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Posterior Cervical Microdiscectomy vs. ADCF?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:36 AM in Neck Pain: Cervical
I am new here and hoping I can get opinions and advice from those who have been through it.
I am a healthy and active 45 yr old male in the Boston area. I have a cervical disc herniation (C6-C7) impinging on nerve in my left arm. This caused terrible pain for several weeks. I am relatively pain free after cervical epidural cortisone shot (2 weeks ago), but now I have significant weekness in my left triceps and continuing numbness in my left thumb and index finger.
I have seen 2 spine doctors both recommend surgery if I want a chance to regain strength in my triceps. (I like to work out so this is important to me) One Dr recommends Posterior cervical microdiscectomy (PCM). The other says ACDF. I am opting for PCM this week as it does not require fusion. This Dr says he can successfully remove the herniation this way and I should avoid fusion as I am “young” his word. ;) I know PCM surgical pain is greater, but long-term, I am hoping I will be better off without fusion. Also ACDF dr doesn't want to do surgery for another mth. Am I making the right decision chosing PCM over ACDF?


  • welcome and i'm glad your pain isnt too bad now. i like the PCM approach. once you are fused the options are less and stress can be placed on adjacent disks. with the PCM your future options are more.
    there are many people here to share their thoughts...plus many articles and videos to examine. i hope your arm strength returns....pete
  • Hi Pete,
    Thanks for the reply. I appreciate your opinion.
    Your comment about "stress can be placed on adjacent disks", is one of the concerns the Dr who wants to do PCM mentioned.

    I would appreciate any isight that others have to offer as well.
  • I had ADCF. The PCM seemed to be a hightmare waiting to happen and I could not live with the reminders of the operation a posterier procedure would leave as far as I could tell 15 years ago when I had my operation. Things may have really changed in 15 years, but the tiny incision on my neck for the C5-6-7 surgery with ADCF - I had has served me well.
  • Welcome to Spine-Health, the home of all things spiney. There are great peeps here as well as tons of information regarding our spines.

    The first think I though of when I read your post was that if you have the PCM and it works, great. If not, then you can still have the ACDF. It does seem like there would be more options down the line with the PCM.

    I don't regret my ACDF at all, but because it was a pretty big surgery (3-lvl), I still have some pain and muscle spasm issues. I was losing the use of my left arm and had significant tingling 24/7 in my right arm previous to surgery, but both of those symptoms were completely gone when I woke up afterwords. I hope the PCM gives you the same relief.

    Many people here will tell you to go with your gut feeling regarding your treatment and it sounds like that's what you're doing. Good luck and let us know how it goes.

  • I had Posterior Cervical Foraminotomy C5-6 & C6-7 almost 5 mos ago. ~X(
    hehe YES post op was painful, but worth it!
    MRI showed C6-7 (making left arm pain & numb) degenerated disc, impending on the nerve there. My doc said "I'll go ahead & free up C5-6 area too while I'm in there" because it was showing degeneration slightly and one day will need it done. It was a success! Roto Ruter (sp?) some say!
    I have read all over this forum & it seems the recovery from the posterior approach is alot more painful. But I, like you, did not want a fusion! [(
    Especially if not necessary to cure the problem.
    You saw what Pete wrote.
    take care
  • First let me say welcome to spine-health. Have a look around and do your research before you make any decisions. Everyone had given you sound advice that they can always go back and fuse latter if need be. The actual incision from posterior surgery is a bit rougher to deal with. However, your recovery over all should be shorter, as you won't be waiting for fusion or hardware to set up. Each person is different and the reasons for surgery are different as well. Some herniations can't be gotten to from the posterior approach, hence the need for anterior. About the biggest set back of posterior surgery is muscle spams. Since you have two completely differing view points may I suggest that you get a third opinion. Anyway just thought I would stop by and welcome you to spine-health. Take care and look forward to reading more of your post.
  • Hi Spence, and welcome to this site. This is such a difficult decision!

    ACDF. I'm all for trying to prevent fusion, because that is so permanent. Since your area is C6/7 you should not lose much ROM, because most of the rotation movement comes from higher up in the neck. It may be a factor when bending your head down, as in chin to chest, but my opinion would be that you would not lose enough motion for it to bother you.

    (I am not a doctor, just learn through experience, and I hope you will discuss anything you learn here with your doctor to validate its correctness.)

    PCM. I just read about the PCM. I didn't know much about it. Do they use any hardware? It seems to me that the work is done without the need for hardware to support you afterwards. That would be a plus.

    When you read on here that the posterior approach is much more difficult, keep in mind that many have had rather large reconstructive surgeries from the back, usually after having an anterior approach before. I don't know if it would be fitting to compare pain levels or recovery times with other surgeries done. I haven't read of anyone who had a posterior microdiscectomy. It does sound like it would not be too invasive, yet there are risks with it.

    Following is a link about the posterior cervical microdiscectomy. http://www.spine-health.com/treatment/back-surgery/posterior-cervical-decompression-microdiscectomy-surgery

    I'll be curious to see how it all works out. I think I would be concerned about ensuring they create enough space for the nerve root--the main goal is to relieve the pressure off of that!

    Good luck, and again, welcome to spine-health!
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Spence & all: Get another opinion, like tamtam said. Ask questions too!
    I began my journey a year ago with pain & numbness in my left arm. Did the MRI, went to PT of ALL sorts, had the injections, did another MRI with contrast & saw 3 dif. surgeons. The first 2 said they'd go in from the front & free the nerve, but more than likely a second surgery would be necessary for an addt'l area around it. The 3rd one said he would rather get both areas at same time, while he's in there & that's when the decision was made to enter through the back of neck. Yes, it is a more painful post op, because of all the muscle disturbance! YOU have to keep in mind that none of us in here are drs & can only tell you about their situation.
    Myself, 5 mos post op, now 99.9% recovered! Times I forget I even had the surgery!

    4/28/09 Posterior Cervical Foraminotomy C5-6 & C6-7
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