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Can Someone Translate This For Me?

DeniseO_oDDeniseO_o Posts: 114
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: 9,697
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    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • DeniseO_oDDeniseO_o Posts: 114
    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 :-)
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  • 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 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
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  • 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.

  • 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 :-)
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