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Can Someone Translate This For Me?

DeniseO_oDDeniseO_o Posts: 115
edited 02/05/2015 - 10:48 AM in Neck Pain: Cervical
C6-C7: There is broad-based central, bilateral paracentral and bilateral lateral disc protrusion, right greater than left measuring 3 mm centrally and bilateral paracentrally and a 4 mm laterally into the right neural foramen. This mildly effaces the anterior thecal sac and touches but does not deform the cervical cord. Mild focal spinal stenosis is present with severe right sided neural foraminal stenosis and mild left-sided neural foraminal stenosis secondary to the disc protrusion.

I met with the Neurosurgeon a few days ago and he said one month of physical therapy then surgery whenever I am ready. Apparently thanks to Insurance I have to "go through the motions" before they'll approve the surgery but he's convinced the therapy will not help alleviate the symptoms.
I am a healthy woman in my mid 30's with two small children. Any insight as to if my condition *does* definitely point to surgery would be much appreciated. Oh, he did say it would be a disc replacement through the front of my neck.

ACDF C6/C7 on 05/20/15
...and it was the best decision of my life :-)


  • LizLiz Posts: 7,832
    Welcome to Spine-Health

    Use that above hyperlink to help you get started with Spine-Health and navigate through the system.

    If there are any questions, you can always post them here, send Liz or myself a private message or contact Ron rdilauro@veritashealth.com

    There is nobody on the forum medically qualified to interpret a MRI finding


    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • DeniseO_oDDeniseO_o Posts: 115
    edited 02/05/2015 - 11:14 AM
    I didn't mean interpret it, but whether or not they've had the same findings and if physical therapy worked for them, or did they opt for surgery. I'm just looking for someone who has experienced what I am going through, or can relate in one way or another.

    ETA: I know my condition so I don't need "explaining" or reading of the MRI, per say. By "translate" I mean share similar experiences.
    ACDF C6/C7 on 05/20/15
    ...and it was the best decision of my life :-)
  • yatesy1983yyatesy1983 Posts: 2
    edited 02/06/2015 - 3:00 AM
    I have left c5-c6 protrusion and thecal sac indentation with some slight indentation of the cord. I posted a very long psot about my experience so far.

    If I was you I'd get a second opinion before surgery, I'm not saying it's not the right path to take but for me I've gone down the conservative route and I'm managing fine so far.
  • I was reading about CSE...it seems to apply to Lumbar issues...does it also apply if neck issues are C5-6 area?
  • It is a decision that cannot be made in a vacuum. Are you 30 years old, fairly active, and likely to protrude the disk again or are you 65 and only interested in playing bridge every now and then? And of course the big questions, do you have pain and numbness and is this procedure likely to make things better?

    Modern research says that the disc itself will never heal. If it is weak it will stay weak, if you have a hole it will only get bigger.I know that's hard to except but there are other places in the body like that also, for example the ACL that athletes tend to tear.

    It's true that the surrounding material and the injured tissue will get better should the protrusion subside. It's also true that your body can remove fragmented material if you have a disc herniation and not simply a protrusion. And in the example case of the ACL, the knee feels better once the ligament stops flapping around and has been disintegrated by the immune system.

    But in none of those cases have things actually healed. So the question becomes, do you want to manage for the rest of your life or do you want to fix it with surgery?

    Good luck
  • Explain what you mean here: "It's also true that your body can remove fragmented material if you have a disc herniation and not simply a protrusion"

    I thought herniated and protrusion is one in the same?

    I am seeing another Neurosurgeon at the end of this month for a second opinion. I am a 34 year old full time working mom with two small children (6 and 2), I can't afford to yoyo with debilitating pain only to have temporary relief with conservative treatment. But I'm also not fully educated on my condition either. I hope this Dr is more forthcoming with information because I've read so much with no real understanding of it all. I do know that surgery for me would be through the front of my neck (disc replacement) and I've been told it has a great success rate. And also the incision in the front supposedly brings less risks. I'm at the stage to where this sounds very appealing :'-(
    ACDF C6/C7 on 05/20/15
    ...and it was the best decision of my life :-)
  • I think I write too much. Anyhoo ...

