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Suggest Treatment For Disc Narrowing Of The Spinal Canal

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Posted on Thu, 8 May 2014
Question: There is a mild angular kyphosis centred at C5C6 where there is disc narrowing, disc dehydration and osteophytosis. Axial scans show a small right paracentral disc protrusion which impinges on the surface of the cord. There is bony encroachment on the exit foramina bilaterally. No other finding Significant spondylosis demonstrated at C5C6 with a small right paracentral disc abutting the anterior cord and bilateral osteophytosis is this serious and what is the prognosis... will i need an operation?
doctor
Answered by Dr. Karl Logan (14 hours later)
Brief Answer: Depends on your symptoms Detailed Answer: The main indication for surgery in the neck is narrowing of the spinal canal where the spinal cord passes through and narrowing of the holes through which the nerves pass. You do have both of these on your MRI scan, however they so not sound severe. The mild deformity in your neck (kyphosis) is a secondary consideration. Do you need surgery? This would depend on your symptoms. If you have shooting pains and numbness/weakness in your arms, if you have become unsteady on you feet or noticed and change in the way you walk then yes you may benefit from surgery. If you have only neck pain then probably not although this would be a secondary consideration and weak indication for surgery. I hope this information helps
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Karl Logan (27 minutes later)
My follow up questions is;- I had severe neck pain for approximately six weeks... this has curtailed as I am attending a physiotherapist who is taking a very safe approach.. an expert in her field.. ultrasound .. gentle manipulation etc.. I have mild pins and needles on my hands.. this all started off with arm pain but all of this is gone.. I am definitely improving as I exercise every day... gentle exercise.. I am concerned about the disc.. also I have another scan...lower lumbar degenerative disc disease with right sided L4L5 disc protrusion.. improvement from a scan taken in 2012 which showed a large right sided L4-5 disc protrusion. There is degenerative disc disease of moderate degree L5-5 where there is moderate disc narrowing with loss of disc signal. No evidence of spinal stenosis is shown. No focal bone destruction is shown.. this gives me trouble from time to time and I have had an epidural done in February.. would I benefit from surgery here... I meant to say L5S1.. also small schomori's nodes in lower dorsal discs and the L1-2 disc// upper lumbar discs are normal
doctor
Answered by Dr. Karl Logan (3 hours later)
Brief Answer: Surgery not indicated at present. Detailed Answer: From the symptoms you describe it does not sound although surgery at the present time would be of benefit either in your cervical or lumbar spine. your symptoms seem to be improving with physiotherapy and I would continue with this. if you develop arm pain and weakness or notice any change in your walking or bowel or urinary habit then you might reconsider this and / or get further imaging such as an MRI scan.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Karl Logan (15 hours later)
Thanks for this information. I am just wondering if it is normal to be still in pain around the neck area after eight weeks... will this settle.... and also sleeping is a big problem... any suggestions on sleeping methods... i have slight pins and needles on my hand from time to time but this is probably the nerve just let me know.. thanks so much for all your help
doctor
Answered by Dr. Karl Logan (4 hours later)
Brief Answer: Ongoing discomfort likely Detailed Answer: Hi, With the degenerative changes you have in your neck, I think it's likely that you will continue to have some discomfort. This can be managed with physiotherapy, massage and analgesic medication particularly anti-inflammatory medications. You may want to try a soft collar and an antispasmodic / sedative at night such as Ativan. Neuralgic pain can be improved with neuromodulating medication such as gabapentin and amitryptiline. CT guided nerve root injection with steroids can also help. I hope this information is of benefit to you.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Karl Logan (23 hours later)
Are the inections safe? Would acupuncture be good? Do you think that surgery may be possible at some point.. my biggest problem at the moment is night time.. any particular mattress you would recommend? Thanks
doctor
Answered by Dr. Karl Logan (7 hours later)
Brief Answer: Small risks of injection, Surgery possible Detailed Answer: Hi, The injections are safe in the right hands, as with everything there are very small risks which the physician performing the injections would go through with you before proceeding. Yes surgery may be possible if you continue to have significant symptoms. The commonest operation would be some sort of cervical fusion operation. There is no scientific evidence for one type of mattress over another although many people with spinal issues prefer a firmer mattress than a softer accomodative one. I hope you find a solution to your symptoms Best wishes
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Karl Logan (24 hours later)
Thanks.. I am finding your information very helpful... A question.. the pain I experience is more down my right side and often causing leg weakness.. for example right now.. could the disc issue in my lumbar spine be causing the leg weakness.. also can lower back pain cause upper back pain and neck pain... thanks... do you think I would benefit from an operation in my lower back judging from what I told you.. thanks
doctor
Answered by Dr. Karl Logan (53 minutes later)
Brief Answer: Yes disc prolapse can cause weakness. Detailed Answer: Hi again XXXXXXX Thanks for your further questions. Yes disc prolapse in the lumbar spine can cause leg weakness. The commonest level for a disc prolapse in the lumbar spine is the L5/S1 level which causes numbness on the outside of the foot and weakness in the buttock and calf muscles. I had surgery for such a problem myself last year. If the disc in the lumbar spine is not causing any spinal cord or nerve root compression then it is likely not responsible for your weakness. You told me that you had disc disease / narrowing with no spinal stenosis - i.e. narrowing of the spinal canal. There was no mention of nerve root compression. Disc disease in itself does not warrant surgical intervention. The best indication for surgery is nerve or spinal cord compression. Yes pain in one part of your spine can lead to pain in the other parts and this is where physiotherapy and massage can help improve your symptoms. I hope this helps answer your questions. Best wishes
