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ACDF or not? Help please

pritdayppritday Posts: 6
edited 06/11/2012 - 9:02 AM in Neck Pain: Cervical
I'm debating on whether or not to have this surgery. I've already consulted with two neurosurgeons. The first one highly recommends it and thinks PT might do more damage. The second one thinks it would be fine to wait a month to see how I feel. I'm in my early 30's and currently have intermittent pins and needles in my left arm and soreness around my shoulder blade and shoulder. Here are the findings from my MRI...

1. There is straightening and significant reversal of the normal cervical lordosis consistent with torticollis.
2. There is a broad-based bulging annulus at C5-C6 with compression on the thecal sac and partial disc desiccation.
3. At the C6-C7 level there is a moderately large 3-4 mm left paracentral/posterolateral disc herniatiom with compression on the thecal sac and partial extension into the medial aspect of the left neural foramen with associates left neuroforaminak stenosis. The annular tear is clearly visualized. There is flattening of the anterior surface of the spinal cord itself, without evidence of significant direct cord compression. There is mild circumferential canal stenosis and disc desiccation.

I wish I had a more definitive answer as to if I should have this surgery or not. I'm not really in that much pain but I'm concerned about an increased risk of paralysis in the off chance that I was In a car accident or something.


  • Excuse the typos....if I knew how to edit my post I would fix it. Damn autocorrect.
  • As I understand, if you have herniation, it will never heal. I'm looking at C4/C5 C5/C6 ACDF myself in May. One other consideration is that the longer your nerve is impinged, the greater the risk of permanent damage. How long have you had symptoms?
  • t84a said:
    How long have you had symptoms?
    Approximately 1 month.
  • Can anyone else offer any advice? Please and thank-you! :-)
  • Once the disc is torn and herniated there is no repairing it. Surgery must be done. If you can handle the pain and feel you can wait then do it. But if the pain gets severe, you should have the surgery.

    Also the longer your nerve is compressed/damaged the longer it takes to heal. You can even get permanent nerve damage.

    I had intermittent pain for 4 years and severe pain for 2 years before my surgery. I am glad I had my acdf and I do have less pain than pre op, however I do still have chronic pain, but at least it is manageable now.
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • On Wednesday I had an ACDF on levels C5 to C6 and C6 to C7. My pain began as a feeling of fire ants stinging my upper back. Within a week I had lost feeling in both hands. I didn't feel like I had an option. Immediately after surgery the burning in my back was gone, but my hands were still numb. I was afraid that I had permanent nerve damage, but within another 24 hrs. the numbness was gone. I share the concerns of the posters before me. The damaged disc will not heal itself and the longer you wait the better the chance that you will do permanent damage. Believe me, it scared me to death. I would correct the problem as soon as possible. It will only get worse on its own.
  • Do you guys really think it won't repair itself if I just give it enough time? I think I'm doing a little better every day. Honestly, it doesn't hurt as much as it used to. I'm scared of having surgery.
  • Actually....
    Most herniated discs heal on their own over time (one to six months). The goals of treatment are to:
    Relieve pain, weakness or numbness in the leg and lower back or cervical region.

    Prevent further injury by teaching the patient techniques and exercises for care of the back or neck.

    More than 90% of patients who have a herniated disc will improve within six months after nonsurgical treatment. For this reason, nonsurgical treatment is usually tried before surgery is considered.

    Nonsurgical treatment usually includes:
    Rest, followed by a gradual increase in activity
    Medication to control pain and inflammation
    Exercises recommended by the doctor or physical therapist to help reduce pain and strengthen the muscles that support the back or neck.

    In some cases, herniated discs heal on their own by a process called resorption. During resorption, the body absorbs parts (fragments or tissue) from a herniated disc that has ruptured.

    Surgery may become necessary in only a small number (less than 10 percent) of people who have herniated discs. Surgery may be considered for people who have progressive nerve damage or severe weakness or numbness or for those whose pain has not been relieved by other methods.

    There are 10's of thousands of people who have disc issues every day. Some have severe pain...some have absolutely no symptoms at all.

    If you were to do MRI's on a random 100 people on the street over 30....a large percentage would have disc issues and show even bulges or herniations...

    There really isn't a right/wrong answer for your own body..

    I, personally, only had surgery when the risk of being paralyzed was imminent....

  • I don't believe a disc that has shredded apart and pieces have extruded into your nerve root and spinal canal can or will heal its self?
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • When a disc has herniated and torn(annular tear)and it's contents are seen in the canal and foramina(openings in the bone that allow the nerve roots to pass through), it will not "heal" itself.

    What it will do, is scar over or continue to leak disc contents. If the disc scars over, the contents that have already leaked out may be reabsorbed, or,as your MRI states, they are drying out which may shrink them a bit, causing less pressure, or they will continue to produce your currrent symptoms.

    Time will tell. I had a traumatic injury with multiple vertebral fractures and herniations, with central cord syndrome, from the direct pressure on the spinal cord from one of the fractured vertabrae(C4). I had a fusion before I left the hospital, and most of my symptoms went away before discharge.

    I still have some chronic pain, although much less, and limited motion, some of that is from the other injuries.

    Everyone's experiences are different, I'm just grateful to have an intact spinal cord and be walking etc.

    Your body will tell you what to do, by increasing or decreasing pain or mobility, has been my experience.

