - suggested gentle cervical traction - tried for 2 days - I am unsure whether the traction made it worse or it had to get worse any ways - the weakness of right arm/hand appeared to increase - reconsulted Neurosurgeon - suggested - if weakness worsens - will need surgery - ACDF - likely because he does not do ADRs or MICF.
- saw Ortho-spine today - in NYC - recommended MICF since I have motor weakness which seems to be getting worse and it has been 3 weeks since symptoms started.
- I am considering MICF seriously at this time, but as suggested by all of you - I need to ask him - whether I should get a discogram before the surgery?
Question I still have - I noticed very subtle, short lasting (few seconds) pain on left side of my neck for last 2-3 days - with some myokymia in left sided muscles as well - very transient though - Does that warrant a repeat MRI before the surgery?

Thanks to all
God bless

Navneet

Hi Navneet, Thanks for keeping in touch. How much did you tell the doctor today...did you mention the new pain on the left side? Your MRI is very recent, is it not? I think you need to ask all these questions to the doctor you saw today, and hopefully he can get back to you very soon, since things are progressing quickly.

Do you have his email? He is normally very good about answering quickly, especially if he is concerned about your symptoms.

I'm sorry things are getting worse instead of better, but you are very lucky to be getting some good advice so early in your experience with this pain. So many of us let it go far too long before finding help with doctors as good as you have found already.

Please continue your fight...you are doing a great job, even if it doesn't feel like it right now.

Hi Sue,
I was quite satisfied after meeting this OS doc. He did answer most of my concerns. yes. i did tell him about my new left side symptoms, however subtle or fleeting they are. he did say that he might repeat my MRI prior to the MICF, yes my MRI is just 2 weeks old at this time and my pain is 3 weeks old - grrrrrrr -

Like Mark, Allan, Chalres and Rich have suggested - I really need to ask my doc whether the pain in the back of my neck is from the disc? and would I need a discogram. Though for sure the weakness is from nerve compression and I hope that this pain in the back of neck - is actually from the annulus tear - and resolve in 6-12 weeks like they say - they usually do.

I hope all goes well
Wishing luk