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MRI for cervical spine stated large fresh left paracentral disc herniation is seen. Surgery important?

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Spine Surgeon
Practicing since : 2002
Answered : 102 Questions

Need you advise on the condition as reported vide MRI done for Cervical Spine at Pinnacle imaging centre on 12May12. Consulting doctor is Dr XXXXXXX B Peshattiwar (Consultant Spine Surgeon) who has advised AOF/ALDF OR Nucleoplasty with guarded program. Need advise on what we should do, whether go ahead with surgery or consult some other doctor or alternate medicine.

Large fresh left paracentral disc herniation is seen at C5-6 level indenting on the ventrolateral cord surface with extruded disc material encroaching into left neural foramina causing indentation of left existing 6 nerve root.

Second mail with image attachments follows in some time (size constraints)

Thanks & Regards, XXXXXXX Nakhooda
Posted Mon, 4 Jun 2012 in Osteoporosis
Answered by Dr. Krishna Kumar 30 hours later
thank you for sharing your problem with me.
I could not open the zip file probably due to large size.
But can you tell me your symptoms in detail, like neck pain, arm pain, worsening of pain, numbness or weakness, duration of your symptoms etc..because many patients do get away without surgery even when they have large disc prolapse.
so please get back to me with your detailed symptoms
spine surgeon
Above answer was peer-reviewed by
Follow-up: MRI for cervical spine stated large fresh left paracentral disc herniation is seen. Surgery important? 26 hours later

The symptoms started one week back, when getting up from the bed, shoulders and neck area was and could not move, reason was trying to move up in the bed with the support of the head.

Thereafter the condition worsened, the start was a mere sprain type pain in the neck and by Friday there was loosening of the grip with the left hand, with slight pain in the left underarm, elbow and wrist.

We consulted a spine surgeon, and did his reactiviness and firmness tests and concluded that the grip of the left hand was loose as compared to the right. He prescribed Voltaflam 50 and Rablet 20, which we started the same night, he prescribed to do an MRI of cervical spine, which we did on Saturday, results have been shared with you.

Thereafter, took another opinion yesterday from an ortho spine specialist (since the first consultant had recommended surgery) who had a difference of opinion, and he prescribed to continue the same medication, plus also added Medrol 4mg thrice a day for 5 days and thereafter twice a day for next 5 days. He was of the opinion that there are 70% chances of curing with medication, and follow up exercises, so we can try this course and then review the results / progress over the next 7 days, he formed this opinion since presently the pain has subsided, no pain in the hand, it is only in the left upper back portion, which could be a result of having to wear the soft cervical collar.

My wife sometimes also has a headache, which again we think could be a result of wearing the collar.

Request your opinion in this regard.
XXXXXXX Nakhooda
Answered by Dr. Krishna Kumar 10 hours later
thank you for the update and I am glad that she is recovering well. 1 Week is too short a period to recommend surgery in this situation and I go with the second surgeon and he is absolutely right.
I don't think she needs the collar any longer if the neck pain has decreased and I suggest she start moving her neck.
I firmly believe she would get well without a surgery..
Fast relief is a good sign of prognosis
wish you a speedy recovery
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