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Great News - Neurosurgeon Assessment !!!

JoydancerJJoydancer Posts: 463
edited 06/11/2012 - 8:49 AM in Neck Pain: Cervical
Re: Cervical Spine C-6/7, T-1/2

I just got the greatest news, I can hardly contain myself to rap out this to you all !!! :)

Last week, my scans and all diagnostics were mailed for review of #3 Neurosurgeon in the process of assessment....

Just got a call from my the NS (this is Neurosurgeon who did my first 3-level ACDF 16 yras ago, whose Chief of major Neurosurgical Dept in major metro hospitalp. This was my final step in getting second/third opinion assessment of Orthosurgeon,then Neurosurgeon in-state.

NS called me an assessed anterior surgery, foraminal procedure opening up the space from nerve roots, doing a bone implant...is all that is necessary for purpose of freeing up the two levels where he can see I have nerve root compression - - and not doing anterior/posterior !

No need to do hardware implementation, it would be similar to what was done with first ACDF and removing three bone spurs. (I had excellent fusion and good recovery from radiculopathy on that surgery) He confirmed, I should have no problem with successful fusion similar to first surgery, my age 62 was not an issue and not being a smoker confirmed it more!

Covered about concerns of hardware needed for fusion, he disagreed and has had successful bone implant fusion 90% of the time; re: cervical, thoracic bridging, no bridge to previous upper fused levels necessary, that area stable and with successful fusion of the 2 lower levels, would be better than bridging for sure - - hardware bridging all creates problems and I don't need it. He has done many c-spine t-spine adjoining levels without hardware and he would do the same for me.

Soooo, this is a God-send of news! I call his asst in the morning and get appt for surgery!

I am soooo excited and a burden has lifted, like I know you can believe :) !!!



  • That's so terrific Janelle!! I'm so glad that the surgeon is able to help you with a less invasive surgery!! Hope you get it soon, and can start living a new life with less pain!!
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • If I understood what you said, I'm sure I'd be thrilled for you.

    I think you said that he's going to do a bone implant without hardware, and that it has a 90% success rate. I know that sounds high, but is that as high as fusion rates with other surgeries?

    I guess a 90% fusion rate sounded kind of low to me- that means 1 of 10 people who get this surgery do not fuse and need further surgery?
  • Yes, I am dancin on the ceiling...to think for over 3 yrs the verdict I was given by an OS - - truly skill and expertise of surgeon of hardware and to "wait" till neuropathy set in!

    Less-invasive YES and good prognosis for fusion without posterior and bone implant as done before on my other 3 level - - I was successful fused in 7 months and radiculopathy resolved until 6/7 began 10 yrs later! :)

  • Other NS and OS assessments was 60/40 prognosis (with hardware) for successful fusion with anterior - - this is 90/10 bone implant only and when I asked him about success rate without hardware, he said "only if you are a smoker", I responded,no, not a smoker, he said "there should be no problem at all"

  • Janelle,

    So happy for your Great News!! Hopefully the surgery can be scheduled soon while it's still cool and comfy in Florida, vs that dreaded hot and sticky! (G)

    I guess I'm a traditionalist. "No hardware" adjoining below a previous fusion kind of scares me. Your NS obviously knows what he's doing, especially with a 90% fusion rate - that's fantastic! Please keep us posted woman! Again, soooo happy for you!! *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • So do you think that his higher estimated fusion rate has to do with his skill as a surgeon?

    Why did the other surgeons have such low predictions?

    Obviously I don't know that much about fusion rates or what impacts them, you shouldn't feel obliged to educate me. I am just curious as to why the numbers are so low and so variable (I am assuming we're talking just about the rate of fusion, not the success of the surgery).
  • With BMP now being allowed in some cervical surgeries, the fusion rates have gone way up. The traditional "take out the disk, put in the graph or cage" then plate and screws in, *I* understand is still the gold standard for supporting fusion surgery. There have been some with the graph and no hardware that did fine.

