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What happens if I do nothing?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:35 AM in Neck Pain: Cervical
I was recently diagnosed with a large herniation at C6/C7 due to a acute injury. The initial pain started back in 03/09 and was steady until 06/09. Then it went from moderate to severe with pain radiating all the way to my fingers. I have since gone to physical therapy and a chiro and the pain has gone back to its moderate level. With the physical therapy the pain subsided by a new host of problems have surfaced, namely moderate weakness, localized pain in my shoulder and back, numbness and tingling (Nerve Symptoms). My doctor has advised me that I need to have ACDF in order to ensure that the nerve symptoms don't become permanent. I want to know what will happen if I don't do the surgery. Will the weakness get worse? If I resumed by normal extremely active lifestyle would the pain symptoms return? These are all questions that I have asked my doctor, but his answers have been evasive at best. I know there are no guaruntees, but I would like to hear that there is at least some chance of returning to normal. Will I continue to damage the nerve if I do nothing?


  • welcome to this group of people trying to make sense of our spine problems. well you sure have one opinion from a dr. i'd be crazy to disagree with a professional as im just a sufferer like you. however continued pressure on nerves over long periods of time causes nerve damage. if your gut feeling is to wait it might be good idea to get 2nd opinion....hang in there...pete
  • I appreciate the comment. The doctor I am describing is my 2nd opinion. My first wanted to jump to surgery right from the get go. Deep down I "think" I know that I need the surgery, but I am scared to death of it. Like I said before I am extremely active, the last TV program I remember watching was the Cosby show, so I am worried that with or without surgery that is going to change. I have the utmost confidence in my doctor/surgeon, but not so much in my ability to get over the fear of it. I am trying to maintain a positive outlook. Thanks again.
  • I was going to suggest getting at least another opinion from a fellowship-trained spinal specialist. It is very important, especially in your case, to find a surgeon that you are comfortable with...one that is very experienced in the type of surgery he is recommending...one that you can deal with for the long term.

    I have lumbar issues and do not usually make comments regarding cervical issues, but I do know about nerve damage and waiting too long. If you are being advised by a surgeon you respect that you need surgery, and you have had that opinion from other spinal specialists, I would seriously consider their advice. It is possible to have a compressed nerve for a period of time without it causing permanent damage, but there is no reliable way to predict this. You "shouldn't" have permanent damage, says the doctor, but what if you end up being the 1 in whatever number that ends up with permanent damage? No doctor can assure you that you will not have damage. Nor can he assure you with any certainty that the surgery will result in a pain-free life. All he can do is give you the statistical odds. While herniations can and do heal on their own, smaller herniations heal more easily than larger ones. If your doctor believes you will end up having surgery down the road, that is something to think about.

    To answer your questions, I would GUESS that chances are quite good that if you resumed your active lifestyle, your pain will only continue to increase. The herniation could get larger resulting in further nerve compression. There is no way to say which option gives you the greatest chance of returning to normal. Staying the same does not guarantee it and most people are never completely the same after spinal surgery. You may need to keep looking until you can find a specialist that can answer all your questions.

    In the meantime you might want to do some reading on the internet. There are many excellent resources available now, including a lot of research that might be of interest to you.

    It is not easy to make a decision. Almost all of us has been there!! I think the majority of us would do our fusion again if presented with the choice. And most of us were fearful ahead of it, as well!!

    Good luck.
  • Have you had an EMG to determine the extent of your nerve damage? Surgery should always be the last resort, and once you have it you can't go back. (I ain't a doc, and I have not had the sugery.)---Mazy
  • I appreciate the comments. I have been doing a great amount of research and have been learning a lot. Unfortunately I have probably learned too much. I am a type A personality that has to have all the i's dotted and t's crossed before I make a decision, so I will be sure to get all the facts first. Thanks so much.
  • I've had a 3-level ACDF and, although I have a new normal, it's not a bad one. I still have some muscle spasms in my back and an ache in the back of my neck but nothing I can't live with.

    Before surgery, my left arm weakness and muscle pain was worse every day and I'm sure that I would've lost the use of my arm completely if I hadn't had surgery. I also had tingling in my right arm. The strength in my arm returned and the tingling was gone immediately after surgery. I definitely feel better now than pre-surgery.

    Having surgery is a very personal choice, but I didn't want to risk the chance of permanent damage. My surgeon said surgery was imperative and I fully believed him.

    Let us know what you decide.
  • Scott check out the new disc replacements that seem to suggest that the neck has more chance of working "normally" than the "gold standard" ACDF. FDA approved 05/09. The Bryan Disc is approved for:
    • Single Level Use
    • C3-C7
    • Approved for intractable radiculopathy