    They are not exactly the same but the terms are commonly used as if they are. When the disc is protruded think of it as a balloon ready to pop. When the disc is herniated it has popped. Except for diseased people, all of your symptoms come down to simple anatomy. In the "balloon" state the disc is pressing on areas that it shouldn't and in the "herniated" state the inner material floats out and pieces of the disc itself start to break off. Over time a herniated disc collapses completely while breaking off pieces here and there, a protruded disc either pops or goes back down and then may or may not come back again.

    In the case of the herniation your body will dissolve the escaped material; the immune system will destroy it. It will also start decaying naturally since it no longer has blood flow. It will not stay there forever. In my case it took 5 or 6 months each time which is about average. Protrusions go down sooner and can be speeded by steroids and staying away from aggravating activities. I repeat, your body will disintegrate the escaped material.

    I went through healing and re-injury stages three times on the left side and then a final injury stage on the right. At no time did physical therapy, steroid injections, or anti-inflammatories have any significant or lasting impact, the reason is simple. None of those things make the disc fragments go away. I will also warn you that the last injury time was the worst. I could barely use my right hand and the pain started from the time I woke to the time I went to bed time, every single day. Don't wait to that point if you can. There is an interesting philosophical debate that you will run into in the world, some doctors, family members and friends think that you should wait until you are practically paralyzed before having surgery. I think it is horseshit.

    I never saw a neurosurgeon until the final episode but I don't view all of the treatment prior to the neurosurgeons as a waste of time because it was a tremendous learning experience. Not only did I learn the anatomy, I learned that doctors only know their area of practice well and have a hard time seeing outside of it, you would be amazed how much miss-information is in popular society and the medical field itself. Inflammation and swelling is not the cause of all pain. The cost of that learning experience of course was time, money, pain, numbness and sometimes self-doubt. Maybe that one semester of medical school in the nineties paid off before I decided medicine wasn't for me and quit.

    Under no circumstances should you compare yourself to a back patient or compare yourself to people that have a herniation but no symptoms. In the case of a back patient surgery is an absolute last resort. The reason is that the success rate is low, meaning that the procedure either does not help at all or only marginally helps. It can also cause harm to the patient. The reason that you should not compare yourself to an asymptomatic person is that the disc is a sphere. It can tear anywhere on that sphere, you just happen to be someone unlucky enough to where it tore in a place such that the escaped material is either hitting a nerve coming out form the spinal cord, or in my case the spinal cord itself.

    So if you wait it out will you be able to forgo surgery? In my case the answer was no. But if you are 65 yrs. old and your discs are already aging and drying and you are not an active person you may not care.

    I would like to give you direct advice concerning your last paragraph. This advice isn't medical so we are okay, here goes: Save up about $250 cash. Then find a neurosurgeon that is not in your network and call them up. It might need to be a smaller place and not a large practice. Explain to them that you would like to pay them out of your own pocket for about forty-five minutes of their time to go over your case notes, your MRI, and the questions you have. Let them know up front that they will not be able to do the surgery because they are not in your insurance network.

    I am done writing for today,
  • The last Neurosurgeon eluded to the fact that if my issue was going to repair itself, it would have done so already. Which that makes sense to how you explained a protrusion. (This started for me in October).
    Anyway, it wasn't too much, you made complete sense. Until the very end, that is.
    I know what you're getting at. You want me to get a professionals opinion from someone who's not going to make a big buck off me. So, now I'm back in self doubt mode which is, is this because there's legitimate alternatives to surgery or so that I'd feel more confident in hearing surgery is inevitable?

    I agree that this is not comparable to a back patient. It frustrates me because family/friends who offer "help" make it out like I'm this lazy, complacent idiot who's foolishly following Dr's Iike they hold the Gospel truth. Truth is, I've seen my Dr, I've had a steroid shot, prednisone scrip, X-ray, EMG, MRI, Chiropractic work, one neurosurgeon and another at the end of the month. Meanwhile, I'very had to quit going to the gym and also carrying my baby. I take pain pills daily and the depression from chronic pain is lurking as I fight to keep it at bay. Sorry for the tangent, I just feel so lost & confused and I wish this would all go away. I'm scared but determined at the same time. I almost feel like my life is on hold or something, it's really weird.