    Hope this helps some,
  • Nearly everyone on this post is giving medical advice and I don't see and MD behind your names. The proper advice is for the original poster to either take the advice of one of their consultants, or go for a third opinion if they are still unsure. None of us on this site are qualified to give out medical advice, even though we may have seen a lot of doctors and had many surgeries, you really should make this decision between yourself and a physician.
  • Please note that forum members give their opinions based on their own personal experiences. It is important to differentiate between that and peer reviewed medical advice from experienced physicians. Spine Health is more than just a member forum. It also has a vast amount of information provided by participating physicians who write articles for all of us to gather information from. This is a short quote from one that I have linked below. It should help provide the OP with a bit more insight and also set the discussion back on track.

    Richard Stahler M.D. said:
    Treatments for a Cervical Herniated Disc

    The majority of the time, the arm pain from a cervical herniated disc can be controlled with medication, and conservative (non-surgical) treatments alone are enough to resolve the condition.

    Once the arm pain does start to improve it is unlikely to return, although it may take longer for the weakness and numbness/tingling to improve. If the arm pain gets better it is acceptable to continue with conservative treatment, as there really is no literature that supports the theory that surgery for cervical disc herniation helps the nerve root heal quicker.

    All treatments for a cervical herniated disc are essentially designed to help resolve the arm pain, and usually the weakness and numbness/tingling will resolve with time.
  • Maybe the fact that you seem very unsure about having surgery, mean that you are not quite ready mentally to do it?
    I do believe that most of us have a certain level of hesitation all the way up to surgery, its a life changing thing, for better or worse. However, once you are mentally ready for surgery, you can be scared and hesitant towards what will be, but you also know that you cannot keep on living like you are now.

    My 2 level ACDF is in 3 weeks, Im scared as h... and at least once everyday I think puh, I still have time to cancel. Before I got booked a few weeks ago, I was a basket case and so confused, but still, I just knew I had to do it because I cannot live like this anymore. I have gone for 5 years with conservative treatment, but pain has gotten greater, more loss of mobility and numbness and weakness progresses.

    A year ago I was not ready, now I am.
    You will know when you are ready.

    Best of luck with any descicion you go with, as well as recovery,
    Cause: car accident & genetics
    Effect: herniations C4-7, stenosis, osteoarthritis, myelopathy, neuropathy
    Non-invasive Treatment: everything under the sun
    Invasive Treatment: 2 level ACDF, C5 & C6, May 2012
    Moving Forward: SCS
  • I appreciate all of your comments and understand that this isn't medical advice but rather the anecdotal experiences and/or opinions of people that have gone through the same thing.

    Ms. Pixie: no, I'm not ready for surgery yet, despite having two neurosurgeons recommend surgery. I guess I'll know when I'm ready.

    Is there anyone here that has had that surgery when they weren't in intense pain?
  • I can honestly say that I was not in intense pain when I had my ACDF surgery last week. Burning pain behind my left shoulder and numbness in both hands, but my symptoms usually presented themselves late in the day when I was using the computer (similar to carpal tunnel symptoms) and when I was looking up to watch tv (mounted to the wall), putting pressure on the area. I saw my surgeon on the 10th and had the ACDF on the 11th. I knew that surgery was eventually coming and I didn't want to chance permanent nerve damage by waiting. I am now 11 days out of surgery and I feel fine. The surgery only required one stitch on the front of my neck and there is no visible scar now. Mine was a multi-level fusion of C5 to C6 and C6 to C7. My only complaint is my lifting restrictions. My suggestion is that you not suffer needlessly, but listen to your body.
  • I met with my NS two days ago and he recommended that I wait. I was in severe pain in my right arm and had severe numbness in my right thumb and index finger from Sep 2011-Jan 2012. Since that time, the pain and numbness has subsided. Both he and another NS tell me that I need surgery. The only question is, when. kbswinger gives good advice (listen to your body) as that is exactly what my NS told me. If the pain comes back with a vengence, it's time for me. Good luck.
  • Can't tell you which way to go. I had neck/shoulder/arm issues for a couple of years before being diagnosed with two herniated discs and the C5-C6, C6-C7 being bone-to-bone with bone spurs...had surgery in 2010, two discs removed or what was left of them...3 vertebrae fused...with chip of bone from my hip. The pain was a lot easier to tolerate after the surgery, in the level 1-2 range after therapy. I returned to work in 2 months...a year later, appears one of the fused vertebrae didn't take. Had trigger point injections, cervical steroid injections, and going back to see the doc again to see what if anything can be done. Good luck on whatever you decide. It worked pretty well for a while. Will see what the doctor finds in the next few weeks...
  • I am not qualified to tell you what choice to make but I do think having trust in your doctor might help. I had my surgery last Tuesday and i am already feeling much better and hoping that it was a success.

    I decided that there was no way I was going to get better without surgery and I had 3 doctors telling me there was really no other choice.

    So, I asked around about my neurosurgeon and everyone told me he was the best in town.

    I finally felt at easy when he came to talk to me just before surgery and looked over to my mother who seemed more afraid than me and said. " I am going to do the best I can, the rest we will leave to the Lord."
    Right at that moment I felt at peace with it and just put my faith and trust into the Doctors hands.

    I hope whatever decision you make that you will get better,
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