    Or the PRESTIGE Artificial Disc. Search the study of 2007 and look for a doctor that performs this. I would think it would be worth your time if you fit the perameters.
  • When I was first diagnosed with a congenital fusion and DDD, I was told I would need surgery, but was prescribed pain meds and PT. After that, I was still in terrible pain, but waited to do anything about it and it went away on its own. 6 months later my left arm started feeling numb and in a matter of days, I lost use of my left hand completely. I never had any symptoms like this when I was having the pain. I returned to my NS who put me through a variety of tests, MRI, EMG, Mylogram, and she said I did need the surgery but she wasn't sure it would fix the problems because my test results weren't adding up. I went for a second opinion, and after having 2 cortisone injections (I had to do it so my insurance would pay for the surgery)I had an ACDF on my C7/T1. (my congential fusion is at the C6/C7 level.) MY NS said that I could have had permanent nerve damage without the surgery and may not have gotten the use of my hand back if I had waited much longer. Now I have new symptoms, 8 months after surgery and again, I am losing the use of my hand. I am now going to a 3rd NS. I know I need surgery on C4/C5 but the NS that did the first surgery still doesn't want to do the surgery because "You are too young to lose ROM" I am afraid to wait much longer because my hand is getting worse. So off to another NS to see what his opinion is. The spine-health forums have really helped me and I hope they help you too. My gut says and told me in the past to do what I think is best, and so far, I have not been disappointed. The surgery did help, and I wish the 2nd NS would have done both fusions. Maybe I wouldn't be going through this right now. Good luck!

  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    They say the five most dangerous words in the english language is "maybe it will go away".

    Its called DDD for a reason. Its degenerative and progressive. Not to mention the constant acute - chronic pain that we deal with. I beleive that when the pain and symptoms are bad enough ..... most of us will beg for surgery. I know .... I did X2 ..... If your not at that stage yet .... that's a positive sign .... on the other hand ... I was told that the amount of time for nerves to regain some function after constant compression is equal to the amount of time it has been compressed. Although I'm far from perfect in ROM, function, and level of pain, I am better than before the first and better than before the second .... I don't need to be completely narc'd out because of the pain 24/7 ... nor do I want to put a gun to my head(neck) .... Its progress - not perfection .... but not progressive disease .... too much ... slowed down.

    Bless all of us!

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • Understand where you're coming from. I started having left shoulder pain this spring. Thought i'd strained/torn my rotator cuff playing basketball. Being a physical, active guy at a relatively young age (36) I figured it would heal on its own. After 90 days of daily intense left arm pain, i started seeking treatment. Went through Xrays, EMG, MRI, etc. Ended up seeing two spine surgeons. Both seriously recommended ACDF due to two herniated discs C5-6 & 6-7 that were putting pressure on spine.

    Over the last 30 days i have seen significant weakening of my left arm/shoulder. I could live with the pain but can't risk permanent loss of use with my arm. I have two very young kids and unfortuantley i am left-handed which is the arm causing me issues. My surgeon says he will consider the surgery a success if the radiating pain goes away and my arm does not weaken any further. He said the stregnth may or may not return. The only other ACDF recipient i know had great success and an easy recovery except for failing to regain his arm and shoulder stregnth 100%. He estimates it at 90% 18 months post-op.

    I have my two level ACDF scheduled for mid-Sept.

    Online research is scary. The medical journals are complicated and the blogs tend to focus on the negative after effects. My hope is that the large majority of surgeries are successful and most patients never need this blog as a resource.

    Best of luck to you.
  • Welcome to Spine-health. Making the decision to have an ACDF is difficult, and should be taken seriously as it appears you are doing. I always suggest that one gets at least 2 opinions from spine specialists before proceeding to surgery.

    You have asked some tough questions, that unfortunately no one can really answer.
    My doctor has advised me that I need to have ACDF in order to ensure that the nerve symptoms don't become permanent. I want to know what will happen if I don't do the surgery. Will the weakness get worse? If I resumed by normal extremely active lifestyle would the pain symptoms return? These are all questions that I have asked my doctor, but his answers have been evasive at best. I know there are no guaruntees, but I would like to hear that there is at least some chance of returning to normal. Will I continue to damage the nerve if I do nothing?
    Have you tried epidural steroid injections? I have heard that sometimes the steroid will reduce the inflammation enough to allow the disc herniation to shrink and relieve the compression on the nerve root causing the problems. Most insurance companies will require you to have at least one prior to heading to the OR. It sounds as if your problem is from the nerve root and not cord compression, so that is a plus. If the pain is tolerable, waiting may not be a bad idea, at least long enough to get a third surgical opinion.

    On a positive note, many people have single level ACDF surgeries and return to a very active lifestyle. Some doctors will tell you that you can return to work in as little as 2 weeks, and some people really do. I know a couple of people who have done just that, and have gotten along extremely well post op.

    Good luck Scott.


    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Hello Scott-

    In August 2007 I had a one level disectomy w/ fusion at C5-C6 level. I had a herniated disc that was about to cut my spinal cord in half according to the showings of my MRI.
    I was in constant pain, my right arm hurt constantly, I couldnt sit comfortably, couldnt sleep.
    It has been 2 years since my surgery and in my case, I feel that a majority of my strength has come back. The recovery for me was a good hard month with continuing improvement thereon.
    Prior to surgery I taught an aerobic kickboxing class..post surgery approx. 3-4 months later I was teaching again but not as often and had to listen to what my neck was telling me on how aggressive I could be. In my case, I am not regretful of my neck surgery at all and would do it again in a heartbeat. I used a neurosurgeon that I cherish to this day and believe he has my best interests always in mind!
    I wish you the best of luck!!!!!!!!
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