Should i have surgery on my neck or injection? i have a herniated disc at my c5-6 cervical that is compressing a nerve that is givin me right arm pain and numbness.should i choose to have surgery instead of the injection to asure that i want have issues w

Surgery : Surgery and injections are not interchangeable options- they work in completely different ways. The decision is made typically on what symptoms you have, what your examination shows, and what your MRI demonstrates. Injections are typically done under x-ray guidance (fluoroscopy) to direct a needle, under local anesthesia, into either the spinal canal (for an epidural injection) or into the small canal through which an individual nerve leaves the spine (a selective nerve root block, into the foramen). Typically, both a numbing medicine (local anesthetic) and a steroid are injected together. A diagnostic block may only use the local anesthetic without the steroid. The local anesthesia gives you temporary relief of the nerve pain, and the steroid may give you longer relief. To be clear, injections do not make the disc herniation resolve or heal any faster. However, as the majority of disc herniations will heal without surgery, injections often help control the pain while the body is trying to heal itself. I always prescribe physical therapy with injections. In my experience, injections do nothing for numbness, or for weakness- only for pain relief. The advantage of an injection is that it can be done without general anesthesia, in the office, and with quick recovery. The disadvantage is that it does not remove the herniated disc, or take the pressure off of the nerve, so the injection relief may be short-lived. Surgery is much more invasive, but does involve direct decompression of the pinched nerve, with complete removal of the herniated disc. This treats both pain, weakness, and numbness. However, surgery is also much more involved, with an overnight stay in the hospital, general anesthesia, and recovery over several weeks. It is a more permanent treatment, however. I send lots of patients for injections and operate on many others. The patient who responds best to injections is one whose primary complaint is pain (little numbness and no weakness), who has a smaller disc herniation, with recent symptoms, and who has no signs/symptoms of spinal cord compression. Patients with larger herniations are less likely to improve with conservative treatments, and typically do better with surgery. Patients with signs/symptoms of spinal cord compression, or those with progressive weakness of the arm/hand, or with severe pain, often do better with surgery. Patients with long-standing symptoms (more than 6 months) likely have a disc herniation that is not healing, and are less likely to have long-term relief with injections.

Injections : Injections or surgery do not assure you will not have future issues with your neck. Injections usually provide short term relief (3 to 6 months) but occasional do provide long term relief (years). Surgery may remove the disk, but surgery produces changes that can lead to future spine problems that may need treatment. Epidural steroid injections and surgery are not mutually exclusive treatments. Steroid injections relieve pain from decreasing swelling (neutralizing and washing out inflammatory chemicals). This gives time for the body to heal itself and may even remove the herniated disk preventing future problems with that disk. Surgery removes the disk off the nerve. The two most common spine surgery for c5-6 disk is posterior cervical discectomy and anterior cervical discectomy, fusion and plate (acdfp). Posterior discectomy removes the disk through the back of the neck. It avoids fusion but may weaken the c5-6 level resulting in instability and future problems. Acdfp removes the disk through the front of the neck, fuses the disk space and holds it together with metal plate and screws. This is a very good surgery but fusion stops movement at the c5-6 level and the other levels c4-5 and c6-7 must take up the slack and move more (adjacent level instability). This may lead to increased damage at these levels and again future spine problems. Newer surgical techniques include endoscopic discectomy and artificial disk replacement. Since I do both steroid injections and surgery and see good results with both treatments. I usually recommend epidural steroid injections as initial treatment in cervical disk disease when there is not significant neurological dysfunction. Surgery is reserved for patients who fail to respond to steroid injections.

Depends: This decision is based in part on a detailed history, exam and review of your studies, but most importantly your own thoughts as well. The benefit to the injection is that if it works, you can be better very quickly and without surgery. The downside is the shot can be temporary and so the pain can come back. Surgery is successful and a permanent fix, but it is surgery. Thank you.

It depends: It depends on the details of the severity of symptoms, disability, treatment failure, and severity of disc problem. Modern surgical protocols and artificial disc surgery allow for fast mobilization and physical recovery.