Hernia in C5-6
February 19, 2008 8:58 AM   Subscribe

My doc thinks I have a herniated disc at c5-6, and wants to operate does anyone have experience with this injury and if so, could you tell me a bit about it.

I am 23 and sometime during the past 6-8 mo. I started having pain down the side of my right arm. In addition I have what feels like an awful knot behind my right shoulder blade and a general feeling of tightness or pulling down my right arm. For several months it has not gotten especially worse, though it has not improved in the slightest either. The pain has more recently spread down to my forearm and towards the end of last week (following several days of skiing) my thumb started going numb once in a while. So on Friday I went to see a spine specialist and he told me I essentially have a textbook herniated disc at c5-6 which is pinching the nerve and causing the symptoms described above. I am scheduled for an MRI tomorrow and plan on scheduling an appointment with another doctor for a second opinion, but I would like to know if anyone else has had this particular injury and what your experience has been. I have read that therapy and meds are an option, but that seems to be geared toward those (smart) people who take care of their injuries soon after they occur. Given that this herniation seems to have occurred quite a while ago, surgery is the option that my doctor recommended. I don't have a whole lot more info yet (whether they want to go in through the front or the back for example), but I would love to hear from some mefites as to how their experience went. Thanks, any advice is greatly appreciated. I live in Chicago and while I have a doctor I trust and a referral for a second doctor, if anyone is especially enthusiastic about their doc I'd love to hear it.
posted by bernsno to Health & Fitness (19 answers total) 2 users marked this as a favorite
I had a problem with a bulging disc from a random back injury at age 27, and there was a possibility of needing surgery for the condition. I went to a chiropractor first, which was not the right thing to do at the time. It helped the immediate pain, but afterward I found out more damage could have been done (thankfully it wasn't). I already had severe pain and loss of sensation and strength in my right foot.

Regardless, a trip to a specialist resulted in the diagnosis and the recommendation to try cortisone shots in the surrounding area to reduce swelling and relieve pressure over a series of three treatments. She did warn that it might not be successful, but she regarded surgery as a last resort because of potential risk and especially the lack of success in many cases.

Long story short, the shots did help, and after a few months I was pretty much good as new. The area is always going to be weaker, and if it does rupture she said surgery would be basically the only option.

Good luck, there can definitely be a light at the end of the tunnel on this.
posted by shinynewnick at 10:03 AM on February 19, 2008

I cant speak for herniated disc in the neck, but I've the same general experience in the L5 so it was my legs that were going numb etc. I put up with the gradually worsening pain over a few months until it finally got so bad that I literally couldnt sit down without almost crying. My treatment was drugs (anti-inflammatory etc) and physical therapy. Surgery was a last resort. After three - four months of fairly exhaustive therapy I was more or less healed.

IANAD but it may be that your doc is concerned that if you do have scar tissue built up around the disc, a standard drug/PT treatment may not work, or he may be worried that because its in your neck, thats just way too potentially dangerous for paralysis etc. Sounds reasonable to me. Then again, my herniated disc appears to have been caused, or at least aggravated by, a minor congenital spinal defect so I could have had the roots of problem for years (and possible scar tissue) and therapy worked just fine.

Ask for a second opinion. That's always a good idea.
posted by elendil71 at 10:17 AM on February 19, 2008

OK - first thing...take a deep breath and stop worrying. You're going to be fine. What you are going through is very common and very, very fixable.

I had L5-S1 surgery in 2003. I had been experiencing numbness and pain radiating through my left leg for a few months. At first I thought it was a muscle pull of some sort, then after it was diagnosed as sciatica I tried steroids, yoga, massage, physical therapy. I did not try rest because rest was not an option. I saw four doctors and they all said the disc was bulging enough so that a surgical solution was warranted. I believed the diagnosis because I made a point to see different types of docs - I saw an orthopedic surgeon ("sports medicine"), a neurosurgeon, a neurologist, and my regular doc. I did get an MRI. I would definitely recommend getting second or third opinions from docs that are in different fields. When it comes time to choose what doc will cut you, I found that the neurosurgeon did discectomies and laminectomies a hundred times per year and the other doctors did them only occasionally.

The surgery was outpatient, went in that morning and left at 7 PM. I had zero complications and could have walked out of the hospital if it hadn't been against their policy. I missed only one work of work, was back doing physical therapy within days, back doing my own workouts with heavy weights 6 weeks later, and back playing catcher in the baseball league the next season. I have no lasting side effects except that it took some time to get my hamstring flexibility back. I like anyone would eschew surgery when possible but in this case it worked perfectly and I would do it all over again without hesitation.

