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Should you have ACDF with spinal cord compression but no symptoms?

acdfcandidate3aacdfcandidate3 Posts: 4
edited 06/11/2012 - 9:00 AM in Back Surgery and Neck Surgery
Hello all. I've really found this site to be very informative. This is my first post and would appreciate any thoughts or opinions

I have suffered with herniation and bulges in a few discs (mostly C5-C6) for about 5 years. I work at a desk for about 9 to 11 hours a day. When first diagnosed, I had frequent muscle spasms in the upper back, but after some disciplined physical therapy, these symptoms have gradually reduced. I have gone as long as 18 months without symptoms, but when the spasms do return, they typically take about a week to subside. I have responded well to epidural injections and other treatments - so in summary, my symptoms have been manageable.

Starting with an MRI in 2008, mild spinal cord compression was detected. This was also identified in additional MRIs in 2010 and late 2011. The first 2 MRIs showed mild cord compression; the last one shows mild to moderate. Each time my MRI was examined, the spinal surgeon stated that as long as I was asymptomatic, it did not make sense to have surgery. However, I got 2nd, 3rd, and 4th opinions on my most recent MRI and all 3 doctors (an orthopedic spine surgeon, a neurosurgeon, and my primary care physician) all said that I need a 1 level ACDF surgery ASAP - primarily due to the spinal cord being compressed (mild to moderate). They have stated that even though I don't currently have symptoms, it's just a matter of time before these come since my cord is compressed.

My original spinal surgeon still maintains the view that I should not have surgery b/c I don't have symptoms and when I do have symptoms, I have responded well to non surgical treatments. However, now that I have 3 other independent opinions stating that I need it ASAP, I am really confused.

Any insights / opinions would be most appreciated! I am scheduled for surgery in 2 weeks and have a newborn on the way - I want to make sure I'm making the right decision for both me and my future kid.



  • First let me say welcome to spine-health. One thing that comes to mind is myelopathy, which I am not sure the surgeons discussed with you. It can lead to issues with walking and hand and arm involvement. The problem is once it is present there is no reversing the symptoms just stop the progression, and is caused from spinal cord compressions. Which my guess is the other surgeons want to keep you out of this state. The symptoms can come on rather settle but get progressive over time. You can read up on it here by placing the name in the search function at the top of the page.

    Should you have surgery or wait? That is a very personal decision. Surgery is surgery and comes with risk. You have to weigh the benefits against the risk. Obvious your first surgeon wouldn't do the surgery, so you would have to go with one of your other opinions should you choose that route

    Just thought I would stop by and welcome you to spine-health. If I can be of any assistance don't hesitate to pm me. Take care and keep us posted on what route you choose.

  • This is a hard one, and it seems that different surgeons have different opinions. Some want to take the pressure off the cord immediately to stop any damage to it while others feel that as cervical surgery comes with risks, then they will wait as long as possible.

    My surgeons have been watching me and reviewing my neck every 6 months for a year. In October the registrar said that it was time for surgery and explained that it would be a two-level ACDF. He told me all the risks, percentages of it helping or not and also stated that the sooner we do it the better the chance of it being successful. He then went to talk to the consultant and came back after about 15 minutes and said that the consultant was much more experienced and that we should wait another 6 months. Other than the consultant being more experienced, he didn't give any reasons for this change of plan.

    My next appointment is in April. Meanwhile my symptoms are slowly getting worse. I just hope that they don't leave me too long and I end up with permanent cord or nerve damage.

    Please do let us know how you get on. I especially, will be very interested to hear.
    When is your baby due? That should certainly be taken into consideration in making the decision. Looking after a newborn baby straight after cervical surgery would, I imagine, be difficult. In the early days of recovery, as far as I know, you aren't able to lift much at all (that might not be a problem) and are not able to look down (that would almost certainly be a problem).

  • Welcome to the forum. I can appreciate your difficult decision. My case was very similar. I'm 53 years old and had my first MRI 15 years ago when I was 38, with symptoms of tingling/numbness in my right hand. It was first diagnosed as Carpal Tunnel. (I wore a wrist splint to sleep for 4 months and was so pissed at the restless nights needlessly endured when it was then determined not to be Carpal Tunnel - LOL). Anyway, with PT the tingling subsided. At the time my doctors told me it was most likely a matter of time until I would need surgery, but to bide my time in order to maximize the advancements in spinal surgery that were happening every day.

