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Suggest Treatment For C5-C6 Disc Bulge
Brief Answer:
Nothing alarming
Detailed Answer:
I read your question carefully and I understand your concern.
It is true that the MRI notes a disc bulge. For the moment it doesn't seem to narrow the foramina, the canals where the nerve roots pass to leave the spine, so doesn't compress the nerve roots. It doesn't compress the spinal cord either, although it is in close contact with it and can not be completely excluded considering the weakness in her hands.
However in terms of management I do not think it calls for surgery or any other invasive therapy. For now management should be based on physical therapy and over the counter painkillers like Ibuprofen. That should be enough.
If the examining doctor feels strongly that there are signs of nerve compression despite the lack od it on MRI then at times nerve conduction studies can be done to investigate that.
I remain at your disposal for other questions.
Nothing alarming
Detailed Answer:
I read your question carefully and I understand your concern.
It is true that the MRI notes a disc bulge. For the moment it doesn't seem to narrow the foramina, the canals where the nerve roots pass to leave the spine, so doesn't compress the nerve roots. It doesn't compress the spinal cord either, although it is in close contact with it and can not be completely excluded considering the weakness in her hands.
However in terms of management I do not think it calls for surgery or any other invasive therapy. For now management should be based on physical therapy and over the counter painkillers like Ibuprofen. That should be enough.
If the examining doctor feels strongly that there are signs of nerve compression despite the lack od it on MRI then at times nerve conduction studies can be done to investigate that.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi doctor... she had tried nurofen (IBUPROFEN) but that doesn't seem to help ... she has been taking pain killers which contain codeine (panadeine forte) which gets her deep sleep.. But helps relieve the pain to a certain extent. she is working as a storeperson which requires her to lift upto 10-15kgs above her head and put on rackings... she doesnt want to leave her job... she is doing physical therapy every monday ... it helps her for the rest of the monday but the pain kicks in later on monday nights... do u think she should increase her physical therapy sessions..?? she is currently trying LYRICA.. since last night....!!! which she said just helps her sleep. but when she wakes up the pain is there...!!
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional information.
The frequency of the physical therapy can be increased. Initially it is usually 2-3 times a week for the first 4-6 weeks, then reduced to about once a week. Protocols can vary though.
Regarding the medication she must remember that drugs like Ibuprofen and Lyrica do only alleviate her symptoms, they do not remove the cause, unfortunately no drug can. So she should really reconsider her line of work as lifting weights is not exactly beneficial to her spine I am afraid. Even if she gets better with physio now, the strain on her spine over time will make it likely to have again problems in the future.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for the additional information.
The frequency of the physical therapy can be increased. Initially it is usually 2-3 times a week for the first 4-6 weeks, then reduced to about once a week. Protocols can vary though.
Regarding the medication she must remember that drugs like Ibuprofen and Lyrica do only alleviate her symptoms, they do not remove the cause, unfortunately no drug can. So she should really reconsider her line of work as lifting weights is not exactly beneficial to her spine I am afraid. Even if she gets better with physio now, the strain on her spine over time will make it likely to have again problems in the future.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
ohh thanks doctor for your advise.... for now i will try and increase her physical therapy sessions.. would u by any chance recommend chiropractic and accupunture sessions aswell...?????
Brief Answer:
Read below
Detailed Answer:
In terms of proven efficacy there are not enough studies to evaluate chiropractics and accupuncture benefit compared to other methods.
There are some indications of benefit of chiropractics in lumbar spine issues, but less so in cervical spine. Also as a neurologist who deals a lot with stroke, I have had a few cases with stroke due to cervical artery wall dissection after chiropractic manipulation. So even though that is a very rare complication, I can't really recommend it since no proven benefit.
The lack of studies applies to accupuncture as well, but I have had some patients who have had some success, so if the rest fails it can be tried.
Read below
Detailed Answer:
In terms of proven efficacy there are not enough studies to evaluate chiropractics and accupuncture benefit compared to other methods.
There are some indications of benefit of chiropractics in lumbar spine issues, but less so in cervical spine. Also as a neurologist who deals a lot with stroke, I have had a few cases with stroke due to cervical artery wall dissection after chiropractic manipulation. So even though that is a very rare complication, I can't really recommend it since no proven benefit.