    My guess is Janelle will be in a hard collar longer than those of us who had hardware. Look at what my different hardware did and is doing to me? I'll have to have that mess redone, and like Janelle, C7/8 (T1) will be added. I don't think they would chance 3 or 4 levels without hardware. I know my fingers are crossed for her. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Brenda, if that's way up, what were the fusion rates before? I would have expected higher than 90%, much less the 60% the other doctors are quoting her.

    Did your doctors ever give you a probability of non-fusion? Mine did not, but since he gave me a 95% probability of overall success, the probability of fusion must be higher than that.
  • HB,

    Janelle has a lot going on in her neck, hence the original assessments at a 60% success rate. It wasn't so much that they didn't think she would fuse, but what was the 'benefit' likely to be recovered with the surgery? So for her, she fuses fine, it was whether her nerves could be freed, and the nerves recover.

    Her history reads better than I can type it, but since any surgery in our spine affects the whole area around it, that was the main issues for her. She also when given the 60% didn't have the additional issues of the C8 nerves. I think her surgeon is giving the fusion rate odds. No doctor can give us guarantees on what the nerve reaction is going to be.

    My surgeon didn't give me the rates on my first fusion with him, but did for the second. The second, I was told there was more than a 50% chance the nerve damage was permanent, but that the surgery would stop further damage. That portion of the surgery (fusion wise), I too was given 90% rate of successful fusion - then my C6 cracked! Can't always predict some things in spiney land! (G)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I am just as surprised as you with no hardware with to his and it being cervical-thoracic...I asked simple ?'s it was not a planned consult, with set amount of time to ask prepared ?'s.

    Phone call was a surprise from him to me, end of day when I had mailed everything to his office and asst had told me it hadn't arrived yet. I thought I'd be set up with him by his asst to talk/discuss/review.

    Anyway, I'm a not dancin on the ceiling right now, I am seriously reflecting all assessments now 2 surgeons previous, no question hardware to be used, both in agreement about anterior approach for nerve compression, but poster required for fusion + stability. How do you get away from that ?!

    This NS has not seen me, just recent MRI CT, he did not weigh in on complex issues of fusion above, bridging cervical-thoracic as much as we could have if I was there. I asked him what was next step, after his assessment, anterior only with bone implant, should be quite successful, he said if I wanted to move ahead with it, call his office and get pre-surgery info and scheduled.

    I can tell you this, I am in much serious review of such a wide difference of assessment to say th we least, I fear it isn't that easy for what my spine issues are. Believe me, the first and I believe the last surgeon assessment for me in deciding this will be the surgeon who knew me for 7 yrs monitoring spinal changes, mva trauma, mri cts for all of C-6/7, T-1/2 and whole c-spine analyzed as complex as it is, deformity above, scoliosis, etc

    That is the one who assessed: anterior for freeing up nerve compression affecting arm/hand C-6/7 7-T-1 with hardware and possibly having to do posterior for successful fusion and stabilization.

    And, the last assessment from him was backing off of the surgery, saying it would not be a successful outcome / prognosis not good for arm/hand recovery and most likely doing 2 complex anterior & posterior surgeries, with some risk to voice/swallowing since it is a revision surgery.

    Sooo, I continue to pray for guidance and my decision....oh my this becomes yet again very complex and I hope to make a final decision that I know for the most-part I can trust is the "right" one - - not easy, Woman, not easy at all !

  • Thought I'd just say...

    This is truly surprising assessment and I guess it isn't necessarily "great news", when it is put on the table of wide variance of previous surgeons' assessments.

    Since my OS said "no go" low prognosis and not successful outcome of symptoms in April, and yes my symptoms had not at that point gone into full neuropathy nerve damage in left arm hand fingers.

    I'm in a true roller-coaster ride with trying to get clear valid, appropriate to accurate assessment of some serious surgery on my c-spine down into t-spine.

    And it's not what I would have like to be experiencing with the time that has been forced to happen with diagnostics/review complexity of my c-spine and capable, highly experienced surgeons with skill, ability to assess the complex issues of my whole c-spine and offer clear assessment, and appropriate procedures to the best of their experience/knowledge for removing multiple osteophytes, implantation of bone and/or hardware, stabilization and freeing up nerve root compression which appears could be happening at two levels.