My advice. Get addidional opinions from different specialists, find out which specialist has the nicest car and house from doing your specific procedure, block out a week on your calendar, and go ahead and do it.

Good luck!
posted by vito90 at 10:27 AM on February 19, 2008

My wife got a lot of relief from Dr. Sarno's books. YMMV.
posted by shothotbot at 10:31 AM on February 19, 2008

I had a very similar injury just last year (I'm 34 years old), only to the disc at L4-L5, so instead of pain in my arm, I had it in my leg. I'd had lower back spasms off and on for years, and finally last August I had one that all of a sudden went away, only to be replaced by intense pain shooting down my left leg and numbness in my left foot.

After an MRI, I was told that the disc at L4-L5 had herniated and ruptured, and that the piece that had broken off was compressing the nerve. I went to one of the best neurosurgeons in the DC area (where I live). After examining my MRI, he expressed surprise that I was able to walk at all (albeit not well). He told me that he could give me medications and physical therapy, but he gave me a 95% probability of ending up in surgery anyway. I had surgery two days later, since he had the availability and I was in enough pain that even with Vicodin I was having trouble sleeping.

The surgery was quick and relatively easy, not even requiring admission to the hospital. I had to stay home for a while and use ice and take Percocet, and for a short time get my wife to tape plastic over the bandage so I could shower, and get her help to change the dressing at least daily. It hurt a lot after the surgery, but it was a more tolerable kind of pain. I did some telecommuting when I wasn't doped up on Percocet, and gradually the incision healed, though I did have to take antibiotics for a short time because it didn't seem to be healing quickly enough and they were concerned about infection.

I wish I could tell you that after the incision healed everything was back to normal. But some of the shooting pain—though not nearly as much as I'd had before the surgery—lingered, as well as the numbness in my foot. My surgeon sent me to a pain management specialist, and he gave me some lidocaine shots, each of which helped for about four days but had no lasting effect. He sent me to physical therapy for six weeks, which did no discernible good. He put me on medications to help the nerve heal.

And that's where I am today. I had the surgery on September 13 of last year, and five months later I still have pain radiating from my lower back and hip down my leg and I can't remember the last time I could feel the toes on my left foot. I'm taking Lyrica and Cymbalta, which so far haven't helped that I've noticed, and I may have to change to something else because I'm having some side effects that are definitely undesirable. I had another MRI, which showed some scar tissue and some minor bone spurs on a vertebra, but nothing that (according to the surgeon) warrants surgery. They've talked to me about having a Spinal Cord Stimulator implanted, but I'm not quite ready to have an electronic device stuck inside my body just yet. The surgeon told me that there's a very real possibility I may never recover all the feeling in my foot.

I understand that many people have much better results than I have had. And I may yet improve, of course, as it evidently can take a fair bit of time to get better from something like this. And I also have to say that I don't regret the surgery at all, since I'm in a good deal less pain than I was in, and (according to the surgeon) there was a distinct possibility that, without surgery, I would have lost the ability to use my left leg at all.

If you have any further questions that I can help with, please e-mail me (my address is in my profile).

Best of luck!
posted by cerebus19 at 10:32 AM on February 19, 2008

I am currently managing a herniated disc, and have previously had surgery for a ruptured disc. It is not true that therapy and meds are only useful shortly after the injury. Back surgery has a huge failure rate, so it is well worthwhile to pursue other methods first. Surgery will still be available if those fail. Bear in mind that the advice you are given will be directly correlated to the specialty of the person giving it; i.e., surgeons tend to see a need for surgery. Before making any decisions, you should consult with a top physiatrist. These people are sort of the consultants of the back injury world--they take a global view of the situation and refer you to the proper specialists for treatment. They don't have a vested interest in one approach over another so are more able to give you an objective assessment.
posted by Enroute at 10:46 AM on February 19, 2008

I have had three operations on the L4-L5 level. The third and last was a spinal fusion. The first one last 23 years. I was 15 at the time of the 1st surgery. I am currently experiencing the same pain as you in my right arm. I have degenerative discs. I think the best course of action in hindsight is to try PT, have cortisone shots, then try shots directly into the disc, then have surgery. The surgery has been very successful for me, but YMMV. I also think you have little to lose by trying alternatives to surgery first.
posted by JohnnyGunn at 10:51 AM on February 19, 2008

I was looking at surgery for an L4/5 herniation at about your age. I'm 34 now, and never had the surgery. I did do a lot of physical therapy and learned how to deal with the pain (the words "OK, well now we'll have to do the surgery" really helped the pain go away, to be honest). For years I managed the pain, then I started exercising more - strengthening the core muscles - and it hardly bothers me today. Biggest issue with me was fixing my posture (which I began almost immediately post-diagnosis, following a weekend in which I was so sore I could do nothing except remain slumped over in agony for the duration of a 5-hour car ride).

