Brief Answer:
Imaging studies don't necessarily correlate with clinical symptoms

Detailed Answer:
Good evening. Many thanks for posing your question on this forum. I am a neurologist and face these types of patients and questions daily. In actuality, on the surface, I would have to APPLAUD the neurosurgeon for preferring to recommend conservative therapy before right for what would likely easier (and more financially beneficial for him) and expected which would be to schedule you for surgery.

We know that imaging studies do not always tell the true story of what's going on clinically. For example, studies have shown that when random people (without any symptoms of back pain or discomfort) are given MRI's of their backs that 25-40% of them will have at least BULGING DISKS in at least 1 spinal column segment with many having pathology in at least 2 segments of the column. Again, these are people WITHOUT PAIN and WITHOUT any known disease. Another way to look at that statement is to say that if we took random people from the street without any symptoms of nerve, cord, or spinal column disease and made predictions of what symptoms they were suffering from (pain, numbness, tingling, weakness, etc.) simply based on what their imaging studies looked like that 25-40% of the time we would be way off base. In other words, interpreting MRI's of backs in a vacuum without knowing the clinical picture is not a precise science.

We also know that 50% of all compressive neuropathies or radiculopathies will resolve on their own SPONTANEOUSLY without anything more than analgesics and a good aggressive program of PT. At first glance of your case combined with the fact that a SURGEON...think of it....a guy who makes a living NOT by recommending that patients go to PT and "try it again" but rather by scheduling operations told you to hold off? Well, I think that's remarkable. It's almost amazing...I don't see that type of PATIENCE exercised by a surgeon very often.

Remember, neurosurgical procedures in the neck and back are typically 50/50 propositions. You can either get better or you can worse. Therefore, why not try something more conservative without being aggressively invasive and see if you don't happen to be one of the 50% of people who spontaneously resolve. Hey, someone's got to get that kind of benefit from NOT submitting to surgery....why not see if it's maybe you?

You could also ask to have 2 other tests done to try and lend support to the neurosurgeon's point of view....or alternatively to challenge his point of view. And that is an EMG/NCV test as well as a CT MYELOGRAM which is geared toward showing the outline of nerves and nerve roots as they exit the spinal cord. Therefore, any abnormalities in these studies lends more credibility to the notion that you may not need surgery at this time and that we should be MORE PATIENT toward our patients! LOL.

In the electrical study (EMG/NCV) we can look specifically at the muscles and limbs that are being affected and try and track what we call fibrillation potentials. If present, then, there could be more credibility given to the notion that you need to get surgery and it needs to be done sooner rather than later.

If the EMG/NCV turns out negative for any extraneous motor or sensory activity then, it is less likely than any pathology in the neck need be "fixed" right away...there's still time.

Bottom line is this: If this were my neck, my pain, and my frustration at wanting to get better....A LOT BETTER then, I would take the neurosurgeon's advice and go through another round or maybe even 2 of PT before consideration be given to going under the knife. Maybe the neurosurgeon will end up doing your case. That's fine....what he saved you from potentially was being in the 50% of patients who actually feel WORSE after getting neck surgery. Remember, I said that these surgeries are 50/50. 50% you get better, 50% of the time you get worse.....it is rarely the case that after surgery a patient is exactly the same as they were before. Wouldn't you rather be taking 1 more shot at that SPONTANEOUS RESOLUTION cure as opposed to having to either get cut or go on lifelong medication? I would!

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.

I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information informative and would be grateful for a few words of feedback.

Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible. I'd like to know how things turn out for you as the information may help guide opinions in patients with similar issues.

All the best to you during these holidays!

This consult request has taken a total of 39 minutes of time to read, research, and respond.

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