Had A ACDF. MRI Showing Broad Base Central Disc Protrusion. Should I Be Worried?

Posted on Sat, 2 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 2 Nov 2013 Answered on

Thu, 21 Nov 2013 Last reviewed on

Question : I had a ACDF done last year in nov. I receieve some relief from the surgery for about 2 months. I had a problem with fusing as well as development more pain on my left side, such as arm pain and weakness. I just had a MRI which states the following. At the c3/c4 level there is a broad base central disch protusion measuring 1mm producing effacement of the thecal sac. At C4/C5 level, there is mild disc space narrowing, a central disc protusion measuring 3mm, and a right paracental disc protusion measuring a 4.5 these findings produce mild central canstenosis and moderate stenosis of the right lateral recess. My concern with the radiiology report seems to be a big difference a report that was given just in April, which states the following. 1. Status post aterior interbody fusion at the c5-c6 and c6-c7 levels. The interbody grafts appear to be solidly incororated into the c5 and c6 inferior endplates but are only tenuously incorporated into the c6 c7 superior endplates far anteriorly. Thre is not evidence of facetal cusion on either side at these levels. Anterior plate and scew fixation of the c6, c6 and c7 vertbral bodies is noted. Thee is not evidence of loosening of instrumentation. 2. 3mm broad-base spondylotic posterocentral protusion at c5 c5 level 3. 2mm broad base posterior protrusion at c3 c4 level 4. 1 mm broad based posterior protusion at c3 c3 level 3. Multiple level bilateral cercical neural foraminal stenosis, detailed above 6. mild muliple level bilateral cervica

Answered by Dr. K. Naga Ravi Prasad (1 hour later)

Brief Answer: C4 disc herniation is unlikely due to surgery. Detailed Answer: Hi, thanks for writing to XXXXXXX Presence of arm pain & weakness suggests the compression of the nerve root supplying that area in the cervical spine, which is termed as Radiculopathy. The disc herniation that is showing up at C4 level is unlikely due to surgery (as ACDF perse will not produce disc protrusions). As the C5-C7 levels are fused, there occurs no movement at these levels. The immediate level above, where the movements tend to occur is C4 level. So, during routine daily activities, more movement occurs at C4 level causing a disc herniation at that level. The conservative management of your condition involves - Soft Collar: Soft collar allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles. Medicines: Analgesic are needed in the acute phase. Muscle relaxants are essential for relieving muscle spasms once the acute pain subsides. Neurotropic vitamins like METHYLCOBALAMINE (activated Vit B12) or PREGABALIN will help in alleviating the neuropathic pain. Physiotherapy: Once the acute phase of pain has subsided, Isometric strengthening exercises of the paravertebral muscles are started. Improving neck strength and flexibility with simple exercises may lessen discomfort and pain. Moist heat can be useful Epidural steroids: are useful for patients with severe radicular pains in the limbs. Cortisone is a powerful anti-inflammatory preparation and so its injections in the "epidural space" can decrease swelling as well as pain. Hope I have addressed your query. Happy to help further Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (17 minutes later)

one of the question I had is 3mm and 4.5mm herination large in size? also does this indicate that I have a impingment on my spinal cord? I have had 3 injections post surgery and have had two prior to surgery. They only work for a few months and then the pain comes right back. My neck keeps locking up. is this due to the disc.

Answered by Dr. K. Naga Ravi Prasad (36 minutes later)

Brief Answer: MRI scan will diagnose Disc impingement on Cord. Detailed Answer: Hi, Nice to hear from you. The size of th disc herniation and disc impingement causing compression over the spinal cord can only be made out on an MRI scan of the involved spine. It is true that the clinical improvement in symptoms due to epidural steroid injections is only short lived ranging from a few weeks to few months. They will not provide permanent pain relief. Your neck getting locked up may be indirectly attributed to the disc protrusion as any amount of pain arising in the neck during movements will produce a protective muscle spasm leading to halting of neck movements. Hope I have justified your query. Good day

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar