Question
QUESTION: My MRI shows a significant spinal cord compression caused by a budging disc at C4/C5.  Though it is visually impressive on the MRI, tests done by my neurosurgeon and neurologist show no signs of myelopathy.  I do have  constant back pain slight weakness on my right arm & leg.  My neurosurgeon recommends surgery with artifical disc but I am unsure.  Would it be a wise choice to go ahead with surgery to avoid possible future problems should the compression get worse?   Thank you.




ANSWER: Hi Jay-
visually impressive, huh?  i can ony imagine...=)

the option people often start out with is a steroid injection at the site of the bad disc- it doesn't always work, but it's a non-invasive, relatively risk-free procedure.  personally (being averse to surgery in general) I'd ask your doc why they want to skip this possibility.  Many people if given MRIs show disc abnormalities, but it's considered something to leave alone unless symptoms are present. you do have some symptoms, but at what level of severity I cannot say.

If your doctor can explain to your satisfaction (ie, risk of complication too great, whatever) the need for jumping right in to surgery, i can tell you that his/her suggestion is not 'out there' in terms of accepted medical advice, etc. It is done fairly often with good success these days.  

it is still however much more of a pain in the behind than going in for a shot of steroids.  so get them to explain it to you, yes?

this is what i would do if it were me, anyway...
good luck, and please write again if you have further questions
leslie

---------- FOLLOW-UP ----------

QUESTION: Hi Leslie,
Thank you for bringing up the steroid injection option.  I was not aware of it and now wonder why none of my doctors (pcp, neurologist & neurosurgeon) suggested this.  I will definitely ask them.  Though I have some symptoms, I consider them minor.  My back pain is tolerable and my arm/leg weakness is slight.  My doctors also think that my symptoms are NOT typical of spinal cord injuries.  I was told, however, that if I wait too long, the cord compression could get worse then there could be irreversible damages since spinal cord injuries are almost always irreversible.  That is my biggest concern.  Although there seems to be conflicting information whether a budging/herniated disc can cause permanent, irreversible spinal cord injuries.   Do you have any information regarding this?

Thank you.

Answer
hi jay-
hmmm I've not heard of herniated discs causing permanent damage- but this may just be my limited experience, I can see how it could if the bulge was bad enough. I agree with them that you do not currently have what would be thought of as a SCI, and with the way you describe your ailments I'd think a steroid shot would be the logical first try

The injections (of methylprednisolone or something similar, maybe depomedrol) don't work for everyone, so it's not assured it'll help you.  But it really can't hurt, its not nearly as costly as surgery (money and time and health-wise), and you could still have the surgery if needed...

Sorry i don't have a more definitive answer for you- certainly a badly bulging disc is nothing to ignore, but neither is it (IN MY OPINION) reason to leap under someone's raised scalpel.

Ask the doctors about the injections, make em earn their fees, see what they say. If you trust them, go with them. If you're not convinced, get a second opinion. This is my best advice

good luck- you know where I am if I can help somehow-
leslie