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Spine and Back Health

Treatment of Cervical Disc Herniation

11/02/2009

Question:

I was recently in a car accident where I was hit from behind causing me to hit the car in fromt of me. I am experiencing severe pain from my neck to between my shoulder blades, shooting to both shoulders and alternating down both arms (depending on which arm I use more during the day). Besides feeling like I have knives stuck in my neck, middle of my back and shoulders, I also experience needle pricking sensations in my neck and numbmess/tingling in my fingers.

My MRI states: C5-6 level there is a focal left paracentral disc herniation indenting the left ventral margin of the thecal. Medication (hydricodone and motrin)are barely contolling the pain. The spine specialist has reccomended steroid shots and physical therapy.

My concern and question is these shots may work-but only temporarilly. How likely is it that I go to physical therapy, return to work and then the shots stop working and I am right back to this horrible pain? It is my thinking that I would rather this be FIXED, not "lets try shots and therapy first" and have recurrent problems that leave me unable to work or clean my house periodically for the rest of my life! We use our arms and neck for virtually everything. You don`t realize it until you are unable to. I already have a L4-5 disc that loves to periodically bulge leaving me with a constant ache and occasional sciatica. I function with this-but the cervical issue I am not.

Answer:

Hello, thank you for your question. I get asked this frequently by patients in clinic, usually ones who are having trouble coping with the pain and/or have some major issues with work, finances, etc. and don't feel they can "afford to waste time". The fundamental flaw in your thinking that you'd "rather this be FIXED" is two-fold. Number one is the assumption that surgery will be successful.

You must never forget that surgical treatment for cervical disc problems is generally very successful "the chances are good", but there are a certain number of people who will get no relief from surgery whatsoever, or might even end up worse than they started! Not only can the primary symptoms get worse, but a complication could lead to a whole new problem you don't already have, such as profound difficulty swallowing, a hoarse voice, or something worse like nerve damage.

Furthermore, as far as the concern about having lingering problems if you have more conservative treatments you must keep in mind that even after a "successful" surgery many patients are left with more mild, but chronic lingering issues with their necks. Don't get me wrong, as a surgeon I'm all for surgery when it is truly the best option, and it usually works very well, but you can't assume it'll make everything right again. The second problem is in the other assumption that the conservative treatment is "just a band-aid" and that the symptoms will come back again. You are falling victim to the idea that you need an external force or entity to FIX what's wrong with you, forgetting that the body is capable of tremendous healing by itself, often just needing a "nudge" in the right direction.

The reality is that more than 2/3 of people with the kind of pain you have will eventually get better, period, without surgery. Sometimes a nerve just "gets its bell rung" at the time of the trauma, and is inflamed, but with a few steroid shots and PT it will settle down. Keep in mind, a large portion of the population have small disc herniations (I have one at C5-6) visible on their MRIs and have no symptoms at all. This means your MRI doesn't have to be "fixed" for you to feel better.

The bottom line is, the treatment that has been recommended to you might not work, or might only work temporarily, but that's a risk you take with any treatment, surgical or otherwise. Jumping into surgery is usually not the first solution. If you don't get better after about 6-8 weeks of treatment it might be time to re-evaluate your options. Your spine specialist should keep in touch with you and see how you are doing. Good luck.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University