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New here - questions about ACDF

tiresmokettiresmoke Posts: 10
edited 06/11/2012 - 8:46 AM in Neck Pain: Cervical
Here's my story. I first noticed a problem a few years back -- I would have a numbness / tingling in my left arm whenever I sneezed. Like any good man will do, I ignored it hoping it would go away. I also would experience an extremely stiff neck / shoulders from time to time that I wrote off as stress-related. Time passed and I started getting more numbness / tingling / pain in my left hand and elbow area along with increased frequency of neck stiffness and soreness.

In March, I went to my GP for a physical and mentioned the issues. She sent me to get an xray which showed some spurring, foramen narrowing, and general arthritic conditions, which seemed a little advanced for someone who is only 36 years old. Then she sent me for a cervical MRI. The MRI showed three bulging discs, foramen narrowing, etc. Then I got sent to a physiatrist, went through some physical therapy, had two steroid epidurals, and didn't find much difference. He put me on Lyrica (75mg three times a day) and Mobic as needed. The Lyrica seems to help some and the Mobic only works on the pain when I have it.

The pain, numbness & tingling isn't really all that bad most times. It changes in intensity depending on position and activity. It's tolerable and certainly not debilitating. I also have fairly good strength. It has, however, been getting more noticeable and has started on the right side (hand) as well to a small degree.

I went to see an Ortho who reviewed my MRI films prior to walking into the examining room with me for the first time. After the exam, she expressed surprise that I'm not in worse shape considering what she saw in the MRI. She recommended an artificial disc combined with fusion and suggested that my condition is going to just degenerate over time considering the non-herniated discs don't look all that healthy either. Since my insurance is going to cover artificial disc replacement at this time, I left for a second opinion.

I saw another Ortho who spent all of 5 minutes with me after keeping me waiting for nearly 1.5 hours. He didn't look at the films (only the reports), didn't really listen to me when I said I tried PT and it didn't work (he actually wrote a script for PT saying I should "try it" so he definitely wasn't paying attention) and ended up saying that he didn't think surgery was a good option because he woudn't want to operate on someone who "looks so comfortable". I left his office annoyed and still looking for what I feel is a legit "second" opinion.

I was able to obtain an appointment with a very highly regarded Neurosurgeon who works out of a top hospital. He basically said get the surgery and get it soon because the longer I go, the greater the chance of permanent nerve damage. He would fuse 2 levels -- leaving one bad disc alone because he feels 3 levels would be too much at this point. He said that he and the Neurosurgery Dept do not do any artificial disc replacements because he feels the technology available is sub-par when compared to fusion at this point. (I did further research on this on my own and it appears that what's approved in the US is many years behind what's used in Europe.)

Now I'm confused. I have been advised to get surgery from people who look like they know what they are talking about. They also have implied that waiting until the symptoms get worse (which they say they will) is a bad idea for my long term prognosis. However, as it stands, I can totally live with the symptoms I currently have. They aren't so bad that I *need* to get them taken care of right now, IMO.

However, it seems that my MRI paints an ugly picture and that I'm lucky to not be much worse off considering my condition. Of course, maybe I'm wrong?

I actually made ANOTHER appointment with a top Ortho in the area who works out of another top hospital. Am I being stupid? What advice do you folks have?

Thanks much in advance!!!


  • First let me say welcome to spine-health. Have a look around and you will find many others going through what your are or whom have gone through it.

    AS far as surgery, it is very personal decision and only you can make that call. However with that being said i am one of those that surgery didn't come fast enough and ended with permanent nerve damage. Then it became more of a emergency than I can schedule when it is easy for me. Keep in mind when your messing with the cervical spine your cord is there as well.

    I have been on these boards for quit sometime and seen people whom have gone to surgery and said it was the best choice they ever made. Unfortunately those ppl are gone and out living normal busy every day lives.