    How long since you've had your surgery?

    svbagley said:
    ACDF C6/C7 on 05/20/15
    ...and it was the best decision of my life :-)
  • I am sorry for putting you back in self-doubt. The reason that I was suggesting a third neurosurgeon was not to steer you away from surgery, it is that I think it will help you feel confident in your decision when you finally get around to making it.

    I suspect that decision will be surgery and you are going to need confidence to commit to it. It is also going to give you comfort as you approach the surgery date and when you encounter doctors or family members that advise against it. I suspect that the third neurosurgeon will confirm what the other neurosurgeon said. I would further bet that your disc is torn in addition to being protruded. Regardless touching the spinal cord is a significant.

    Your initial post seemed to be looking for a way out of surgery so I was trying to explain that yes in fact you can get to a point where you have little or no symptoms but you will have to go through a long period of hell to get there and it doesn't last even when you do. Medical research back that up also. I do not recommend what I did to anyone unless you love pain and numbness. In hindsight I think I was in denial that I had a neck issue.

    In one of you other posts you had some worries about the actual surgery. For that be sure to select a surgeon that you feel will do a good job in the actual surgery. You may need to do some research on that. The scar from the surgery is not bad. It is a fine line and people don’t notice it. I actually have to point it out to people that want to see it. The worst part of post-surgery is the swallowing and the self-doubt that returns because your symptoms don’t go away immediately. Nerve surgery is unlike other surgeries in that respect.

  • itsautonomicitsautonomic LouisianaPosts: 1,807
    You just need to be aware of pro/cons of disc replacement . How many has this surgeon done and what type is he going to implant?
    I had a disc that generated pain for a very long time that an ESI helped and my pain for most part from that disc went away , it was in my thoracic and cervical much more mobile so a bit different.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Did you find some days you felt cured then other days you were in agony again? Why is that? I've tried to identify what might lead to bad (and good) days but I've yet to find a link either way.

    And you know I think I'll always doubt my decision in trusting my research and professional recommendations due to always having those people who like to think they can live your life for you.

    ACDF C6/C7 on 05/20/15
    ...and it was the best decision of my life :-)
  • "Did you find some days you felt cured then other days you were in agony again? Why is that? I've tried to identify what might lead to bad (and good) days but I've yet to find a link either way. "

    I think you are subscribing too much psychology to this. You are in pain because of physiological reasons, something is off in your body. Not everything can be fixed by lifestyle changes or gutted out through toughness.

    "And you know I think I'll always doubt my decision in trusting my research" and professional recommendations due to always having those people who like to think they can live your life for you"

    Maybe you could just let this run its course for a while and see how it goes. As long as there is no risk of permanent damage you will learn a lot about yourself and you can always come back to the surgery decision later.


  • I too have cervical issues. Herniated discs at C4/5/5 and C5/6. Just for your information, I have tried every non invasive therapy out there for the past year and a half. I did acupuncture for 6 months, chiropractic, I did physical therapy for a year, just had a facet injection, nothing gave me more than 2 days relief. So more than likely my next step will be surgery. I think it is normal to have days where you almost feel human again and start to doubt yourself. I had days where I thought "If I feel like this the rest of my life I am good with that, it's not that bad, why am I considering surgery, haven't had a pain pill all day, Yay!" And then somehow the next day I wake up with my back spasming all day, my hand is numb all day, I have a debilitating headache and my neck feels like someone stabbed me with a knife and my shoulder blade feels like I've been branded like a cow, I pop pain pills through out the day and I think "If I feel like this the rest of my life I will blow my brains out, I am in a funk, It takes everything I have to get out of bed to tend to my family and life sucks". So welcome to the world of chronic pain and neck issues. I think for me that is what has been the most frustrating. Every day is different. I can't make plans for the weekend or even to meet a friend for lunch during the week because I have no idea what I am going to wake up to. Will it be a good day with no pain pills needed or will it be a horrible shitty day where I am in debilitating pain all day? It really is 50/50.
    The best thing you can do is research the surgical procedure and make yourself comfortable with it. I knew in my heart that if everything failed I would end up having surgery, not because I had to, but because I am or was a young 40 year old active mom of two a give teenage boys and an active husband. I want to play golf again, and run and go to the gym and living an,IFE of 50/50 will not get me there. The chances of me getting that life back will only happen if I have surgery and my issues get fixed. I think all the non invasive things are just a bandaid to buy you time. So do your research, get several opinions so when you are ready to have surgery you will have a surgeon you are confident with.

