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deciding whether to have cervical fusion

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:27 AM in Neck Pain: Cervical

I'm new here. I recently had a cervical MRI requested by my new primary care physician. I have dealt with neck problems for many years, and had an MRI 12 years ago which revealed HNP at C5-6 and C6-7. I've never had even an epidural, as my pain has been controllable with Naproxyn twice a day. I have occasional tingling in my left lateral deltoid, and at the base of my neck. I have atrophy throughout my right arm, but had an EMG when I noticed this, and it was normal according to the MD. My most recent MRI reveals HNP at C4-5, predominantly central and to the right. This material completely effaces the ventral thecal space and flattens the adjacent spinal cord. There is suggestion of a small amount of edema or myelomalacia within the spinal cord. Extruded disk material extends below the level of the interspace to the right of midline almost to the C5-6 interspace. C4-5 interspace is moderately narrowed. Osteophytes result in mild to moderate narrowing of the right formamen and minimal narrowing of the left. At C5-6 there is marked narrowing of the disk space with dessication. Spondylotic changes about the ventral aspect of the spinal cord without deformity. Uncovertebral disease results in moderate narrowing of both foramina. At C6-7 there are similar changes producing mild/moderate central canal and moderate foraminal stenosis bilaterally left greater than right. When compared to my MRI's of 12 years ago, C5-6 and C6-7's herniations look smaller than they used to.
Sounds like I'm suffering, but I'm really very functional! I work as a physical therapist assistant, and I'm not at all excited at the prospect of the surgery recommended by my neurosurgeon. I see what people go through and my experience has been that once you have surgery, it seems to create a cascade of problems.
I'm curious to know if anyone has avoided surgery in a situation like this. I'm into acupuncture, exercise, etc., and wonder if there's a possibility of waiting this out and seeing if my body will reabsorb some of this herniation as it has at the 2 lower levels.


  • dilaurodilauro ConnecticutPosts: 9,865

    For a Spine-Health Site introduction, Click on :

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    Please feel free to contact me at rdilauro@gmail.com or send me a message
    Avoiding spinal surgery manytime comes done to the level of disc impinge and nerve problems you are dealing with.
    Yes, disc herniation can reduce and basically heal. Having the proper Conservative treatments is important in helping this along.
    Avoiding surgery should always be a top priority. Once you have exhausted all Conservative treatments and they have not helped, the surgery may be the only solution.

    The biggest fear or potential damage is when the disc start to impinge the nerve root. Dealing with nerve pain can be very painful and difficult to resolve. So, manytimes in this cases it makes sense to have surgery. I have had both cervical and lumbar surgeries (7 in total) and with one of my lumbar surgeries I waited too long and now I have permanent nerve damage in my part of my right leg and into 3 of my toes.

    The good news is of all the spinal surgeries (cervical, thoracic and lumbar), the cervical surgeries generally have the more positive results, require less recovery time and have great chances of never having those problems again

    Good luck, hope that things go well for you
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Hello Patio. I joined about 18 months and haven't been on the site for a while. I seen your blog and would like to share some things I went through. I have chronic Degenerative Disc Disease and over the last twelve years it has caused many problems. I was at this point also, with my symptoms of a constant stiff neck, stingers, pinched nerves with radiating pain down both arms through the triceps, and if I had to have my neck manipulated by my doctor, I had an electrical shock going out my fingers. Cervical stenosis, foraminal stenosis, 4 herniated disc's C3 to C7 and several large osteophites--bone spurs--was the reading from MRI's. I put it off way to long--about 4 years and then the symptoms increased if you can believe that. I was taking Vicodin like candy, muscles relaxers, Darvocet, and other pain med from my Dr. that finally I couldn't take any more of it. I finally had Cervical Decompression (Laminectomy)at 4 levels on Oct. 12th, 2007. It really did help---at the time. I waited way to long to do this. My age (55) and occupation has a lot to do with my neck issues, I do heavy collision work for a Cadillac dealership and I would always get the hard hits, because my boss wouldn't trust anyone else to do them, but that is another story.
    Now, once I went back to work the pain was still there and after about 4 months back I was taking pain meds again as my symptoms started to return. Now, they are back full force as before, I had new x-rays and an MRI done a week ago. MRI looked ok, the x-rays turned up something not ok. Two of my vertebra, C4-C5 has moved forward, the material between the disc hasn't moved, the bones themselves have shifted. I'm not going to wait this time, Feb 2nd my neurosurgeon is going to fix it (should I say "install") a titanium plate and screws. I wouldn't put it off, and it's up to you in your case. Get a second opinion, I did and got the same answers. DDD is the main problem I have causing all of this, and I probably will not ever be pain free because of the chronic arthritis, but if I wait, get in a vehicle accident or fall and whiplash my neck, it could be very bad since the two vertebra have shifted. Good luck--

