Question
I am a 31 yrs old in good health. 3 weeks ago I moved some furniture and woke up unable to move my head with unreal pain in my left shoulder/arm and numbness in my thumb, pointer and middle finger. I have seen several Docs and a Chiro. I have 2 ruptured discs in my neck. 5 and 6. I have been on steriods, muscle relaxers, a nerve tranqulizer and pain meds just to function. I'm scheduled for surgery. How long is it safe to put surgery off with the pain getting some what better? My left arm is very weak. Is that normal for a disc rupture? and how long might it last? The MRI shows a disc fragment against a nerve. Any info is appreciated. THANKS!!

Answer
Lee,

Thank you for your question.

Disc herniations can be thought of as either contained or non-contained, with containment referring the location of the inner gel-like disc material, called the nucleus pulposus.

Basically, the various terms to describe a herniated disc refer to how far the disc has deformed beyond its normal boundaries. Contained disc herniations are those in which the disc has deformed or displaced, but the inner nucleus pulposus has not escaped from the confines of the disc fibers. Non-contained disc herniations (generally associated with a ruptured disc) are those in which the nucleus pulposus has totally escaped from the disc fibers.

Many researchers believe that the reason why so much pain is produced from a disc rupture is because the disc itself does not receive a direct blood supply. It absorbs its nutrients from the vertebrae. When the disc material escapes and comes in contact with the blood circulation, the body "recognizes" the disc material as a foreign substance, since the blood normally does not come into contact with that material, and initiates a massive inflammatory response.

A truly ruptured disc is generally considered a red flag for surgical intervention, especially if there are progressive neurological symptoms (i.e., loss of limb function). Some surgeons feel that the longer rogue disc material compresses a nerve, the more difficult it is for the patient to recover full nerve function even after surgery, although this can be a very patient-specific phenomenon.

Although I can't tell you how long you should put off surgery, if at all, since that is a very patient-specific decision that needs to be made by your attending clinicians who understand your entire clinical picture, generally, most neurosurgeons or orthopedic spine surgeons would be more concerned with the patient's loss of neurological function versus their pain levels when making the decision to have surgery. You might find the following medical article on cervical disc disease helpful in providing additional information:

http://emedicine.medscape.com/article/305720-overview