My advice? Back surgery SOMETIMES helps and other times it doesn't. Talk to your doc, and listen. Get a second medical opinion, and listen to that doc as well. Talk to an osteopathic doc (think chiropractor, but with a general practitioner's license and surgical training) if possible, one who has had time to review your MRI films.

Above all, take the various gloom and doom / amazing success stories here for what they are: anecdotal evidence that sometimes it works out on its own, sometimes it doesn't, sometimes surgery helps and other times things don't improve much. But please, talk to several doctors. Don't listen exclusively to some yahoos on some greenish website for anything other than suggestions.
posted by caution live frogs at 11:18 AM on February 19, 2008

This is screaming for ikkyu2's input.
posted by gramcracker at 12:37 PM on February 19, 2008

I would humbly suggest avoiding a chiropractor at this point.
posted by RikiTikiTavi at 1:50 PM on February 19, 2008

You do not mention whether you have experienced any weakness or inability to control motion. With mere (I know) pain and some numbness I believe the standard of care is to first try non-surgical treatments. Some docs are quick to recommend surgery. The best ones usually are not. Definitely do not have surgery without getting a second opinion. This is one of those times when it pays to seek out the best doctors in your area. In particular, you might want to see a neurologist for an evaluation. Someone who does not perform surgery themselves is less likely to suggest it as a cure than a neurosurgeon or orthopedic surgeon. I am thinking that in this region a neurosurgeon is probably preferred if surgery becomes necessary.
posted by caddis at 2:06 PM on February 19, 2008

I would humbly suggest avoiding a chiropractor at this point.

And because of all the advice I received in that thread, I cancelled the chiro and am seeing an MD next week. I'll be watching this thread on pins and needles. You wish someone would just rip out with their teeth that knot in yourshoulder blade, right?!
posted by wafaa at 2:48 PM on February 19, 2008

I have a herniated disc in a comparable spot. I did exercises and physiotherapy along with non-surgical mechanical spinal decompression on a rack, and my symptoms went away (numbness in fingers, etc). I would be very, very sure that surgery is your only option (it was offered to me, but after talking with a few people who'd had it and wished they hadn't, I decided to see if I could manage my symptoms in other ways, and while I have a flare-up now and then, exercise and muscle relaxants soon get me back to normal), so definitely get a second opinion.
posted by biscotti at 5:53 PM on February 19, 2008

C6-C7 here - same symptoms, including the worrisome numbing of the fingers. I had the surgery after several rounds with physical therapy. My surgery was most definitely not outpatient. It was major surgery (They go into your neck through the front - right next to my carotid - aieee!) under general anesthesia and I was in the hospital for 2 days.

The physical therapy had provided some relief from the pain, but the reason I ended up going for surgery was the numbing in my hands started getting worse, and that was really frightening. Post-surgery, the pain and numbness was GONE. It didn't fade away, it was gone completely. (My surgeon told me this would likely be the case, which made surgery so appealing - get it DONE once and for all.)

However - if faced with the same choices again, I would try physical therapy again before going for the surgery right away. The recovery from the surgery took a lot out of me physically, and I didn't feel completely myself again (as energetic, flexible, strong, etc.) for over a year. But, I am old (38 at the time), and you are young, so your recovery time would likely be much shorter and happier.

I'm in the Chicago area, and I would recommend my surgeon, the hospital and my hot babe post-surgery physical therapist to anyone.
posted by SuperSquirrel at 6:06 PM on February 19, 2008

At age 45 as the result of a vehicle accident I experienced disc damage at C5-C6 and C6-C7. Described after Xray and MRI as, "broad based 6mm to 7mm bulging". Offered surgery as one option with an improvement rate of 50% in 1991 I opted out.

Find out the scale of your disc herniation and consult with a neurologist.

I chose to forego the surgery and accepted varying amounts of pain as a virtually constant companion for several years. I experienced the numbness that makes your hand a useless club laying in your lap at times. I took lots of pain meds and did lots of therapy, mostly swimming, am am now virtually pain free with full mobility and have quit all pain meds. No doubt treatment options have improved vastly since 1991-1992. Listen to your docter and then listen to another docter before making your personal decision.

