Surgical Steroid Injections in the Cervical Spine (C5-C6) for a Herniated Disc: Part 1

I don’t think I have actually discussed the results of the surgical treatment that I had, so I’m going to take a moment and write up a description of what I have, what happened, and how it has been. I realize that each body is unique in both its pain and its responses, and that there’s no guarantee my response and experience will be yours. However, whenever a new treatment / method / drug / practice comes into my life (whether via a doctor or a recommendation), I do tons of research on it, including reading testimonials from folks who have gone through it and shared their thoughts. So here’s mine; I hope it helps someone.

The short version is that I’ve had steroid injections in my spine for a herniated / bulging disc at the C5-C6 position, in my cervical spine. My pain has not been eliminated, but it has been reduced by probably ~50%. This was an amazingly positive thing for me because this injury hadn’t responded to other treatments and was only minimally responsive to drugs. I will have a series of three shots and we are hopeful that it will eliminate the pain once I’m done with the set.

What follows are the details, for those who may be dealing with something similar.

History of the Pain
For the last 3-4 years, I’ve dealt with sudden bouts of excruciating pain in my neck: I’ll wake up with my neck so stiff and in so much pain that I can’t even turn my head one way or the other, can’t tilt my ear down to my shoulder, etc. On days like that, I can’t even drive a car due to limited mobility, so I would take a sick day, and stay in bed with a hot pad on the stiff area, and advil, and rest. The pain would be incredibly limiting (pain level 8-9, on the pain scale of 10) for a day; usually the next day would be moderate-but-dealable pain (5-7), and within 2-3 days the stiffness and would gradually vanish. This happened a few times a year — enough to be concerned, sure, but to be honest it wasn’t frequent enough to make it a high priority. (I have enough other health issues and medical costs to focus on.) There was no trigger I could remember that started an episode, although it was somewhat linked with my insomnia (although the pain may have caused me to be unable to sleep), and the pain and stiffness always eventually went away.

Some time last May or June, I noticed increasing and constant pain from the general area of the junction between my neck / back / shoulders. The level of pain varied from day to day (wavering from a 3-5 on the pain scale); it was never as bad as the episodes I was used to having, but at the same time, I noticed it never went away. Again, there was no specific trigger, physical or otherwise, that I can remember that might be to blame for causing the issue / injury. As it stands, that’s over 11 months I’ve been in constant, daily pain.

Once I realized this pain wasn’t going away – like my other episodes tended to, the main reason I hadn’t spent serious time and money investigating the issue – I went to the doctor and started the long process of diagnosis.

History of the Treatments and the Diagnosis
Previously, when I’d talked to my doctor before about the extreme episodes with my neck, he’d given me high-dose naproxen and prescribed hot pad and rest, since that worked. However, when I went in with this somewhat-related-but-really-kind-of-new-or-at-least-different type of pain situation, we both started to take a closer look.

First my doc ordered a series of x-rays.  The x-rays found evidence of arthritis all through my spine. As I’d already been diagnosed with arthritis in my toes/feet, it wasn’t too much of a surprise to find it in my spine. I went to a (separate) chiropractor, who listened to my symptoms and took his own x-rays and told me I had a pinched nerve in there. My doctor prescribed some NSAIDs and physical therapy. The physical therapist I was working with told me I had trigger points in my muscles, which were pulling things too tight and causing the issues. That makes 3 different (but, admittedly, related) diagnoses.

I attended 6 weeks of physical therapy with little to no relief. We did exercises to strengthen the muscles in that area – lat pulls, shoulder shrugs, negative shoulder shrugs (on a dip machine), etc – and used a traction machine. The only part of it I liked was the traction machine. Overall I did not feel any significant improvement, and after 6 weeks I went back to my doctor. We tried muscle relaxers; these did not work either. I went back to the doctor and asked if I could have a prescription for massage therapy (while it isn’t a permanent fix, it remains one of the few things that can make that area feel okay for a short while).

My doctor ordered an MRI, to examine whether the problem was structural – a pinched nerve, a herniated/bulging disc, a skeletomuscular abnormality, etc, in which case massage would not be effective – or whether it was something that could be managed with therapeutic massage.

