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new - 1st opinion4-level ACDF, 2nd opinion 1-level and wait

kaycee1025kkaycee1025 Posts: 5
edited 06/11/2012 - 8:57 AM in New Member Introductions
Hi. I am new and am so thankful to how found this website. I am a 39 year old male who has suffered from aching neck for many years. Recently, it went from aching neck to pain in my shoulders and arms. MRI reveals pretty extensive degeneration. Disc bulging at C3/C4, C5/C5 and C6/C7 causing cord compression at those levels. Abnormal cord signal consistent with myelopathy at C3/C4. C4/C5 is also bad with canal narrowing to 8.5mm but no cord compression. All this is on top of the usual bone spurts, facet joint hypertrophy, narrowing of foramen. My reflexes are off (the usual tests the NS does) but no loss of motor function. Pain is about a 3/10.

The first NS whom I've seen twice is recommending 4-level ACDF C3-C7. Then saw an OSS who recommended only doing 1-level ACDF at C3-C4 to remediate the myelopathy and then adopt a wait and see approach for the other levels. The OSS's rationale was that fusion rates for 4-levels were only 60% with increased risk of dhysphagia and vocal cord impact made it a less attractive choice. I will be getting a third opinion next week.

I have been pretty depressed about my diagnosis (it's been 4 weeks since getting the MRI). Now trying to make the best decision in a very difficult situation. Would appreciate any advice/support.

Does anyone know what 4-level fusion rates are? 60% seems rather low.



  • and welcome to Spine Health. You have found a good place for information and support from others who know what you are going through. :H

    I can't really give you any advice, but I can give you support.

    I am very interested to hear what your NS and OSS say as I am in a similar position to you.

    I have degeneration throughout my neck with cord compression at C3/4 and C4/5. My MRI scan doesn't show high signal, but I do have brisk reflexes. My motor function is ok and I have no sign of Babinski's reflex.

    Last week I saw a neuro registrar who told me that he was recommending a 2 level anterior fusion. He explained the risks of surgery but said that there was also risk to not having surgery. He then went to talk to the consultant but came back and said that the consultant had said we should wait another 6 months (I have already been waiting for a year) to see how things progress.

    I think that I will end up having surgery, but that they are waiting as long as they can because as I have degeneration throughout my neck, there is a chance that a fusion will cause the other levels to go and then I would need further surgery.

    I do have spasticity, which is stiffening spasms every morning in my legs and around my abdomen causing my back to arch up.

    I think that the more levels you have fused, the greater the risk that you won't fuse. Whether it makes a difference if you have one or two levels done first and then add others levels, I am not sure.

    I wish you well, and will watch your story to see how you get on.

    There are lots of members here who have had cervical surgery, and one of our very well known members has just had 5 levels fused as a revision of surgery that didn't fuse.

    Looking forward to getting to know you better. :-)

  • Your situation with regard to waiting longer is along the lines of what my OSS said. Other than doing a 1-level ACDF, he also recommended doing nothing so long as I had no impairment in motor function. He seemed to prefer those over a 4-level ACDF. I am worse than you in that I already have abnormal T2 signal in C3-4. I guess the only thing I would consider is that in the event that there is cord damage down the line, both NS and OSS say that those symptoms (from myelopathy) are generally irreversible. The goal of surgery for me is to prevent further development of symptoms (i.e. loss of motor function, unusual gait, etc).

    I believe it is true that more levels will decrease the probability of fusing. There's info out there on one and two levels but not much on three or more.

    Good luck and stay in touch.

  • I wonder if my walking, which does feel strangely jerky counts as gait problems. It is not consistant. Some days I wonder if it counts as gait problems and then I seem to be ok.

    Does it have to be there all the time to be counted as gait problems?

    I also wonder if I have weakness. I struggle to pick up a heavy pan, carry a plate with one hand, even holding a piece of paper in a pincer grip for more than a minute will cause my hand to ache and sometimes I find it hard to let go. Hanging up washing, drying my hair causes really aching arms, so that I have to stop and shake out my arms before continuing. When my hand and arm strength is tested I think it is ok.

    I find it hard to know about my symptoms. I assume that if it is weakness and gait problems, they will geet worse until it is absolutely obvious.

    Are you intending to go ahead with the surgery on 30th November?

  • The OSS described gait problems to me as a situation where you don't even have a good sense of where your legs are planted so you might stumble and fall. Falling down is a sure sign of something serious and typically means the surgery can't wait - since falling could further damage the spinal cord.

    I actually just scheduled the Nov 30 surgery this week prior to getting my second opinion. I am scheduled for a 3rd opinion next week and maybe even a 4th in early November. I am holding on to that surgery date for now.

    I feel really bad for you regarding your difficulty gripping or holding anything of significant weight. Hang in there.
  • HI Kaycee,

    First let me say welcome to spine-health. Have a look around and you will a few multi-level fusions here, including myself. It is very true what the surgeon told you in reference to being hard to fuse multiple levels. What type of grafting did they suggest the were going to use with these surgeries? If you would go the 4 level route, I would only do it myself using my bone. I have used my bone several times and while yes it is painful, it helps the fusion process. I take it that your issues are not related to any specific injury? Which makes it all the more important I think to use your own bone. Now there is a product called BMP(bone morphongenic protein), which is not supposed to be used in the cervical spine, if used should only be used posterior, according to the FDA guidelines.

    You are also correct the surgery is not to reduce your current symptoms but to stop further progression. Myelopathy can't be reversed, you just live with it. If your symptoms aren't that bad yet you don't want them get worse either.

    Another thing you need to keep in mind with these surgeries, is your Rom(range of motion). Having the same levels fused, I can tell you I don't have much at all. Now grant you I have had a total of 6 surgeries and have lots of scar tissue, but you will still loose a great deal of ROM. So depending on what you do for a living might be something to consider.

    The other important thing to keep in mind is surgery doesn't always take away the pain. There are some whom wake up and the pain is gone, then there are others like me where the nerves are permanently damaged and the pain will be with me the rest of my life. The other issue, I see with a lot of multi-levels is they deal with terrible muscle spasms, a huge issue I still have.

    I am not trying to scare you just give you a bigger picture. It sounds like your doing the right thing in getting multiple opinions and not just jumping in surgery. Do you homework on the surgeons. Keep in mind this surgery does alter your spine for the rest of your life, why the homework is so important. I see members spend more time researching a car than they do this surgery and the surgeons. Be sure to check on the after care as well. Like everything in life there is good and bad. Have a look at the FAQ section and there is a list of 38 questions to ask a surgeon. See what you can answer and what not.

    Just thought I would stop by and welcome you to spine-health. If there is anything I can do don't hesitate to pm me. Take care and keep us posted on your decision and how you do.
  • Thanks for the welcome and the good advice. I will certainly check up on those things.

  • I was wondering how you are getting on.

    I believe that your surgery was due to be on November 30th, and was wondering if you did indeed go ahead with it.

    If you did, how are you doing?

    If you didn't, what plan do you have now?

    I am still waiting!

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