Question
I was involved in a car accident back in 1989 resulting in cervical buldging disc C5-6, to date I now have 3 buldging discs C2-6 causing moderate stenosis.A recent EMG also showed C7 compressed nerve.The pain although some days better than others is constant,radiating into my left shoulder/arm,extreme muscle tightness in left shoulder blade,not to mention headaches.I have done years of therapy, have been taking Flexaril for quite some time(thinking now I am immune to it)and I would say 4 days out of 7 I take OTC medicine.I have also recently tried accupuncture to which I was referred by a pain management physician.All of the above seem to work but only temporary and it seems the time in between treatment is getting less and less.I have tried to discuss with my family doctor the option of surgery, however was only offered other muscle relaxant meds.Quite frankly I am just tired of being in pain and taking pills,not to mention quite scared of any long term or permanent damage to the nerve or spinal cord.I know my other option would be epidural injections however I would rather not.I have heard they do not always work and are very very painful.I feel at this point my next step would be consulting a neurosurgeon. Please advise....34 feeling 64!!

Answer
Dear Kelly,

First let me apologize for not getting back to you sooner, I have been very sick for the last week with a bronchiole infection. Anyway, sorry to hear about all the remaining issues and new disk problems.

The fact that you have moderate stenosis is not good, however, I am not sure whether the nerve roots are stenosed or the spinal cord itself.  Either way, this is not good.  I am also not quite sure what type of therapy you have done, so I will assume for this correspondence that you mean physical therapy.  Your assertion that the previous treatments did help to reduce pain is a good sign, but you must also realize that the disk does not heal well do the fact that it has a very deficient blood supply and has to rely on movement to get the nutrition it needs for repair.  Not to mention that anytime you are erect, the disk is under gravitational load which compounds the issue.  Check out this quote:

揟he spinal injury weakens the spine and predisposes the patient to further injury, regardless of type and extent of damage. This phenomenon is especially true when protection of the injured part is not adequate. Ligaments and muscles heal only by scar formation, and the annulus fibrosis of the disk is almost powerless to heal tears of its substance.?
David B. Levine, M.D., The Painful Back, Page 451, Chapter 92

Now concerning the epidural injections, you are correct in the fact they they often do not work to control the pain, and they will not do anything to correct the problem. However, when performed by a good pain management physician, they should not be painful.  Local anesthetic should be used at the injection site, and deeper in the tissue before the actual epidural is performed, and when this occurs the pain is minimal, just pressure is felt.  Most physicians perform the injection this way.  Epidural injections also run the risk of creating meningeal headaches (irritation to the covering of the spinal cord) due to the puncture of the thecal sac of the spinal cord. It is an informed decision that you should consider, but make sure that you get all the facts first.

Now, one thing that I would recommend that you consider is axial decompression.  This is a technique where a mechanized unit is utilized to decrease the effect of gravity on the disks while pulling on the spine in incremental pulses.  It works on the principle of IMBIBITION, which basically means pumping fluid back into the disk through vertebral movement.  Many people have been helped with this form of traction, and your bulging disk material makes you a prime candidate.  Some machines you may like to research are:  Accuspina, DRX 9000, Vax-D, Lordex, Chatanooga DTS, Spine Med.

This technology has gotten some bad press due to some doctors advertising and pricing of the treatment, but the scientific principles are valid and the devices are good.  Make sure that you do not pay too much for this though.  Some doctors charge more than $5000.00 for a treatment schedule to perform decompression which is ridiculous.  You should expect to pay approximately $2750.00 to $3200.00 for decompression, and many insurances will pay a portion of this bill.  Check around in your local community for a chiropractic physician who has the technology to perform this type of care, but make sure the numbers make sense, and that they are willing to either file your insurance or submit a superbill on your behalf to help reduce the costs.

If the decompression does not help to significantly reduce your pain and dysfunction, I would suggest that you seek the advice of a competent neurosurgeon.  A diskectomy surgery can often reduce the insult to the spinal cord and nerve roots with only small incisions and a limited recovery.  Obviously I would like to keep you out of surgery, but sometimes it is the best choice for resolution and the benefits will outweigh the risks.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net