The MRI came back with evidence of a herniated and/or bulged disc in the C5-C6 area of my cervical spine. [Please note that this was the fourth diagnosis I had recieved, but that it was (finally!) based on actual fucking data - a frigging MRI – and that it was an actual thing that was treatable and dealable and concrete rather than “it could be X Y and or Z” like I had been hearing for months. This was in October of last year, and while a herniated disc isn’t great news (especially when you are only 30something and arthritic) it was a conclusive diagnosis and I actually cried a little bit in relief.] At this point, I was also given Vicodin to help reduce the pain and help me sleep better.

It was unclear from the first report whether it was herniated or bulging (or both? I still don’t even know), so I was sent to a neurosurgeon specialist to discuss the results. That doctor was a complete waste of space and time, and I loathed him, so I was sent to a third place, which is the pain management clinic I am currently working with.

When I went to see my new doctor there, he reviewed my symptoms and my history and my actual neck / back / shoulders, and presented some theories and a path forward. He said it was difficult to tell whether my muscles were tight because of the spinal problems, or if my spine had been pulled out of correctness by muscle problems. So he suggested a three-tier approach. First he gave me a cocktail series of much better drugs (see below). Second, he wanted to try steroid injections into some trigger points in my muscles to see if that provided any relief. The third step would be injections into my spine, if the first two didn’t work – but he did in fact schedule the spinal injections that very day, since there is a long wait period to get in for that kind of procedure.

I went in for the trigger point injections in January. To do these, a (certified and trained) doctor prepares a syringe with a blend of anesthetic and steroids, and then finds the trigger points in your muscles (usually places of extreme tightness and pain, often transferring pain to other areas as well), shoves the needle in until it feels like it hits the trigger point, and injects the solution. For me, these trigger point muscle injections were pretty completely ineffective.

Because everything else was ineffective, we went ahead with the scheduled spinal injections on 28 February.

History of the Drugs
For arthritis, NSAIDs are usually prescribed for pain-relief and anti-inflammatory action; my doc gave me high-dose naproxen again. The naproxen did not seem to reduce any of the pain. We then tried meloxicam, which helped a small amount, but did not significantly reduce the pain. NSAIDs have worked on me in the past – I have recurring tendonitis – but did not work on this problem in my neck / back / shoulders, which mainly told us it wasn’t entirely inflammation-related.

Next we tried a muscle relaxer, cyclobenzaprine (Flexeril). Again, this had little effect on the area in my neck / back / shoulders. This pointed somewhat to it not being a muscle problem.

Next I was given a low dose of Vicodin (hydrocodone/acetaminophen) to take at night, to dull the pain and help me sleep. The Vic was mildly effective – at that point I would take any pain relief with grabby hands – but not significantly.

When I finally got to the doctor at the main management clinic, I was given a four drug cocktail series which, when taken in various combinations, was actually moderately effective on my pain levels. I was prescribed a higher dose of Vicodin for nights; tramadol, another opiate-type pain treating drug, but one that would not make me as drowsy as Vicodin, meaning I could take it during the day while on the job; methocarbamol, a muscle relaxeroften used to treat skeletal muscle spasms, at a reasonably high dose; and high-dose ibuprofin (Advil).

I am sure my liver hates me for it, but this 4-drug combination cocktail is actually able to provide me with a moderate level of relief. (Ironically my liver might hate me but I must have a stomach of steel, as all of these drugs warn for potential stomach irritation and I’ve had next to none even at these high doses. I am glad one part of my body works correctly.) I take the tramadol, methocarbamol, and the giant ibu in the morning before work, an ibu and a relaxer at lunch if I am in significant pain, and when I get home I take another dose of tramadol / methocarbamol / ibu – unless the pain is significantly bad, in which case, I take a Vicodin, the methocarbamol, and an ibu.

The Procedure
My procedure was scheduled for 1:45pm; I had to arrive at 12:45pm. I was told to fast starting at midnight before the procedure. (This meant I stayed home from work for the entire day – I don’t trust myself at my dangerous job while fasting because I’m hypoglycemic.)

I went in, changed into the ~lovely~ hospital gown, and was given: an IV drip, the O2 hookup thing in my nose, electrical pads on my front and back to track heart rate, the finger thing to detect pulse etc… lots and lots of connections.