    Dave Howard

    DDD, 4 level laminectomy 10/12/2007, Feb. 2nd, 2009 for plates and screws C4-C5, plus many other issues in there
  • That is all I can give. With you being a PT you know a lot. I had what I thought was a usual "crick" in the neck for many years and then my right arm started hurting, just like a tooth ache. This went on for 2 years before a new pcp found that it was my neck causing all the pain. He sent me to a ortho spine specialist who looked at my MRI and could not believe that all I had been taking for pain was asprin or tylenol. My neck was a train wreck. I had the acdf done and then 5 months later had a revision done. I have gone down hill ever since. I have permanent nerve damage and now the disc above my fusion is bulging. I do think I waited too long and could have had a better outcome if I had surgery sooner. There are days, many days, I wish I had never had the surgery. Do people really become paralysed if they don't have the surgery or is this just a phrase that surgeons use? I guess I have way too much time to think about it, can't do much more because of pain which is mostly nerve pain.

  • Thanks for sharing your experience. I've been told I could be paralyzed (or stop breathing) if I don't have the surgery, but I've never actually known of a case where that happened without a trauma. Of course, those patients don't come in for out-patient therapy!
    The most interesting thing is that I haven't had to take anything stronger than Naproxyn for several years. I used to take muscle relaxers and the occasional lor-tab for C5-6 and C6-7. When C4-5 went, I thought I was having a heart attack at first, until I realized it was in that dermatome, and when I applied ice to my neck, the pain went away. I didn't even go to my doctor complaining of my neck recently - I went because of foot pain. Because she was new to my case, she requested I have a cervical MRI, and then everyone has freaked out, telling me I need surgery. Stories like yours make me think I need to avoid surgery if at all possible, but I also realize it carries risks! Thanks for being there, and good luck to you!
  • Hi Patio, and welcome.

    I had a 3-level C4-7 ACDF with hardware (8 screws). I consider my surgery a success. At 3 months post-op, two of my levels are fused (C4-5 & C5-6) and C6-7, the most difficult to fuse, is on it's way. I just got free of my neck brace last Wednesday and am feeling more and more normal every day.

    If you have to have surgery, it's very, very important to have complete trust in your surgeon. Mine was very conservative and had me wear a hard brace for 4 weeks then a soft collar for 2 months. I start PT next week and the doc said I should be back on the golf course by April.

    Good luck and keep us posted.
  • Hi Dave,

    Thanks for sharing your thoughts and experience. It sounds like you have had quite a journey with your DDD, and your job makes it very difficult to avoid stress to your neck and back.
    My gut feeling right now is to wait a little while as long as I'm not having pain or weakness, while researching my options and finding out what other's experiences have been. I'd like to go back in 6 months and have another MRI to see if things have improved or gotten worse. In the meantime, I plan to do lots of stabilization exercises for my spine and improve my nutrition. Even if I have to go through surgery, it will be in my best interest to be in the best shape possible.
    Best of luck to you with your upcoming surgery. Let me know how it goes.

  • Hi Ron-

    Thanks for your response and support. It's great to know there are others out there willing to share their experience.
    I hadn't heard that cervical surgery is easier to recover from, so that's good news for me at this time.
    I'm curious about what symptoms you were having when you "waited too long" to have one surgery. At this time, I'm trying conservative care, but don't want to ignore something that will cost me in the long run. No one can explain why I have atrophy in my right neck and arm, yet the EMG was normal. It has been with me for many years. I also have bulges at L2,3&4, with some tingling in the left lateral thigh, but this is of no concern to the neurosurgeon at this time.
    If anyone knows of surgeries or treatments upcoming on the horizon that may be worth holding out for, I'm hoping to hear of them - just in case! Also, perhaps you can help me find all the best research and forum sites.
    Take care, and thanks for being there!