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Karl Logan (14 minutes later)
Thanks so much XXXXXXX . you can tell I am an anxious sort of individual.. I was at Physiotherapy today..as I told you I am with an excellent physiotherapist.. who lectures also here in UCD.. well known.. she works on my neck. . and states she won't do traction as there is no indication to do so.. she works on me weekly..and gently..there is no arm pain now only neck pain.. she works on my lower back also. do you think traction would ease the pain in my neck.. i had dreadful back pain at one time which eventually settled after an epidural.. gives me trouble from time to time but i do my exercises.. my neck flares from time to time and my physio does not want me to do exercises on my neck for the next week when I will see her again.. it is not a disky pain.. more stiffness.. just hoping it settles.. nine weeks now
doctor
Answered by Dr. Karl Logan (3 hours later)
Brief Answer: Traction won't help Detailed Answer: Hi XXXXXXX Your physio is right that traction doesn't usually work. She sounds extremely competent. Your obviously in good hands. as your continuing to see improvement I would be reassured. best wishes
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Karl Logan (15 hours later)
Thanks XXXXXXX .. is it always quite sore when someone is working on you.. it is taking time to bring down the inflammation but my physio is taking it very slowly..is nine weeks along time to have uncomfort and difficulty sleeping around the neck area given my condition... i really am trying to avoid surgery and hope i will not in this sort of discomfort all my life or it would not be worth living
doctor
Answered by Dr. Karl Logan (25 minutes later)
Brief Answer: It's normal to be sore after Physio Detailed Answer: Hi, Usually after Physio your symptoms do get worse for a few days, that is quite normal. If you continue to see improvements with Physio then it is worthwhile and I would continue with it. I understand your concerns but I think as long as you are improving you should give it more time before seeking additional or different treatment. best wishes
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Karl Logan (1 hour later)
Thanks XXXXXXX . have you seen scans in the neck much worse than this.and have you yourself ever conducted neck surgery
doctor
Answered by Dr. Karl Logan (9 hours later)
Brief Answer: Yes and yes to your questions Detailed Answer: Hi XXXXXXX I haven't seen your scan although from what you describe, yes I have seen much worse scans than yours. Yes I have done surgeries such as the ones we've talked too and about. Best wishes
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Karl Logan (7 hours later)
and one last thing on that injury have the surgeries been successful.the reason I am asking all these questions is for a second opinion as I am attending an orprod consultant in one months time who has a stong connection with my a physiotherapist and I want to make sure that if he decides to do surgery that I am knowledgeable. He has read the scans already and wrote to me and said that he does'nt see a need for an operation at this point as there is not enough pressure on the spinal cord unless the symptoms got worse..he also has a good reputation. He saw the scan in February 10th, 2014.. is there any possibility of knowing when this all happened.. hence disc issues? thaniks so much I meant say that I had a brain scan done also and they were clear.. basically he said that he would not advise anything unless symptoms were progressing which happened .. the reason I had the scan was for arm pain and pins and needles..then the pain all went to the neck area when I started to get physio... he basically said that there is sufficient pressure on the spinal cord to warrant surgical intervention. I also had a brain scan which was clear and he said that there was no serious underlying pathology to cause the pins and needles
doctor
Answered by Dr. Karl Logan (2 hours later)
Brief Answer: Sounds like you are in good hands Detailed Answer: hi XXXXXXX thanks for the further questions. the surgeon you are dealing with sounds like he has excellent judgement. from what we have discussed I would agree with him. it sounds to me like you are in very good hands and you should be reassured by our recent conversation. I hope your symptoms continue to improve. best wishes
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Karl Logan (9 hours later)
Thanks so much for all your help. I hope I do not have too many more questions.. when you are going through this sort of stuff.. it is difficult which you understand having had back issues.. XXXXX
doctor
Answered by Dr. Karl Logan (3 hours later)
Brief Answer: My pleasure Detailed Answer: Hi XXXXXXX It's been good talking about your medical issues. I really do hope the conversation has helped your anxiety best wishes Karl
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Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Karl Logan

Orthopaedic Surgeon

Practicing since :1999

Answered : 705 Questions

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Suggest Treatment For Disc Narrowing Of The Spinal Canal

Brief Answer: Depends on your symptoms Detailed Answer: The main indication for surgery in the neck is narrowing of the spinal canal where the spinal cord passes through and narrowing of the holes through which the nerves pass. You do have both of these on your MRI scan, however they so not sound severe. The mild deformity in your neck (kyphosis) is a secondary consideration. Do you need surgery? This would depend on your symptoms. If you have shooting pains and numbness/weakness in your arms, if you have become unsteady on you feet or noticed and change in the way you walk then yes you may benefit from surgery. If you have only neck pain then probably not although this would be a secondary consideration and weak indication for surgery. I hope this information helps