    The assessments became necessary since April, 2010 and I have been met with some wide variance of assessment with regard to procedure and prognosis now, each of them highly skilled 25+ or more in c-spine complex surgery. And unfortunately, a third assessment was necessary because of a lack of patient-to-surgeon lack in getting those assessments accomplished ! (unprofessionalism, integrity and inability of me being able to fully engage with the surgeon qualified, knowledgable ?'s :W which was shocking considering the complexity of my case.

    This last assessment was a NS surgeon who had not seen me in over 16 yrs, who did my first ACDF C-3/4 thru C-5/6 and bone implant only, with successful relief of symptoms and fusion. He agreed to review what the updated assessments and MRI CT scans were and give his assessment. A surprise phone call from him not set up as a phone consult yet, with his simple assessment and just a few questions to him, was a swing to the extremely simple and just like my previous surgery to free up nerves !

    It's quite a surprise to hear from him no hardware and only one approach, anterior - - sweet to my ears :) but quite perplexing in my whole understanding and complex factors in my c-spine/t-spine. :W

    Call for MORE discernment and making a final decision somewhere in this wide variance assessment, most credible, most experienced, who can I trust/establish faith in makes it all the more complex !

    I do know I will make a decision and move forward knowing it was the best I could have made for what I have been dealt, that is what I am living with, and the surgeons who have assessed with such mix of high experience, lacking integrity in patient interaction, presenting simple to complex surgery plans.

    In discerning all of this mix - - it all really comes does come back to ME (more than ever) the path is not clear at all from what they gave me...

    It's the hardest decision I have ever had to make... :O But, I must make it, this has been heavy in being able to move forward with my life, surgery or living with and adapting, preparing for complex difficult spine surgery, or supporting myself with the flare-ups...finding strength for either path...

    I Must Move On with Decision Made - Fully Ready for One-Step at a Time and Finding the Good that is There in Either Choice

  • I know how you feel, and didn't mean to rain on your parade! It's nice to finally meet a surgeon who is confident that he can deal with your issues and is positive about the outcomes!

  • Janelle,

    Sorry, meant to reply after my PM, but my right hand started cramping so bad, had to log off to let it do its thing! (G)

    Since I am looking at those same levels being done in the near future, I've been watching your trials and tribulations with these various surgeons and their assessments. I know for the 2 I had, hardware was very much in the picture, with or without revising the levels above! I guess to me, joining two areas (cervical to rigid thoracic), hardware makes sense. But maybe it's that difference as to why he may not need it?

    Before you schedule surgery, is he going to talk voice with you anymore? I guess what I am thinking is you can (you probably did knowing you - big smile) ask direct questions, and too state any doubts for him to clarify?

    As for an 'easy decision', we both knew with our lovely necks, *that* was not going to be a card dealt to us! Eh? (G) The good in all this Janelle? You are great with digging and researching in so far as options and various spine experts in the field verses just a good surgeon if you know what I mean.

    Always here to bounce PM's or talk to vent, or chew over thoughts and ideas. Big supportive *HUGZ* my dear friend.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Janelle,

    I hear that!!! We are pretty much in the same shoes except for our C2/3's being different. I haven't given up on mine yet, and I know you haven't either. Just like our first ever fusion, *we* internally knew the right answer when that time came.

    My hubby supports whatever decision I make as he knows like you, I don't just jump at what sounds good at the time. He calls me a research fiend! (G) Now that I am retired, my *most* important case file? Mine! You are in that same boat.

    Additional to hardware on my 2 opinions, both said anterior and then posterior for the surgery. Have you done any net surfing to see if the sort of surgery they are offering is done that way by other doctors? Not to say switch doctors, but to see if others had adjoining without hardware, and all anteriorly? Just curious. Please keep us posted. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I am curious about the different percentages of successful fusion with and without hardware. I thought that they could use a cage with BMP either way. What are the advantages of not having a plate put in. Isn't that giving the neck extra stability while the fusion is taking place?
  • So happy for your good news!!!
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