    I think svbagley has some great advice. I have asked him for advice myself. I think his experience is like many, where you do all the non invasive stuff to prevent surgery and you end up needing the surgery anyway.
    It's better to get it sooner rather than later I believe. Too many people wait too long for fear of the surgery and they end up doing irreparable damage to their spine and nerves.
    I hope my long winded message helps you. Feel free to PM me if you need to vent. As a mom I understand the frustration of everyday being different in regards to your pain. Good luck to you.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    Honestly trying to find what makes for a good day or bad day is a worthwhile tracking , you may find a pattern in it , foods, activities, meds etc. it's something that everyone should try to track at least for a while to see if a pattern present itself. Any edge against pain you have is worthwhile
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • I find on days that I do a lot of driving, or standing with my head looking down (which as a mom I'm in this position often, while cooking, doing laundry, doing dishes, etc) the next day I pay the price. That is great advice.
  • DeniseO_oDDeniseO_o Posts: 115
    edited 03/09/2015 - 3:57 AM
    BlessedMom74 said:

    Yeah, it is definitely unpredictable. I guess I am fortunate in that even with my worst days, I am still functional. I am miserable, sad, etc. but I can still work, take care of my kids, etc. It just gets more challenging. I am definitely having surgery but my MIL is visiting from abroad and will be here for 6 weeks. I do not want her coming here thinking she has to take care of me, or do extra while I'm under lifting restrictions (hello, heavy toddler). So, I am merely trying to survive with temporary relief until after Summer. This Thursday I am scheduled for a nerve block and I start PT as well. My surgeon did tell me that this might make me feel worse and that if I am a few weeks in and want to tap out, that's fine. The ball is in my court and I say "when" on everything. On one hand that's a relief but on the other hand I hate the decision is in my hands. My Husband is already upset I am delaying until his Mum leaves so if anything he won't let me put it off much longer after that.
    ACDF C6/C7 on 05/20/15
    ...and it was the best decision of my life :-)
  • BlessedMom74BBlessedMom74 Posts: 322
    edited 03/09/2015 - 5:24 AM
    Hi DeniseO_o, I understand how hard it is as mothers to relinquish control and let someone else take care of us. Honestly, I would kill to have someone stay with me for 6 weeks. I would have surgery in a heart beat. I would take advantage of that help and have surgery while she is there. My dilemma is that I don't have that kind of support or help. Trying to figure out how to get my kids to school,etc....is a challenge. My husband travels for work a lot so all that usually falls on me.
    I too am very functional even on my worst days, which makes us pay the price later. I think pain is your body's way of saying "something is wrong, slow down". I hope you do well with your nerve block. I had a facet injection a week ago and it made my pain worse. I came home from the procedure in tears. My poor kids never see me cry and it scared them to see me be such a wreck. I think this experience has been a learning opportunity for me to accept help when I have it and to relinquish control. I am an uber type A and I like to do everything on my own. I never ask for help until now. If your MiL is willing to help for 6 weeks I would gratefully accept the help and allow some healing to occur. Allow someone else to take care of you for a change. Give yourself that gift. This is major surgery. Giving yourself 6 weeks to not lift anything would help you heal beautifully.
  • DeniseO_oDDeniseO_o Posts: 115
    edited 03/10/2015 - 6:43 AM
    BlessedMom74 said:

    Oh no....she's coming here to visit. It just so happens that my neck took a shit right around the same time. She's elderly and actually just had a knee replacement Nov/Dec last year so she's physically not "able" to do much of anything other than sit and enjoy her grandkids that she only sees once every year to two years :-( She's also not mentally sound to be able to take care of them in a safe way, if that makes sense. She can absolutely tend to me as far as getting me something to eat/drink but I don't want her coming here and taking all that on. My Husband and I can handle this much better after we enjoy her visit.
    ACDF C6/C7 on 05/20/15
    ...and it was the best decision of my life :-)
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