Question
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Followup: i was hurt picking someone up at a chassunna the wrong way. i don't think it is degenerative, but at 48, it may be. the epidureal seemed only to have an affect for 2-4 days (i have had 2 epidureals so far) RF ablation did not have any lasting effect either.
is there any reason that IDET could not be used in the cervical area?
i have also heard of many cases that the disc implant has had some problems resulting in haveing to go back and make corrections within the 1st or 2nd year after surgery, do you think this is the case?
what should be basic recovery time for this type of surgery?
thank you again,
g'mar uchasima tova
Richard Horvitz

Question -
i am a 48 year old male with a herniated disc c-4/c 5, i was incapacitated even with medications due to the pain & spasms from my left shoulder through wrist. numbness regularly, i tried Physical Therapy-no positive results, finally i tried deep acupunture & a little chiropractic therapy which relieved the pain & some of the spasms for approx 6-8 months, but when the pain & spasms came back the acupunture, etc didn't help. the injury happened approx 5 years ago. i was told to have the surgery years ago, but...surgery, i felt, wasn't the solution since i haven't the funds to be out of work for 3-6 weeks or more between the surgery & rehab. i was also told that there is an experimental procedure called i-dot surgery where the doctor injects a silicone based subtance at the point of herniation to give more space between the vertibrae, but i haven't been able to locate anyone who does it.
other info:
there is a partial fusion of c2 c3 apparently congenitial, there is a loss of cervical lordosis, straighting of cervical spine may be secondary to muscle spasms, at the c5-c6 level the interverbral disk is partially and mildly reduced in height, moderate left paracentral posterolateral disk herniation causes moderate to severe nueral foraminal encrochment, there is contralateral bulging of the disk and moderate right neural foraminal encroachment, there is moderate central canal stenosis and mild to moderate cord compression at this level.
at the L 2-3 level , the intervertebral disk is partially desiccated, with preservation of disk height. left paracentral posterior disk contour abnormally is incompletely  visualizes. this may represent a small disk herniation. there is a mild narrowing of the spinal canal at this level, the neural formina are patent bilaterally.
this information is off the mri report
thank you for any assistance and / or suggestions
be well,
Richard
Answer -
Dear Richard,

Your description is quite typical of cervical disc disease. Most patients will have recurrent episodes of severe radiating pain which resolve with time ?only to recur at a future date.
If the pain is bearable, I suggest you "ride the storm out" with pain killers and various symptomatic treatments such as chiropractic or acupuncture. If the pain is unbearable, don't hesitate to have surgery done. Cervical disc surgery today is much safer than in the past, with very good results usually.
If you are still hesitant regarding open surgery, there are a few alternatives. The simplest is having a cervical epidural or foraminal steroid injection. This injection can reduce the pain and end a radicular episode. Another alternative is Radio-frequency ablation. In this technique an electrode that transmits RF signal is introduced into the neck and can reduce pain in many instances. I haven't heard of i-dot. What you probably mean is IDET, but this technique is mostly used in the Lumbar spine.

If you do chose to have open surgery,  there is a new trend today that replaces traditional discectomy-and-fusion surgery, and that is artificial disc surgery. In this innovative technique, the damaged disc is replaced with a metal and plastic prosthesis that preserves the spine motion. I use the 'Bryan' prosthesis (made by Medtronic, Memphis Tennessee) with very promising results, but I'm not sure if it is already available to US patients.

I hope this helps.

Dr. N. Rahamimov

dear Dr. N. Rahamimov
Followup: i was hurt picking someone up at a chassunna the wrong way. i don't think it is degenerative, but at 48, it may be. the epidureal seemed only to have an affect for 2-4 days (i have had 2 epidureals so far) RF ablation did not have any lasting effect either.
is there any reason that IDET could not be used in the cervical area?
i have also heard of many cases that the disc implant has had some problems resulting in haveing to go back and make corrections within the 1st or 2nd year after surgery, do you think this is the case?
what should be basic recovery time for this type of surgery?
thank you again,
g'mar uchasima tova
Richard Horvitz  

Answer
Any type of surgery can require revision. Artificial cervical discs have been in use for a very short time relatively, so there is no way to know how frequently they will have to be revised. The experience up to now has been very promising.
IDET is not done in the cervical spine, as far as I know, for safety reasons. I do not perform it.