    The surgery itself the post op pain is not quit bad, depends on wether you use your bone or cadaver bone and the entry method posterior or anterior. Sense you said ACDF i would assume anterior which is pretty much the gold standard. As far as recovery goes, everyone is different. I can tell you after my first surgery I was back at work at 10 weeks in a high stress and physically demanding job. So as I say everyone is different, I have seen some who have office desk jobs return as soon as two weeks, Of course that would be all up to your surgeons.

    I would go for the fourth opinion as your unsure and just see what happens. It is not unusual to get different opinions. So just see what they have to say. YOu might also want to look at the surgical video here on ACDF and under the FAQ section is a list of questions to ask a surgeon.

    Just thought I would stop by and welcome you to spine-health, and if i can be of any help in the future don't hesitate to pm me. Keep us posted and take care for now.
  • Welcome to the site!!! :) Tamtam pretty well covered all the bases. So far it looks like you are looking at the situation with logic and clear thought. Getting additional opinions isn't a bad thing either. As to whether or not to have surgery you have to look at the whole picture.

    How the symptoms affect you, affects on daily life, prognosis "if" you do vs "if you don't have the surgery, lifestyle, recommendations, risks if you don't etc. It all boils down to being a very personal decision in most cases. Your body has sent you warning messages, and now you are doing your homework.

    Surgery for some is 'a ball hit out of the ballpark', and for some a nightmare - something else to add to your decision making. No surgery is a guarantee, but most good surgeons can give you pretty good odds as to whether it would be of benefit to you. My first fusion was a 'ball hit out of the park', brought my life back to normal. My last one, not so good - permanent damage. Not from the surgery mind you - the nerve was damaged once the disk violently herniated onto the nerve root. The surgery *did* prevent further damage though.

    Please keep us posted on what you decide, and how it goes. Again, welcome aboard!!! :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thank you for the comments so far. I would be having an anterior entry and, IIRC, the levels fused would be C5/C6 and C6/C7. I'm kind of nervous considering my C4/C5 is bad as well, and I have to imagine that a fusion of two levels right below an already bulging disc is almost certain to lead to another fusion in the future. Another thing I keep thinking about is that, considering how bad my neck is from no particular acute injury, I probably have (or will develop) back problems down the road, too. I figure why would it only be happening in my neck and stop?

    I think my biggest concern is regret -- either doing it and not being happy or not doing it and getting worse.

    If the symptoms were horrible or I was suffering from some acute injury that needed immediate attention, the decision would be much easier. However, I'm not to that point despite what my MRI must be showing the docs.

    When I had the epidurals done, I basically felt that while there were risks, costs, and discomfort involved, it was worth giving it a try. However, when it comes to a multi-level cervical fusion, those risks, costs, and discomfort are much greater. I *should* be weighing them against my long-term prognosis. But I can't help but just weighing them against my current condition, which is tolerable.

    I work in an office in front of a computer so I can problem return to work sooner than someone doing physical labor, but I'll still have to blow through a year's worth of vacation days... I guess I should be happy that I'll still be collecting a paycheck, though. Plus it's not a good time for me to be out of work (as if there is ever a good time).

    As of three years ago, I'm also minus a thyroid (found a tumor) so I am sort of familiar with what it's like to have post-surgical throat pain. Now I'll have another scar. ;-) I have to remember to ask the surgeon if the scar tissue from my thyroidectomy will affect the procedure in any way.

    I am going to go through with my appointment for another opinion at the end of the month. At the very least, it will give me more peace of mind and another option for a good surgeon / hospital, in case he agrees with the previous docs about surgery.
  • As I figured from your first post, and now with this one, you are looking at this whole thing in a logical well thought out manner. That is the best part of the whole process, surgery or no surgery.

    I've found that my body knew better than I when I had to have surgery. Work, yeppers, work has to weigh into the mix as well. You also have a good attitude with all of this, and that is nothing but a plus in your favor.

