I have neck pain and numbness down my right arm. I haven’t had a recent injury, but I was in a rear end car collision 10 years ago. I have developed grinding and neck pain and stiffness. I have had numbness in my fingers that was primarily at night, but now it happens at work when I am on the computer and phone and when I am sitting watching TV at night. I have neck pain and stiffness when riding in a car or on a plane and trying to turn my head to talk to someone. The pain is not constant, but is worse when I am in different positions while sleeping or working. I continue to do my job. I work at a computer and on the phone and I have to carry very large files. I am worn out at night and sleep is affected. I can’t get comfortable sometimes. I have had definite problems with concentration at work and I think lack of sleep contributes to that. The numbness is in the hand affecting the thumb and index fingers, but also the other fingers. I have upper arm pain at times, but I have more upper shoulder pain. Massaging the neck, upper back and shoulders helps. I have used heat and ice to help relieve the pain. I take Alleve primarily.
I had a NCS 6 months ago on my right arm to see if carpal tunnel was the issue. I was told no, but there was no other explanation. I had complained about shoulder pain to my TP in the past. Three months ago I told her about the neck pain and how it hurts and that I have headaches and pain from neck down into the upper back.. After an x-ray of c spine, she recommended a MRI and after the results she referred me to a neurosurgeon. The neurosurgeon said I had a herniated disc with severe spinal cord involvement. Looking at the MRI there was closing of the spinal fluid at C5-.6. He said I had a serious condition and surgery was a definite possibility. He said I ran a great risk of spinal cord damage. After a myelogram, he said I had a bone spur that is pressing on the spinal cord and I have a flattening of the spinal canal (?). The doctor recommends surgery. I have not had any PT or injections or any other treatment. Is this a step I should be taking before having surgery or is it possible that I have a condition that is severe enough that these others methods would not do any good? The neurosurgeon has an excellent reputation and comes highly recommended by other doctors and neurologists.
?
Dr. Joshua’s Answer:
It seems you have C6 radicular (nerve root) symptoms that match the MRI finding of C5-6 herniation. Therefore I would expect good results from surgery. The phrase “severe spinal cord involvement” puzzles me a bit, I would rather like to hear “nerve root compression”, since you don’t seem to have spinal cord compression symptoms. However, if the herniation is big enough to involve the spinal cord, I suspect the MRI may show nerve root compression as well. Also, is it the bone spur (osteophyte) or the disc herniation that is the main culprit? That’s not entirely clear - although the treatment is the same, and the bone spur tells me you have cervical spine degeneration. The car accident is probably irrelevant here.
Conservative (non-surgical) treatment is always an option as these things have a tendency to heal spontaneously. However, if the symptoms persist for weeks-months, surgery should be considered.
?
Based on the symptoms and MRI findings, and especially on the fact that your neurosurgeon recommends surgery, it sounds like surgery is a good option. If the above details are correct, PT or injections won’t do you any good. On the contrary, in your case PT, let alone manipulation, may result in spinal cord injury. Also, if there is spinal cord compression, there is a chance of serious neurological injury if you should injure your neck in the future. Furthermore, if the pain continues untreated, you risk the chance of developing neuropathic pain which is difficult to treat.
Anterior decompression and fusion is, in good hands, an elegant and highly succesful procedure, when the indication is clear. Complication rate is low, and recovery is fast. However, I usually tell my patients that what the procedure does is get rid of the radicular symptoms, i.e. the upper back pain and arm pain. The finger numbness usually persists, but often disappears or at least diminishes over a longer period of time. Unfortunately it cannot be guaranteed that the procedure helps the localized neck pain at all, because often there are other underlying causes of neck pain which cannot be treated surgically. But after the operation, PT can safely be started for the neck pain.
Advertisement:
Discuss this topic on the Health Forum
More answers in Neurosurgery, Orthopedic, Pain, Spine