    I was relatively symptom free for 15 years, other than occasional pain and stiffness in my neck but nothing severe. My job is fairly demanding and stressful. I too sit at a desk for most of my 10-12 hour day. This past September I had tingling and numbness in my right hand that persisted 24/7 for about a month before I went to the doc. I must admit I really didn't think about the messages from 15 years before. Doc put me on Naproxen for a couple of weeks and that did nothing. By then I had tingling/numbness in my left hand, but only 50% of the time not 24/7. Then the tingling started to radiate up the left arm. Doc sent me for an MRI and results were as I've footnoted below. The NS immediately said surgery was needed because of the cord compression. Same message as you heard. Symptoms will only worsen, and odds of it being reversable are diminished the longer you wait. The most frightening thing I heard was the risk of paralysis with injury. If I were to fall or get in some sort of accident there was serious risk of paralysis because of the spur compressing my spine. My doctors all agreed that surgery was needed.

    I went for a second opinion. The need for surgery was confirmed, although the 2nd NS suggested a posterior approach. Once I was convinced I needed to have surgery I went with my first NS whom I had seen over the years for various bouts of back pain.
    He said ACDF and I scheduled te surgery for 1/17.

    Wouldn't you know it, most of my symptoms subsided about 2 weeks before the date. Now what do I do? The right hand tingling was totally gone, and the left hand/arm was almost gone with only occasional tingling when I reached a certain way. All I kept thinking about was the risk of paralysis. I knew it was not unreasonable because I know that my symptoms were brought on in Sept by a relatively harmless movement. Two things happened on Labor day weekend. I fell and landed with my arms straight out; and I was pruning trees so my neck was hyperextended for many hours while pushing and pulling the 12 foot pruner. Neither of those two are particular dangerous activities.

    I had my surgery on 1/17 - a one level ACDF C4-C5 with fusion. It's been 2 and 1/2 weeks. The recovery is slow and I must admit that my post-op symptoms are worse than pre-op. The tingling/numbness is gone for the most part, but the pain is significant in the back of my neck and across my shoulders and down my upper left arm. With the benefit of this forum and the sharing of experiences of these wonderful people, I do believe these symptoms will subside. I'll keep you posted.

    Because of my stressful job, I probably pushed it by going back to work this past week, only 2 weeks post-op. I did cut my days shorter, but after 3 days of commuting etc. I had to give myself a break and worked from home yesterday. I was exhausted and in pain. Yesterday and today I am feeling much better. I am still taking pain meds but only in the evenings and to sleep. I had my first postop visit with the NS last Monday and he's pretty progressive in post-op directions. I have a soft collar but I don't need to wear it unless I feel it's needed. I have virtually no restriction on movement, other than what my own body tells me. He insists I can't hurt my neck. Sleeping was uncomfortable at first because I thought I needed to sleep on my back. Once I got cleared by NS that my neck movement was ok, I wear my collar to sleep and sleep on my side. All is good again. I can sleep comfortably. Waking up is interesting. I'm somewhat sore and stiff, but after a few minutes I feel good. I actually feel best in the morning and early afternoon. Then the soreness/pain begins in the afternoon/evening.

    I know this is a dump of information, but I thought it may be helpful since you're struggling with the same issue of being relatively asymtomatic.

    I'm hopeful that my current discomfort is only temporary, in which case I will consider the surgery successful and the right decision. I'm told it takes 6 to 8 weeks to recover from the major surgery that it was. The NS did say it we'd see about PT in 2 months. That tells me also how long the process is. I'm impatient.

    I'll keep you posted. And I wish you well.
  • If I could turn back time I would have waited. I prefer all the symptoms I have before than this. Peer reviewed articles explain that surgery is mostly considered when you have moderate to severe myelopathy not mild. I think myelopathy progresses very slowly. If your cord is already being with myelopathy it my stay like that.

    Are you able to buttom your shirt, to walk, to wash the dishes, to typewrite, to move your arms up?? This where the question of my neurologist. She ask me can you walk? Are you able to concentrate? Are you able to write? She checked my strenght and it was well. From what I have asked and seem I have met a lot of people with their cord compress with symptoms that come and go and they are able to do almost anything well at least a lot of stuff.

