New Here - Recent MRI Done and Shocked at The Results

Bones, joints and muscles
1

Hi guys,

Just new here and wanted to try and get some patient info rather than all the medical feedback that I quite frankly don't understand or trust.

Male age 49, started with pain in my right hand 4 years ago. Graduallt transferred to left hand and now is what I would describe generally as a combination of burning, aching tingling and numbness in both hands, wrists and forearms. No other issues, aside from that in good healtha nd do lots of regular physical activity.

Lived with the pain which has gradually got worse and probably is something like a 5/10 on the pain scale now.

Recent stressfull domestic issues seemed to agrivate the pains so finally decided to see a Spine Doctor (I am a Brit but live in the Philippines where medical care is excellent, especially when they see a foreign face with bulging pockets !)

The Dr did all the usual physical tests and none of them replicated the symptoms and her diagnised me with Carpal Tunnel Syndrome in both hands, to which I said "Sorry Sherlock, it ain't CTS).

Ok, he said, go do an MRI, which I just did and have the results (results pasted at the end of this post)

Went back to see the Dr and he said that I need surgery (Fusion of C5 and C6).

So, my quandry now is should I believe him or should I try a different approach.

The first paste below is the original MRI findings and the second paste is a second opinion that I got from an independant on line service.

Many thanks indeed Guys.

IMPRESSION: -BILATERAL NEURAL FORAMINAL STENOSIS AT C5-C6 SECONDARY TO RIGHT FORAMINAL DISC EXTRUSION ON THE RIGHT, BILATERAL UNCOVERTEBRAL JOINT HYPERTROPHY WITH PROMINENT SPUR ON THE LEFT. -CORD EDEMA, C5 AND C6.

Second Opinion

OPINION:

There is a moderate sized, posterior disc protrusion/osteophyte complex at C5/C6 causing moderate spinal canal stenosis, moderate compression of the cervical cord and cord edema. The segment of cord edema extends from the level of the C4/C5 disc to C6/C7 disc and affects the left hemicord more than the right hemicord. Significant bilateral foramen stenosis at C5/C6 with compression of both exiting C6 nerves (right more than left) seen.

 

2

I've just had a cervical fusion of C5-6 because I had a disc pressing on the nerve with accompanying pain in my left arm, wrist and thumb.  Surgery is the last resort. It is probably a good idea to try injections in the first instance (cervical epidurals). I had three of these which unfortunately didn't work and then a Nerve root block injection (the latter is diagnostic as much as anything). If you have a disc pressing on the nerve, then you will be undoubtedly be experiencing these symptoms.

3

Thanks Brevis, it sounds like an identical issue as I have. In my case, the pain is stuill manageable, (Ibuprofen 200mg 3 times a day) does the job so I don't want to go the surgical route until absolutely necessary, but at the same time not wait till it's too late.

4

I've had cervical spondylosis for a long time now: treated with NSAIDs, which unfortunately nearly killed me, now with dihydrocodeine slow release, plus DHC 30mg for breakthrough pain, and paracetamol as and when - it doesn't cure anything, but it enables you to function.  And I wear a support collar sometimes, more often at night.  I would be very slow to take the surgical route - apart from anything else, one slip and you can be far worse off than you were before, eg paralyzed.  And osteophytes can grow back - spondylosis is an osteo-arthritic process: surgery can replace worn joints, but the underlying processes continue.  Depending on how old you are, you might get relief for the rest of your days - but there's always the chance of something going wrong, or just not working.  

I'd go for more conservative treatment, combined with exercise and avoiding weight gain.  Some (not me, I've never tried it) find yoga helpful, which at least won't do you any harm provided you don't try the more extreme positions ....  I think basically one has to accept that this is a condition we're stuck with, that can be managed but not defeated.  But - you might be so fed up with it you'll try anything: and if you do - good luck.  

5

Incidentally, if you're on that regular and high a dosage of Iburprofen, ask your doctor for some form of stomach protection: NSAIDs can play havoc with your stomach lining, and were nearly fatal to me some 2 years ago when they caused a major gastric bleed.  

6

Thanks so much Robert, all you say makes perfect sense, especially the potential slin or fall issue. The Ibuprofen also is a nasty chemical, I do agree, so I will ned to change that in the near future.

 

7

Further comment greatly appreciated............ I just did a EMG/NCV Test today, results all normal, so I am now wondering where the hand and arm pain is coming from with all the tests being normal. The spine "specialists" here are only interested in doing surgery, so I can't get an unadulterated opinion from them unfortunately.

Does anyone happen to know why the test was considered as normal ?

Many thanks,

8

Hi

I would suggest that the 'normal' result is due to the fact that their tests have not identified an actual cause.  Your condition might be in the 'threatening' phase where the degeneration or impimngement isn't too obvious.  Your arm and hand symptoms still point to possible C/S. MRI scan of neck is the best method for determining C/S.  The neurosurgeons will only focus on identified conditions which require surgery.  Physiotherapists have a broader approach which includes conditions which require conservative treatment.  C/S is a progressive condition,  so it might be worth getting a PT appraisal.

9

Thanks Gerry, I have no doubt that you are right about the "threatening" stage as the MRI really does show compression between C5 and C6, so will need to some further investigation I think.