The lack of studies applies to accupuncture as well, but I have had some patients who have had some success, so if the rest fails it can be tried.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
ohh ok so chiropractic session is out of question... i may try accupunture then..!!
our GP advised us to seek an appointment with a neuro-surgeon..who might then evalute the disc bulge and if required give medicines or give her some injection in the disc..!!
i am going to take an appointment tomorrow morning but the appointment time might be 1 month away and i wonder if this will worsen by then..??
my wife is on light duties at work and trying not to lift anything .. she does take codeine meds every now and then.. should she continue on codeine as ibuprofen is not doing any good...and she told me the pain has come to her breast aswell and all the pain i m talking about is only on the left side...head neck shoulder back and chest/breast and inside the breast..it feels tender..!!
our GP advised us to seek an appointment with a neuro-surgeon..who might then evalute the disc bulge and if required give medicines or give her some injection in the disc..!!
i am going to take an appointment tomorrow morning but the appointment time might be 1 month away and i wonder if this will worsen by then..??
my wife is on light duties at work and trying not to lift anything .. she does take codeine meds every now and then.. should she continue on codeine as ibuprofen is not doing any good...and she told me the pain has come to her breast aswell and all the pain i m talking about is only on the left side...head neck shoulder back and chest/breast and inside the breast..it feels tender..!!
Brief Answer:
Read below
Detailed Answer:
I doubt the neurosurgeon can add much at this moment anyway. If one is to be based on that MRI report there is no indication for surgery.
As for local injections, they can be effective. However they are reserved only when all other methods have been tried and failed.
In the meanwhile the current pain killers can be continued, codein as well but only when really necessary, though as I said they only alleviate the symptoms, improvement will be thanks to physical therapy and rest. A short course of muscle relaxant like cyclobenzaprine might help as well.
Read below
Detailed Answer:
I doubt the neurosurgeon can add much at this moment anyway. If one is to be based on that MRI report there is no indication for surgery.
As for local injections, they can be effective. However they are reserved only when all other methods have been tried and failed.
In the meanwhile the current pain killers can be continued, codein as well but only when really necessary, though as I said they only alleviate the symptoms, improvement will be thanks to physical therapy and rest. A short course of muscle relaxant like cyclobenzaprine might help as well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you doctor i will see how my wife feels in 3-5 days and get back to you in roughly a couple of days time thanks for everything.
Brief Answer:
You're welcome
Detailed Answer:
I hope she will be feeling better.
You're welcome
Detailed Answer:
I hope she will be feeling better.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi doctor my mother asked a doctor in XXXXXXX and she said get the NCV nerve conduction velocity test and serum vitamin D3 test done. before seeing a neuro surgeon as we have got an appointment for the 22 July. do you think these tests are important..?? if so i can then ask my GP to prescribe these tests...!! thanks.
Brief Answer:
Read below.
Detailed Answer:
Hello again!
As you might recall I also mentioned in my very first answer the possibility of having nerve conduction studies, so since there are prominent symptoms in the absence of a clear nerve root compression, they are recommended to confirm nerve root compression or not.
As for Vitamin D deficiency, I wouldn't say that is that necessary. It is an inexpensive test so could be done, but I would say that whatever the result wouldn't fully explain the clinical picture and unlikely to change anything in the neurosurgeon decision making.
Read below.
Detailed Answer:
Hello again!
As you might recall I also mentioned in my very first answer the possibility of having nerve conduction studies, so since there are prominent symptoms in the absence of a clear nerve root compression, they are recommended to confirm nerve root compression or not.
As for Vitamin D deficiency, I wouldn't say that is that necessary. It is an inexpensive test so could be done, but I would say that whatever the result wouldn't fully explain the clinical picture and unlikely to change anything in the neurosurgeon decision making.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
ohhh yes.. thank you so much doctor .. i will get back to you... appreciate all your support..i will organise the Nerve Conduction Studies test..!!
Brief Answer:
Thank you
Detailed Answer:
Thank you for your appreciative words. I hope your wife will feel better soon.
Thank you
Detailed Answer:
Thank you for your appreciative words. I hope your wife will feel better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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