  • You can read details of my experience under the post "surgery already????", but here's a short version...I woke up on a Monday morning in June 2008 with severe neck pain. After an MRI and consulting with my chiropractor, ortho, and neursurgeons, I had an ACDF in October. My symptoms weren't even that bad and even before surgery I was able to control the pain with NSAIDS and PT. But I talked to a couple people that postponed their surgeries because they were able to manage the pain with PT, and their recoveries were much rougher than mine and they now have permanent nerve damage. In fact, knowing what an active lifestyle I have, even my chiropractor encouraged me to forgo conservative therapy and to go through with the surgery ASAP.

    I am very pleased with the outcome of my surgery. I am only 3 months out, off all my pain meds, and most days I never even know I had anything done to my neck. I did not wear a collar post-op because my NS didn't want my neck muscles to atrophy or lose ROM. I was flexing, rotating and bending my neck as much as possible from day one and never had to have formal PT. I was back at work part-time after only 2 weeks and back full-time within a month. Right now I can shovel snow, dance, bowl, ride an ATV (carefully) and my NS says I should even be able to being skiing by March. I am very glad I didn't wait to have surgery, and I wouldn't hesitate to do it all over again.

    Good Luck
  • Hello again Patio, It is amazing your not having many symptoms, but since your a PT you know what is and isn't in your case. If your not having any symptoms, you bet I would think twice about going for surgery. I just waited to long before I did anything, My neck was the 6th major surgery I've had, 3 on my knees, appendicitus when I was 7 yrs old and I used to smoke, until my Dr. found some things in my right lung. Had those removed in a hurry and it wasn't cancer thank God, just some things called Granulomas that could or could not change later, so I had them taken out. So, surgery #7 is comming up, and I'm 10 months away from getting my Masters Degree so I can go teach at a college instead of doing the heavy automotive work. When I take a three day weekend, I feel great by Sunday--no pain meds other that tylenol, but once I go back to work, within 2-3 hours I'm hurting again. And in this economy and my age, it's tough to chance occupations, but I repair computers and troubleshoot PC's, networks and other IT stuff, I just can't find a job in that field right now. Hang in there and be careful, I'm just not taking any chances with mine since I seen the x-rays and seen how much everything has moved. I did have a BAD staph infection in my neck wound 2 weeks after surgery that put me back in the hospital for a week, and I was really afraid when that set in, so I'm already on anti-biotics sothat doesn't happen again, plus that infection really messed my muscles up just below my incision. I had a buffalo hump that was really ugly and my surgeon walked me to my hospital room (his office is connected to the hospital)and they had a IV in me even before I could change out of my clothes--it wasn't MRSA thank God, but any staph infection is bad. The infection really complicated my healing and since it was so close to my spinal cord, that could have been deadly. I alomst fainted a couple of times until they got my fever down with ice bags--it shot up to 103.1 in about 3 hours, so I was sick, sick, sick. But they got it out of there and I'm very thankful for their fast action with that. Hang in there and if you start having symtoms, then maybe think about surgery.
  • My boss waited and waited before having surgery against his doctors recomendations (I sent him to my neurosurgeon and he didn't do anything he said) on his neck and his left arm went south, weak, numbness, burning sensations. He had a fusion 20 years ago, then this left arm issue hit and he waited--this damage was below his orignal fusion, and this was damage to a nerve root, but he waited. It did some nerve damage and , only to have some paralyisis and numbness in it now after surgery. Plus, he came back to work after 5 days!!!!( He has a desk job)So it did happen in this case, but going back to work in 5 days is just stupid to me, but it's his neck. He never did any follow up visits either--so he now complains that his surgery didn't work. So, I don't say anything about it.
  • Patio, if more than one doc is telling you that you need to have surgery perhaps it's time to take them seriously. Have you asked them why they feel the need to do the surgery? From your accounts, you have symptoms of nerve and perhaps spinal cord damage. This does not always equal the same amount of pain in everyone. Before my first ACDF I had little pain, more like general discomfort in my neck, and everyone was shocked to see that I had 3 very herniated cervical discs. In some cases, pain alone can not be the guide.

    I now suffer from both nerve damage and myelopathy. My äbsence of pain" is perhaps to blame because I didn't complain about it and who would have thought to look? Once I had the MRI I had surgery within 2 weeks (my choice, the surgeon wanted to do it 2 days later).

    Just my voice of experience but I am curious as to why your docs say that you need surgery.