    As to the level above, and its going bad. Unfortunately I've found that they won't "pre-strike" many times, but only work the areas causing the present symptoms. I guess that can be a good thing, as some MRI's look pretty darn nasty, and nothing comes of it, vs a little bulge, and all manner of problems. I too have had the same concern with my C2/3 (badly bulging and spurs). Its had bulging there since '05' if I remember correctly, but it stayed the course and until recently was non symptomatic. Who knows, surgery could change the load on your upper level and it gets better? Please let us know how it goes and how your appointment goes. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Welcome to Spine-Health.

    Yes, surgery is a very personal decision, one only you can make. My situation was a lot like yours in that at first, I didn't have symptoms in my arms or anything, but I had such an awful pain in the upper-middle of my back that I went to my PCP one week before I was scheduled for my yearly physical. But after an x-ray, PT and then an MRI, I was told to see a surgeon and by that time, two months later, I started having problems in my arms. But my surgeon was amazed that I wasn't having bladder or bowel problems (a very bad sign when you have spine problems).

    I'm glad you're getting another opinion. My personal suggestion is to find a fellowship-trained spine surgeon, either ortho or neuro, but one that only works on spines and preferably specializes in the cervical spine. Spine centers can be good too because many times they have physios and PTs on-site, so it's one-stop shopping. :-)

    I know the scaries part is the unknown - will this be the right decision or not? Will this be successful and lead me back to a normal life? For me, my symptoms had gotten so bad by the time I had surgery that I had numbness and tingling 24/7 in my right arm and my left arm very painful and so weak I couldn't lift a glass of ice water off the table. So I knew I was making the right decision because I couldn't live like that.

    The great news...all that was gone when I woke up after surgery. That happens with more people than you'd imagine. It's also been said on these forums many times that the anticipation is worse than the surgery itself.

    Anyway, I just wanted to stop by and put in my two cents. Please let us know what the next doc says. And don't hesitate to PM me if there's anything I can do or help you with.

    Take care,
  • Hello tiresmoke!
    Sounds like your situation is much like mine. I began with tingling & numbness that was more irritating than anything else & I thought," Ah... I can live with this." But what I learned from my neurosurgeon was my problem would degenerate as I aged. I'm 47 now & have always been very self suffienct & independant. He explained it well. I had 4 degenerated disc, 3 of which were pressing on my spinal cord, which is a serious deal I gathered:) He explained overtime I could go weeks, months, even years & have no additional symptoms. However, then I would have a period of time I would be very symtamatic, and those symptoms would, over time esculate based on the pressure being put on my spinal cord. He urged me to chek out this site, learn about spine health, decide if I wanted to go the PT route for a while before undergoing the surgery. I did so & decided, why treat the symptoms when I could treat the problem and halt the progression of worsening symptoms. Ofcourse I do know since I have degenrative disc disease, I could have addition problems in the future, but again, why just cover up the symptoms with pills that I'm terrified of getting addicted to when I could just fix the problem. I'm almost 2 weeks out of a 3 level fusion C3/4, C4/5, C4/5. I'm doing ok, the swallowing thing so far has been my toughest hurdle and relaxing. I'm a bit of a busy, busy, busy person, so it's hard to slow down for me. Good thing I love movies & reading:) and this site was/is a God's send! Thanks again to all!! Good Luck, hope you make the best choice for you!
  • Thank you to everyone for the support and advice. I guess right now I will just sit tight until I see the other doc a week from Tuesday. I started thinking about all the "what ifs" and going down a lot of different paths in my head... then I realized that I need to just wait. No need to make myself crazy right now.

    In the meantime, I have discussed with my wife what the best timing would be if surgery is needed. I think mid-October will probably be best with both our jobs as well as stuff around the house. It's going to be hard to get along during recovery without doing too much, but I guess I'll have to get used to just sitting around. Like you said, Lynn -- movies and reading.
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