    My psychologist has her cord compress more than what I had and her symptoms comes and go and she says she is better now and she has not have surgery.

    The mri is a tool to help understand your clinical outcome. And mri can show things that may not be there. Discs do heal, in my mris through years I could see mine getting smaller.

    I had a friend from Italy that had his cord compress for ten years and had a surgery but posterior he had a laminectomy. He is great right now! But in Europe they told him that in the states they recur to surgery rather quickly.

    I hit my head a serious of time before surgery, I had an mri and it did not show that the disc was worst.

    Why did I got surgery? I got scared, I confuse anxiety symptoms and medicine symptoms with progression becaus the surgeon told me that it seemed that my arms reflexes where better. But since he saw that I was walking unbalanced he thought I had progression. Nope it was a lot of medicine that cause unbalance.

    I do know that surgery helps a lot of people but for me it should be the last resort specially if you still feel you can handle it.

    I know a lot of stories of people with herniated discs really that have gotten better with time and that can deal with the ups and downs. My neurologist that is accostumed to see a lot of people with compress cord told me a lot of people get better and also told me that she sees a lot of people with surgery that are worst.

    She says people that get better are those that where really bad and had really bad symptoms, so the winning is much more than the loosing.

    Surgery do also involves risks of getting worst. Not everybody get worst but yes I did.

    Maybe I am talking without knowing but just wish to know of anybody that has been diagnosed with myelopathy that is able to buttom their shirts and put their earings and write and walk in a line and is offered surgery the person turns it down and with time it gets worst... I just don't know anybody.

    I do know of people that were not able to buttom their shirts and all that and after surgery get better. But everybody is different and maybe I am biased. If I had a susrgeon that says I don't need it I won't do it. This is my opinion, I am no doctor.
  • Today is a day a could write a lot, but lately it haven't been easy to be able to write so much. Something I could do before surgery. Why? it hurts. Sorry, I am still angry.
  • Thank you all for your quick responses and feedback to my post - I really appreciate hearing everyone's opinions and thoughts.

    TamTam - thank you for welcoming me to the forum

    Jellyhall - thanks for empathizing with my situation. My baby is not due for a few months, which is one of the reasons why the surgeons are recommending that I have the surgery now - to give me enough time to fully recover and have a full and healthy experience with my child.

    Linda510 - thank you so much for your thorough response. our situations sound almost identical - I have the same fears (i.e. risk of paralysis upon injury) and situation as you (long hours, commute, etc.). I do hope that your post-op symptoms subside soon and you deem your surgery a success. Please do post updates on your recovery process.

    Ziga - thank you for sharing your insights as well - I do also hope that you will recover soon as well

    Essentially, I am still on the fence regarding this decision. I do really appreciate everyone's feedback and hope more people provide their thoughts. Aside from what the MRI says and the fact that I get some spasms / episodes every few months, my symptoms are not severe and not consistent. However, my motivations for getting the surgery are: 1. I can control the timing for the surgery and recovery now (vs. if more severe symptoms develop later on and create an emergency), 2. I want to be a father to my child without physical restrictions, 3. I want to avoid the problems that could result from not taking care of this issue if worsening symptoms are inevitable. The reasons for holding back are 1. Fear that surgery may create more problems than the actual symptoms, 2. Fear of creating add'l stress on adjacent discs that will create the need for more surgery in the future, 3. Optimism (although this may be total fantasy) that the body will heal itself. Still confused, but welcoming any additional feedback / thoughts. Thank you all!

  • When I first saw my NS he did all the tests they are supposed to do and my problems then were the pain and numbness and some sensory loss in my thumb on my left hand.

    4 weeks later when I went in for my pre op I tested positive for the Hoffman test(which shows nerve impingement) and clonus in the ankle(that was the same leg that hard started to go numb and what prompted me to go to the ER in November)

    The day of the surgery I failed the hand resistance test on my left hand. That's when they press on your hand and tell you not to let them push it down. When I went in for my post op I still failed the hand resistance test but passed the hoffman test. I asked if I would ever get the strength fully back in my hand and she said she couldn't guarantee it but at least they stopped the progression.