Good Luck
posted by X4ster at 9:55 PM on February 19, 2008

That would be doctor... Maybe there are lingering after effects, or is it after affects.
posted by X4ster at 10:18 PM on February 19, 2008

Very similar situation as others here, and as the OP. Early 20's and two herniated discs at L4-5 area, X-rays, MRI diagnosis, etc, same symptoms; trouble walking, radiating intense pain strong enough to bring tears, etc. I tried PT for 4 months and plateaued with pain relief after about 3. They only give you about half a dozen stretches to do, and quite frankly for the amount of sessions you have it seemed ridiculous to me. Maybe I just had a shitty employee but it was hard to justify paying for the treatment when they take a look at you and ask a few questions, test range of motion and then spend 10 of your 15 minutes there yammering with their coworkers about yuppy fucking sports games they watched together at their yuppy little pub the night before. I did the stretches three times a day, even the ones I could while standing at lunch break, eventually it simply wasn't improving my health in an objective manner.

As a last resort I tried the a "lower lumbar epidural steroid injection" with cortisone and let me tell you that was the most painful thing I have ever felt in my goddamn life, like they just burrowed through my spine and hooked a car battery up to that nerve and let me fry as every CC was pumped around the disc. The immediate residual effects were really horrible too, I spent the night nauseous and in searing pulsing pain running down my entire leg, I could only lay in bed as tears involuntarily streamed out of my eyes. I dunno, I've never broken a bone or had a concussion or needed more than a few stitches so maybe someone with a higher pain tolerance wouldn't mind it so much but I'll be damned if I could ignore it or want to endure it three more times in the next year. When I asked the doctor what most people thought about the injection, he said and I quote "Well, I frankly don't hear back from most of them so either it was the most horrible thing in their life and they'll never do it again and are looking into surgery, or it worked really well and they don't need another one" The whole idea was I needed it as a bump to help the inflammation in the area. In conjunction with my PT exercises things were supposed to smooth out, but it's about 6 weeks since I had the injection and the pain is coming back in full force. Also, this was after being sold a TENS (transcutaneous electrical nerve stimulation) device that is absolutely worthless for the type and level of pain that I have, and in my and apparently the internet at large's opinion is more of a toy for bondage play than an actual proven pain management device. The cortisone and TENS unit were from a "Pain Management Center" which I was referred to by my GP. This same place wouldn't give me muscle relaxers or painkillers, of which I only asked about literally five minutes before I had the cortisone injection which was like my third appointment there in 4 months. If you believe the testimonies on the internet about this condition you'd be lead to believe they hand these out like candy in every other region of the country when you present these symptoms.

Unfortunately I live at fucking ground zero for chiropractic care, and all of my relatives think they are worth a shot. Before trying PT I saw a chiro who tried TENS therapy with a very large semi-portable device on a cart, and "acupuncture" as he referred to it with basically a springloaded impact hammer directly on my goddamn discs, I shit you not. Needless to say, I never went to that fucking maniac ever again. My family again has pressed me to see other chiro care specifically regarding decompression tables, Vax-D, gravity tables, wtfever, etc. I have read very few tales of success with these methods, and I have read countless criticisms of the devices and the shady companies selling them.

All I know is I am too young for surgery and don't want to end up like others here, with half a dozen operations under their belt and fusion as the inevitable catch all. I'm sure a surgeon would take one good look at someone in our case anyway and see a fucking piggy bank waiting to be cracked open, so that doesn't help things either. After trying all of these things to manage this pain over the last year I have only felt increasingly frustrated, depressed and frankly hopeless with regards to current medical care and the honest concern of any of the individuals who have dealt with me in any aforementioned capacities. Which is pretty unfortunate considering all of the goddamn money I've coughed up for apparently absolutely nothing, and this is even after considering adequate insurance coverage.
posted by prostyle at 7:48 AM on February 20, 2008

I would advise you not to give the experiences of the users on here with lumbar herniation too much weight. The differences between the lumbar spine and the cervical spine are just too significant anatomically, functionally, and in terms of possible surgical complication for anecdotal evidence of lumbar herniation to help you much in this matter.
posted by i less than three nsima at 12:50 PM on February 20, 2008

Like prostyle I went through the epidural injection experience. It was supposed to be a series of three injections but the first was so painful that I never had the others. I blacked out and when I woke up it felt like I'd been hit in the head with a club.

PT at the clinic was just to teach me what kinds of stretches and exercises to do that might help. I did PT on my own, 20 minutes or so at a time, several times a day. For the first couple of years I thought the pain and the limits to mobility and activity were going to be with me for the remainder of my life. But now I'm able to function well with few limits.

The neurologist who treated me here in California was terrific, don't know how I would have dealt with things with out him. He's Dr. Ram Dandilaya; but Chicago's a long way from CA.
posted by X4ster at 8:49 PM on February 20, 2008

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