  • i have no surgery regrets. i had the arm pain symptoms for 4 yrs, but never realized it was a neck problem. i had my arm checked out over a yr ago thought it was muscle strain. dealt with the pain a whole yr more till i got a neck pain.when i finally had surgery on nov 13,08. i then realized how many problems were caused by my pinched nerves. i had swollen hands and feet,legs ached and felt like lead,i would stagger and stumble,both arms were in pain,loss of sensitivity in hands and feet and some breathing problems. was only getting a few hours of sleep a night.now going on 10 weeks post op im working out to get stronger, able to walk a long distance and have no pains. sleeping 7-8 hours with no meds whatsoever. some of my left arm aches once in a while but nothing compared to what it was. but when i foound out i had problems it was too late for anything else but surgery. so if there are different choices for you take them. good luck!!!

    my dx- ddd c5-6, herniation c4-5, 2 large bone spurs and 50% disc compression.
  • Hello Dave,

    I'm happy to hear you are getting close to having your Master's Degree so you can teach. That will be so much better for you! I understand what you mean about the difficulty in changing occupations, as I feel a little trapped in mine right now. PT can be very heavy work. I'm thinking of looking into Home Health so I can work part-time, but I've got to do some more research to find out how much lifting is involved there. Also, riding in the car a good part of the day doesn't sound too great. I was just tossing around the idea with my husband about trying to teach exercise classes for people with spine problems in a fitness center. That could be good for me and have a flexible schedule perhaps.
    Anyway, your post makes me feel a little better about trying a conservative approach for now. Thanks!

  • Hi Cath,

    Thanks for your concern, support, and for sharing your experience. I'm glad to hear everything is going well for you. I really need to hear some success stories right now, because I don't see too many of those. I think perhaps many surgeons don't send their patients for PT unless they're having problems.

    Best of luck to you!

  • Wow! I'm happy to read your post. It sounds very positive. May I ask about your choice to use cadaver bone vs. auto-graft?

    I asked my NS about any supplements, and he could not recommend any. Could you tell me more about what you're taking, and how you chose it?

    Also, I'm still anxious to hear of anyone who has done this well after a period of years.

    Thanks so much,
  • Hi Griff,

    Thanks for your concern. My MRI showed swelling and compression of the spinal cord at C4-5. However, I fell 2 weeks before the MRI, so am wondering if the edema and compression will improve with conservative treatment. The doctors seem most concerned with preventing their own liability by not recommending surgery.

    I can't help being concerned with most people telling me they need more than one surgery over time. I'm hoping for more "long-term veterans" giving me their feedback.

    Here's to healing!

  • Hi Cliffy,

    Thanks for sharing your experience. Please keep me posted on your recovery.

    Best wishes,
  • Hey Patio, the compression issue was the reason I had surgery in the first place back in Oct., 2007 Compressed from C3 to C7 and no wonder my symptoms were so bad. Just hope yours don't go there like mine did. DDD can be very troublesome. ~X(
  • My NS actually prefers to use cadaver bone, but he did let me decide. I went with the cadaver bone in order to eliminate surgical incision and subsequent bone pain and potential complications from an autograf. A failed fusion is more likely with cadaver bone, but I was willing to risk it and turns out I've healed perfectly.

    As for my supplements, I've always taken a multi-vitamin. I chose the glucosamine/MSM basically to try and keep all my joints healthy. Basically your spine is just one long series of joints. The Omega 3 is a good natural anti-inflammatory as well as good for my joints, hair, skin, heart, etc. As for the Citrical plus Bone Density, I figured it couldn't hurt to give my body what it needs to build and maintain healthy, strong bones. I came up with the supplements on my own after doing some research...my NS didn't really suggest anything. I figured this is all the same stuff we would give our patients (dogs/cats) if they had a similar surgery, so it probably would be good for me, too.
  • I have tried chirporactic, massage, breast reduction, physical therapy and drug therapies. It has really begun to limit anything and everything for me. Being 35 no surgeon really wants to operate and my NS told me to put it off as long as I can but I am so done putting up with it. I have a "floating" disk that goes back and forth into my spinal chord which causes fluctuations in my symptoms. After discussin at greater length with my NS, he felt it best for me to get the surgery done.
    I would encourage you to seek a second opinion.
    I understand not wanting to have surgery, let alone fusion, but sometimes, the damage being done without it, causes more problems. It did for me...
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