Shortly afterwards they wheeled me back into the room. I was asked to roll over onto my stomach, with a pillow propped up under my upper body. I was told the sedative was being connected; I felt a mild burning as it entered the back of my hand, and then I seriously do not remember another thing until I came to in the recovery room, outside the surgery. From what the doctors and nurses told me it is a responsive procedure, meaning they don’t put you under absolutely completely because they need you to be able to move around when asked, but I sure as hell do not remember a single thing after that chemical went through my IV. (Which is preferable to me — I really, really do not want to know what they’re doing back there.)

The Recovery
I stayed home the rest of the day, because anesthesia = groggy nausea and weird-feeling general body-ness.

For the next 24-48 hours, it was difficult to tell whether there was any improvement, mainly because the injection site itself was painful. I could feel it when lying on my back or rolling up on my upper spine, like in certain yoga poses (which I use to stretch my also-problematic lower back / lumbar region), and it twinged whenever I moved. I was simultaneously worried that there was still pain and hoping that all of the pain was due to the injection site.

Soon, however, the site began to heal. In general, I felt that the pain radiating from the area had improved somewhat but not completely. At first I thought it was maybe 75% improved and wasn’t sure whether the lingering pain was from the injection site or from the disc itself, but as the days went on I could still feel some of the pain. As it leveled off, I’d say it was maybe 50% reduction in pain (both on-site and radiating pain).

A week after, I went for a check-up with the pain management clinic doctor. He told me that in my case – when so many other treatments have been ineffective - any pain improvement is an amazingly good sign, and the fact that I felt the pain had been cut about 50% was not in fact the disappointing “it didn’t work” I’d been thinking it was, but rather an amazingly hopeful sign for this line of treatment being ultimately successful.

The Result
Right now it has been a little over a month since the injections, and I still feel that they helped: I still feel that pain levels have been less than they were before the injections. I would still say 40%-50% is a good estimate: there’s still stiffness and muscle tightness, but there’s a lot less of the piercing, sharp, stabbing type pain I used to get regularly in that area.

I do still need the medications for pain relief – even 50% reduction still leaves me dealing with constant pain – but they are still effective (my body hasn’t “gotten used” to them yet).

My pain management doctor has prescribed me a set of two additional shots, approximately 1 month apart (one is next week; one is at the end of April).  His hope is that a series of 3 procedures will be effective on the pain. Since the first one was effective, there is a good chance that a three-pack will suffice to stop nearly all of the pain I’m dealing with. After the second or third, depending on my recovery, he may prescribe physical therapy.

The theory is that the herniation in the disc makes everything around it inflamed and angry and stretched wrong and aligned wrong and pinched and pulled and pissed off. Injecting with steroids helps calm that shit down, provides a buffer, and reminds it to breathe a little. After the center of the pain-causing area basically gets “paused” by steroids, often the disc will begin to “heal itself”, realigning itself – and the other bits and pieces it has pulled out of whack – to where it’s supposed to be. Since my herniation wasn’t actually significantly out of place (despite the high levels of recurring pain), there’s a reasonable chance that my back will self-heal to a point with enough steroid help.

Because I do have arthritis in my neck / spine, I’ll probably always have some pain in that area, and I’ll have to be careful with what I do — but the source of the stabbing pain could at least be damped down.

Sometimes a series of steroid shots will provide permanent relief. Sometimes steroids provide periods of relief, and then pain slowly returns. As I haven’t yet hit “zero pain”, it’s hard to predict which I’ll be — it will just take time.

However, after all that I’ve been through with all of this, I am profoundly glad to have found something that can actually provide relief. I can manage wait-and-see, now, now that I’m not struggling through constant and chronic pain at a level 5-6 every minute of my day.

My Conclusions
Steroid blocker shots in my spine have produced a significant reduction in pain for me. I am having two more shots and cannot wait to get them in there.

If you have questions about the procedure, about the results, about my pain, anything – please ask! I’m more than happy to tell what I’ve learned in the hopes of helping somebody else out of their black hole of pain and agony.

About sevdrag

Sev Dragomire is a professional chemical engineer, a legitimate nerd, and a certified terrible person. She has the paperwork to prove all three.
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2 Responses to Surgical Steroid Injections in the Cervical Spine (C5-C6) for a Herniated Disc: Part 1

  1. Texmexsop says:

    Thank you so much for your story. Mine is almost exactly the same and my doc told me today that I need steroid injections. PT says its muscles but MRI confirmed herniation. So good to hear that your pain is better.

  2. Pingback: Cervical steroid injections: Round Two of Three | The Worst Hobbyist

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