    All these new symptoms happened within a 5 week period.
  • Now 3.5 weeks postop... most neck and shoulder pain has subsided so no meds (yea!!). Still some stiffness so no driving yet. Two days ago I woke up with numbness in my left hand (a lesser version of which was there preop) and weakness in my left arm. This is new! I'm not happy about it and hoping it's all part of the healing. I called NS and while pleased that pain subsided, when I described new numbness and weakness he said "That's strange." Not what I wanted to hear! I'm to call on Monday with an update and will need to see him if symptoms persist.

    I remain optimistic that this is all part of the long healing process. I'll keep you posted.

    Take care.

  • So in addition to recovering from surgery, I now have Brachial Neuritis. It appears that this is the explanation for the severe post-op pain I had in my left shoulder/arm, which subsided and was immediately followed by weakness/numbness. Since I did not suffer from weakness pre-op, NS thinks this may have been caused by repositioning of arms during surgery. I'm now taking prednisone. The weakness is better but still there, and some palpable pain remains though mild now. Left hand still tingling/numb. NS said ok to start PT, which will be great for everything - neck and arm.

    The good news is the neuritis will heal and I feel good otherwise. Once again, time and patience !!

    I've done some reading and this post-operative Brachial Neuritis is not entirely uncommon. Anyone out there have a similar experience to share?
  • Wow, it was so good to come upon your post ACDFCandidate, and others who have responded, Linda, Poochi, Jellyhall, Ziga !

    My C-Spine has nerve compression, 2-3 levels and effacement of thecal sac (according to MRI) yet I have some signs of myelacia (sp ?) since I began with neuropathic symptoms and nerve compression of nerve roots, most severe on left, but also on the right (moderate) according to MRI.

    I have gone into later phase of DDD C-6/7 T-1/2 and polyneuropathy symptoms all nerve branches in forearm and hand nerve damaged with muscle atrophy and weak ligaments, loss of dexterity, coordination of fingers of left hand for most functions, maintain some control of index and next digit finger (long one), but the ulnar nerve damage has taken much from pinkie finger and adjoining finger, pinkie curls have splint to prevent severe atrophy curl.

    My surgery was recommended in 2009 with MRI and symptoms showing nerve compression, and neuro testing of wrist drop severe, but I have strength back and no more wrist drop, but have advance damage (detailed above), the tasks of buttons = no, earrings = almost unable t do, zippers = no coordination of fingers to thumb = no (severe)

    I have symptoms of balance problems big titme, outer calf of left leg weak, toes, weaker, big toe gets a bad zing of pain (micro-second) and leg flinches after the big toe zings. When I am in recline position in chair is usually when it happens.

    My neck is complex, upper 2 levels deformed from birth, maladaptive hypermobility, considered stable for now, C-3 thru C-5 bone implant fused ACDF 16 yrs ago, boney changes present and ridging, solid fusion, no internal cord views possible ?, C-6/7 severe DDD with massive multiple osteophyte into T-1/2.

    OS (out of state) for 7 yrs held off till neuro symptoms to consider surgery anterior & posterior approach necessary; but after 2 wks and re-assessment determined best not to do surgery and "live with" and hopefully experience slow progression.(April, 2010)

    May, 2010 pain anesthesiologist (my state) did nerve root block on C-8 nerve root = bad results, painful episodes brachial nerve branch all nerves damaged with 6 episodes lasting 2-3 wks each.7

    Got 2 addtional assessments NS's surgery suggested anterior C-5/6/7 posterior 5/6/7/T-1/2 and possibly T-2/3; prognosis not detailed or clear, other than prevent right hand/arm from progressing to advanced nerve damage

    This month, MVA & Neuro pain spasms in ulnar began right arm, back scapular pain on right side under arm dull aching pain, hand getting weaker on grip and stiff in movement, trouble with buttons, zippers strength with dexterity, subtle ridging with forearm muscle (atrophy).

    Surgery is major 9-10 hrs and really tough recovery, plus intrusive and risk of voice/swallow ENT second anterior procedure. (per NS and OS all in agreement) beyond this, I have no firm prognosis given to me when ?'d. I then determined (after much prayer) in Jan 2011 no surgery and re-assess as things progress.