10

Hi Guys, I have now had 5 second opinions on my MRI and symptoms, two of which were from the BUPA second opinion service. They are all unanamous and say get surgery as soon as possible. No worries with that but my next question is, should I go for Cervical Discectomy and fusion or Cervical Discectomy with artificical disc replacement. My research tells me the latter rather than the former. Just wanting to sound out those who may have knowledge or experience as I seriously dont want plates and screws in the front of my neck and like the idea of artificial disc. All commernts sincerely welcome in all shapes and forms, good or bad smile thanks guys.

11

I haven't had the surgery - have been tempted, but the advice I've had has been to avoid it.  If I had to have it, I would go for disc replacement.  But this is purely the result of anecdotal evidence from the very few people I've known who have had surgery.  With this, you need to find the advice you trust most; the best surgeon you can get (reseach his track record); and ensure the after-care, physiotherapy, hospital environment are as good as you can get and are properly explained to you before you have the surgery. 

Again, I say good luck.  Let us know how you get on.  

12

I'd second Robert's comments above.  I had a surgical option 4 years ago, (still available),  but my skepicism advised 'no'.  The C/S symptoms haven't really deteriorated since,  so I now think that was a wise choice.  Probably all comes down to bearability and tolerance.  C/S is changeable,  and can go either way,  so probably worth bearing in mind before surgical decision.  My view now is .....surgery is always available,  but once done,  there's no undoing if outcomes don't meet expectations.  It's a tough one,  for sure.

13

If you search this it is true, I have had surgery for C5/C6  and also had the symptoms in arms and hands be sure to get the right surgeon as after my first op I then lost the use of my legs and am now permanently in a wheelchair and had to have second op to save my upper body, which was successful, but still have numb bits on hands and arms etc.  good luck and get it treated sooner rather than later.

14

Jeez Amanda, thanks for this feedback. I am getting all set and confident to walk into the hospital next week for 3 days and come out and be brand new again..........  guess I need to think deeper.

Guys in gereral, should it be a Othopedic Surgeon or Neurosurgeon who does this surgery, Bupa are managing my case and even they are on teh fence and cant give me a simple one or the other reponse !

Currently I am 49 years old, in good shape 6 feet and 90KG, no other illness, run 30K a week on a treatmill with credible timings - I have pain yes, but I dont want compromise my current ability for the sake of avoiding pain meds. MRI Image attached.......... quite a significant compression in my humble opinion

15

Usually a Neurosurgeon,  far as I'm aware,  because of risk to nerve roots.  I wouldn't like to push argument for surgery in either direction...it works for some,  and has consequences for others.  There's no harm in enquiring about future prospects if not opting for surgery...or even before making decision.  You are also entitled to be informed of any risks.  Surgeon should be able to give a % risk factor.  If all goes well,  as it probably mostly does,  there's obviously not much need for a questioning approach.  But, if not,  it's as well to know about that possible outcome beforehand.  Nothing is guaranteed, and mistakes happen...luckily in a minority of cases.....but not so lucky for those whose surgery isn't sucessful.   It's a tough choice to make.  

16

I suffered for 2 years and tried absolutely everything before I went down the surgical route. In the end the loveliest Neurosurgeon performed the operation for me as he told me the bone spurs were blocking the exit from the nerves into my arm and it really needed to be done, I couldn't sit upright in a car, couldn't use the computer etc etc. It was the last resort for me. I had a disc replacement plus cage (stabilisation) as my surgeon said it was the tried and tested method and he had done numerous operations like this.  Make sure you find someone you have confidence in and who has done the operation many, many times before.  Recovery is pretty quick. It has not cured everthing for me, but I am much better than I was. The main problem I have now is muscle spasms, but I am seeing a physiotherapist regularly. Which part of the country do you live in? (I mean Phil who started this post!)

 

17

My MRI looked pretty similar to yours! In fact I still have two degenerating discs above and below, but he only fused C5-6. Most definitely go for a neurosurgeon not an orthapaedic surgeon. I did a great deal of research on the subject!

 

18

H Brevis, many thanks for this update. To answer your last question, I am a Brit but I live in the Philippines, 49 year old active offshorre worker.

So, on my side I have reached what I think is a viable conclusion and controlled gamble. I am booked for surgery for Saturday 16th May for C5/C6 discectomy and the insertion of a Prestige LP (the one without any screws or plates) I have a team of 4 lined up to do the job - Neurosurgeon, Spinal Surgeon. Orthapedic Surgeon and a wonderful general surgeon who happens to be a life long frind of mine. The cost is anticpated to be around 16K pounds and is being covered totally by my insurers. I am with Bupa and once I made my initial treatment authorisation request, went straight to the BUPA second opinion service and had them engage two spine experts, one from London and one from Switzerland. They came back with an excellent report and were unanymous in their diagnosis and treatment plan, so the insurance diddn't really have a gerat argument at hand. They did say that in my case the severity has been caused by a trauma, but nobosy knows better than myself, I jave not suffered any kind of accident in the last decade or so. Anyhow, its all systems go and fingers crossed for a favourable outocome smile

19

I had mine done by a Neurosurgeon he was lovely, my second op they put the cage with plates and screws as they had to take out 2 vertebrea, and was allowed home the next day.  Good luck for Saturday, keep us posted.

20

Thansjk once again Brevis. I may be wrong, but I feel I have really done my homework on this one and definitely don't want to go the fusion route. I have studied all the stats and pros/cons between both and the only shorcoming on the part of the artificial disc without fusion is that it hasn't been around long enough to get a true representation of its longevity. The great benefit of course, is that fusion is always an option at a later date if we do TDR initially, whereas doing fusion first, pretty much preculdes the optuion for future TDR.