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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Neurology
Satisfied Customers: 17519
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I'm wanting to know what i should do for the following. my

Customer Question

I'm wanting to know what i should do for the following . my MRI reads as follow, at c6-c7 diminished disc signal with posterior broad based disc herniation measuring 2 mm in ap plane and appearing board based. There is no contact of the spinal cord. the formania are patent. i have had spinal injections, physical therapy, chrio and nothing is helping what do you all think i need to do now for the pain. Do you feel Surgery with a disc replacement will take my neck pain away. Should i be having this pain with this small of a herniation and no spinal cord problems
Submitted: 2 months ago.
Category: Neurology
Expert:  Dr. Phil, MD replied 2 months ago.

Hi, this is Dr Phil, here to assist you. I am Board Certified with over 10 years of experience. I will respond with my answer shortly. Thank you.

Expert:  Dr. Phil, MD replied 2 months ago.

what symptoms do you have?

any weakness?

Customer: replied 2 months ago.
I have burning pain in neck and after injection it has gone to my elbow. i am attaching a copy of my mri report
Customer: replied 2 months ago.
I do not have any weakness
Expert:  Dr. Phil, MD replied 2 months ago.

No I do not think surgery is indicated

the MRI findings are not severe

have you had an EMG?

Customer: replied 2 months ago.
No I have not. I don't understand the pain i have with the MRI not being bad. I have read a lot online and understand most people have this pain has a lot worst problems.
Expert:  Dr. Phil, MD replied 2 months ago.

I agree

the pain seems worse than the MRI

that is where the EMG comes in

Customer: replied 2 months ago.
your pretty much saying i just need to learn to handle the pain and go in with my life until its worse that disc replacement surgery is not a good option at this point in my life and at my age .
Expert:  Dr. Phil, MD replied 2 months ago.

That is correct.

is that acceptable to you?

Expert:  Dr. D. Love replied 2 months ago.

Hello. The system says that you have requested a different expert. I am Dr. Love.

I agree with the other expert that surgery is not indicated, but I would word it and explain it slightly differently.

There are some people with pain and an MRI shows an anatomic abnormality that corresponds to the pain, and while those people will typically be tried initially without surgery, it is an option to consider surgery if the pain is persistent and of such severity to accept the risk of surgery.

There are some people with pain and no abnormality seen on an MRI. In these people, the pain is clearly not due to an anatomic abnormality, so surgery is never really an option. It is generally thought to be due to inflammation or to a soft tissue problem near the spine, such as a chronic muscle strain. There are a number of non-surgical options for these people.

Then there are some people with pain and only mild or ambiguous problems seen on the MRI. In these people, the pain is probably not related to the mild or ambiguous abnormality, so are also typically treated with non-surgical treatments. There is another option to consider in someone with findings that are not sufficient to clearly explain the symptoms, which is to inject numbing medicine around the area of the mild or ambiguous abnormality. Numbing medicine will not treat any condition, but it can ease pain if it is associated with that condition. If the numbing medicine eases the pain, then that would support that the mild or ambiguous abnormality is causing the pain. This is more of an option for a nerve root injection than an injection around the spinal cord (numbing the spinal cord is essentially providing spinal anesthesia). A steroid injection may provide similar information, but it is not a certain to work, so the failure to help is not as helpful as the failure of numbing medicine to work.

It is worth noting that people with severe pain can be in any group. It is more common to see severe pain in the first group, but we also see severe pain in the other groups. So, severity of pain is not proof that a person is in the group that would clearly benefit from surgery if the pain persists.

At this point, you are in this third group. Without additional evidence that the pain is due to the mild abnormality, surgery would typically not be considered. You have apparently had a steroid injection that did not help. You can discuss a nerve root injection with numbing medicine to see if the pain eases, but the current information does not support using a surgical intervention.

The usual treatment in this situation would be a combination of physical therapy and medicines to get adequate control of the pain. It may not be possible to relieve 100% of the pain, so there may be some residual pain, but the pain can usually get adequately controlled that it is not as bothersome and does not interfere with your life.

If I can provide any additional information, please let me know.

Expert:  Dr. D. Love replied 2 months ago.

Please let me know if I can provide any further assistance.