    MRI to be done in 2 wks Re-Assess

    One final comment - - the intrusive nature of these spinal surgeries, even more advanced procedures, "minimally invasive" micro tools, I believe the spinal cord, nerve roots are more extensively interconnected, all levels than segregated levels and dermatomes and much to be learned about neuro vascular & neuro muscular in the spine

    Linda, heart-thoughts and prayers for your recovery, so hoping things can go more smoothly....there is so much for our bodies to heal ligaments, muscles, nerves, soft tissue...it takes more time than they say I believe. May you continue to progress and experience positive results and relief of symptoms :)

  • i am of the opinion of "if it ain't broke don't fix it". i have had cord compression, actually still do, and have not showed significant signs of myelopathy for more than 10 years actually (thoracic) ... no need to have an invasive surgery if it is not warranted. good luck with your decision. have had other surgeries but on lumbar spine
  • I am scheduled for adcf c5-6, 6-7 in a week. have had neck issues for years am 47 yr old teacher-been off awhile due to this last flare up summer 2010 radiated into arm, hands etc big time and 3 weeks of severe pain, but now that I've been off and careful it is hardly painful and taking no meds- I too am wondering is this the right time? What issues will improve or be made worse? I live alone so need to know if I'll need someone with me, also have an inside dog and animals including horses outside. Dr. said no collar, 1 night in hospital only and very few restrictions except no lifting anything over 5 lbs for awhile. He also said he does not x-ray to check fusion- they all fuse in time anyway? Any advice-suggestions? I've had surgeries before but am terrified of this one so not sure if I am just chickening out or these are valid questions?!
  • Hello. This is my first time posting. I have a similar situation. I am really having very mild symptoms but my surgeon is recommending a fusion because the spinal cord is severely compressed. I had severe arm pain but it has gone away. I am 40 and a police officer and was hurt on the job. I had a 1 level artificial disc replacement at 5-6 a few years ago and Ct scan now shows herniation at 6-7. That herniation was present in 2009 but it was mild and didn't need surgery. Now it's worse. I went back to work full duty after ADR but I'm concerned about how likely it is I'll be able to do that with a 2 level fusion. my job can be very physical at times.
  • Hello all - thank you to everyone again for posting responses to my post and for sharing your own experiences. I had my surgery just under 2 weeks ago. To recap, I had a 1 level ACDF and a stand alone PEEK cage filled with bone paste was implanted without a separate plate. I stayed in the hospital for 1 night and have been home recovering since. Although I am still getting over muscle knots and stiffness, I do feel much better and do not have many of the symptoms so far that others have cited post-op - I hope it stays that way. I am cautiously optimistic and hopeful that the fusion will be successful over the next several months. I do believe that there is a dearth of comments on this forum from people who have successful surgeries - i.e. if your surgery is a success, you won't bother posting or revisiting the site. However, I do think it is important to let people know that outcomes are positive from this surgery, but due primarily to being in the hands of the right surgeon. I do believe that my surgeon was excellent and that his proper choice of the right sized hardware / implant have been key to how I currently feel. I am looking forward to starting PT in a few weeks and hopefully be back to "normal" over the coming months. Thank you again for all your support and good luck to all!

  • It sounds like you are doing well in your recovery.

    I have just been recommended to have a 2 level ACDF and so am very interested to read others experiences - especially when things sound encouraging! :D

    My surgeon has said that he would use two titanium cages, without bone graft and no plate or collar needed. It reassures me to read that you had a stand alone PEEK cage without a seperate plate.

    My neurosurgeon explained that the cage had 'teeth' to bite into the vertebrae, so no plate would be needed and that my own bone would grow through the holes in the cage. He did say that these cages are put in under stress and that they hold very well. He spoke of a surgeon needing to take one out 2 weeks after surgery and he had to drill it out because it was so well attached!

    Thank you for coming back to let us know how you are doing. I hope that you continue to improve over the coming months. My nuerosurgeon told me that it can take 6 to 12 months to discover the full benefits of the surgery.

    Keep healing :H

  • wyatt13wwyatt13 WashingtonPosts: 4
    I have c6-c7 bilateral moderate to severe spinal stenosis and degenerative disc disease.  I don't meet with my surgeon for another 3 weeks.  I've had all of the conservative treatments and 2 epidural injections over the last 5 years.  Any input on what usually happens next?  Should I expect surgery?...thx
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