I am a 22 year-old male in very good health, but have had chronic neck pain since playing football about 7-8 years ago. In early February of this year, I began to suffer from numbness and tingling in my right arm. An MRI of my cervical spine revealed multilevel disc degeneration. The summary is as follows:
C2-C3 disc shows no bulging.
C3-C4 disc shows broad-based degenerative protrusion with endplate osteophyte spurring resulting in spinal stenosis with cord compression upon the cervical spinal cord, as well as mild bilateral proximal neural foraminal spondylitic narrowing slightly worse on the right.
At C4-C5 there is prominent broad-based degenerative disc protrusion with endplate osteophyte spurring resulting in spinal stenosis with cord compression and bilateral neural foraminal spondylitic narrowing.
At C5-C6 there is also broad-based degenerative disc protrusion with endplate osteophyte spurring resulting in spinal stenosis with cord compression and slight bilateral proximal neural foraminal spondylitic narrowing.
At C6-C7 there is mild degenerative disc bulging unassociated with any spinal stenosis or cord compression or visible foraminal narrowing.
The C7-T1 disc remains normal.
In the cervical spinal cord at C4-C5, to right of midline, there is a small focus of increased T2 signal intensity measuring approximately 7 mm maximal size. This is nonspecific, but the possibility of developed myelomalacia in the midcervical cord is raised.
There is no evidence of syrinx. There is no cerebellar tonsillar herniation through the foramen magnum.
The cervical vertebrae show no fracture and no suspicious marrow infiltrative mass lesion. There is a reversal of the cervical lordosis centered at C4-C5.
Impression: Degenerative cervical spondylitic changes resulting in multilevel spinal canal stenosis with compression upon the cervical spinal cord at C3-C4, and more pronounced at C4-C5 as well as C5-C6.
At C4-C5 the possibility of developing myelomalacia in the cord is raised.
That MRI report is from February 9. I went to see a spinal surgeon who recommended 3-level ACDF of C3-C6 as soon as possible. He said that I was at risk for paralysis or worse if I experienced any trauma to the area. I asked about alternatives (with ADR in mind) and he said that as a doctor who does have replacement experience, I was not a candidate. My knowledge on the subject at that time was far less than it is now, so I did not ask why (i.e. number of levels only, or presence of cervical kyphosis). I initially scheduled the fusion, but canceled it soon after to look into other options. The numbness and tingling I had experienced subsided for about a month at that point.
Then, about 2 weeks ago, my condition worsened significantly for a short time. My right arm and hand felt cold constantly and nerve pains were often present. Also, I began experiencing nerve pains all along my right side -- right leg, foot, and buttock when seated –- something that had never happened before. The same feeling of coldness was often present in my right foot as well. The symptoms lasted for 3 or 4 days, subsiding after extended rest. All that remained then were some slight sensations in the right hand. The symptoms have since returned -- but to a much lesser degree -- in the last few days, although I would not be surprised if they faded away again soon as they seem to come and go in waves now.
Being only 22 years old, I find this all quite shocking to deal with. Nearly every case I have read about refers to patients much older than me. I have no way of knowing how much of my condition is due to sports injuries, congenital issues, or simply poor posture, but I do have great concern over fusion surgery after reading about the high occurrence of adjacent disc degeneration. With mild bulging already present at C6-C7, it wouldn't be long before I'd find myself on the operating table again. I hope to have many decades remaining in my life, and I'd rather not spend them all repairing subsequent failures every few years. I feel that I must act soon though -- regardless of the chosen course of action -- for two reasons. The most obvious one is the seriousness of the risk I face each day in my condition (i.e. paralysis or death). The other is that I am scheduled to enter law school in the fall which will require a recovery from whatever procedure I decide upon by August.
I have read in studies that the reversal of lordosis in my cervical spine makes me a poor candidate for ADR, but my fears about fusion have made me check into it anyway. I came across Germany's Stenum Hospital in my research and sent them my case information. They responded by email -- in a somewhat canned manner -- saying they think they can help me using the Spinal Kinetics M6 cervical disc. They are in the process of reviewing my medical documents and I'll probably get a final response within the next couple weeks. In perusing these forums, I see that there seems to be a great split between those who trust ADR and those who don't. While I'm not one to dwell on a couple bad stories, I do want all the information I can gather before making a decision. I've also read that Bogen Hospital in Germany is well-regarded and I may now check with them as well. Any concrete anecdotes about the procedures and hospitals would be appreciated.
To summarize, I'm looking for unbiased thoughts (if such things exist) on what to do. My surgeon here tells me "fusion", and whoever I talk to in Germany will say "ADR". I just need to know that I'm doing the right thing when it comes down to it. Should I trust the foreign technology for multilevel cervical disc replacement, or is that just asking for more trouble down the road? Which hospital is truly the 'best' and yields the highest success rate? What kind of recovery am I looking at from each of these procedures and is my law school start date likely to prove problematic? As an active 22 year old, am I going to have to limit my activities for the rest of my life after surgery?
I apologize for the length of this post, but I wanted to get everything out there. Any answers or suggestions would be most appreciated. Thank you for your time.