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Help! Doc says ACDF but minimal symptoms....

Hello. I this is my first time posting to this board. Have read many posts over the past few months on here. It have been very helpful with the issue I am dealing with.

I am 39 and started experiencing shooting arm pain, thumb/finger numbness on the right side, and shoulder pain about 3 months ago. After going to urgent care and a shoulder doc, I was referred to an orthopedic spine surgeon who ordered an MRI which showed:

C5/6 - 1 to 1.5 mm traction bulge and AP canal diameter of 9mm.
C6/7 - spurs and 2.5 to 3.0mm disc protrusion into neural foramina. Moderate to severe neural foramina narrowing bilaterally. AP canal diameter of 8mm. Minimal cord contouring.

I have completed 8 weeks of PT and the arm pain/numbness has gone away. However, I now experience muscle spasms on my right arm, finger, shoulder, calf and foot. The spasms/twitching do not hurt and are merely just annoying. Also, I can tell that I have slight tricep weakness but doesn't hinder my work or daily activities. Not on any medications.

Over the past 2 months, I have visited 5 doctors (1 - ortho, 3 - neurosurgeon, 1 - neurologist). They have said:

Ortho: ACDF at C6/7 before end of year to preserve quality of life.
Neurosurgeon 1: ACDF or artificial disc at C6/7 before end of year due to spinal cord compression (which is causing muscle spasms).
Neurosurgeon 2: ACDF at C6/7 before end of year due to spinal cord compression and tricep weakness.
Neurosurgeon 3: NO Surgery. Spinal cord compression is noted, but cord is not bruised or damaged. It is possible I could hold off on surgery for up to 10 years or until I start having numbness again. Tricep weakness is noted but not severe to call for surgery. If surgery, only do ACDF and not artificial disc due to existing bone spurs and complications with artificial discs.
Neurologist: Why am I waiting to have ACDF surgery? Get it done.

My question to y'all is, am I stupid for having second thoughts about getting surgery? I feel great (other than the muscle spasms). All three neurosurgeons have been highly recommended and are known in the community (and I am comfortable with them doing the surgery). I just am afraid (after reading some of the posts on here) that my symptoms will be worse after having an ACDF than what I am feeling now.


Thanks for your help!!


  • I understand your confusion and hesitancy in having the surgery in light of only a few symptoms, along with having received varied opinions from the specialists you have seen. The decision to have surgery is a very personal decision that each of us must make for ourselves, but here is what led me to have an ACDF (C5-C6) this past August.

    When I originally saw my Neurosurgeon four years ago, it was for major lower lumbar pain, and only minimal cervical issues (slight pain in left upper arm, and only occasional - and minimal - left side neck pain). At that time he said we had options regarding my back - PT, ESI's, etc., before surgery, but for my neck, he said there were no options - my cord was being compressed and surgery would be needed - eventually. He said that exactly when I would need the surgery would depend on how quickly the compression progressed. He said it could be months, or it could be years, but that we would monitor it, and when my symptoms began to worsen, then I would need the ACDF. Well, I made it three years before I had the surgery. My symptoms - when they began to worsen - did so very quickly. In mid-May I began having tailbone tingling and numbness, more pronounced pain in my left arm, and tingling in my right arm and hand. So the decision was made, and on August 19, I had the surgery. I wasn't in debilitating pain prior to the surgery - really, the tailbone numbness and tingling were more annoying than anything - but from my research - and what my NS has told me - the symptoms for cervical cord compression can sometimes be mild, but the damage caused by not getting it fixed in a timely manner can be permanent. So in light of all of that, I made the decision to have the surgery. But again, my NS had been monitoring my symptoms for over 3 years before I got to the point where it really became necessary.

    It sounds like you have done due diligence in getting several opinions - which is a good thing. But like I stated above, the decision on whether or not to have surgery is one only you can make, and I wish you the best as you make that decision. I can tell you that I am very glad that I did have mine done. The worst parts of recovery for me were the neck spasms and cramping that I had for about three weeks, and the problem that I had with swallowing for about 10 days. The spasms annoyed me because I didn't really have major pain before my surgery - and suddenly I did! But they have definitely gotten better over time. For the swallowing issue, I just stuck to eating soft foods - apple sauce, yogurt, ice cream, broth, pudding, etc. - and actually lost 10 lbs. in the process! My surgery was 11 weeks ago tomorrow, and for the most part, I don't even think about the fact that I recently had a cervical fusion - it doesn't really give me any problems at all!

    I'm wishing you the best of luck as you make your decision!

  • I can relate to your situation. My arm numbness and pain started back in May. I gave it a couple of weeks before doing a round of oral steroids. They helped the numbness, but not the pain. After getting a MRI early July it was found I have severe cord compression at the C6-7 level. My n/s recommended doing an ADR. My pain is manageable so I wasn't completely on board. I ended up meeting with an o/s who recommended ADR and another n/s that recommended ACDF. I tried p/t which made my pain worse and ended up trying an ESI with no results and am now scheduled for the ADR surgery on Nov 26.
    I ultimately decided that I now feel more confident in having the surgery as I've gotten multiple opinions and tried ESI and p/t.
    My only suggestion is to go with the dr you felt most comfortable with and has adequate experience in doing the procedure. You can also find patient reviews online which helped me with my decision. Good luck!
    March 2002 L4-5 open d/s
    July 2012 L4-5 micro d/s
    November 2013 L4-5 micro d/s
    December 2013 C6-7 ADR
  • Summi1408SSummi1408 Posts: 176
    edited 11/06/2013 - 1:51 PM
    Sorry about all the blank post my phone went crazy. And I could not delete the post sorry.
    I wanted to tell you that your symptoms are pretty close to what mine were. I went through with the surgery 12-13-12. It am completely satisfied with it. I had C5-C6 done. And other than having problems with swallowing for about 2 weeks. I just stuck to soft foods and had no more problems. I have no symptoms with my neck at all.
    Acdf C5 C6 12/13/12
    Laminectomy and Discectomy L5 S1 12/12/13
  • I had ACDF C5-C6 12-13-12. I was the best decision for me and my husband had ACDF on C4-C6. We both had great outcomes. I had some problems swallowing for about 2 weeks. As long as I stuck to soft foods I was fine. Before surgery I had some neck pain, shoulder pain and tingling in my fingers. After surgery I had no pain or tingling. I'm glad I didn't wait because all of my nerve damage was completely taken care of.
    I wish you the best of luck with whatever option you choose.
    Acdf C5 C6 12/13/12
    Laminectomy and Discectomy L5 S1 12/12/13
  • edited 11/06/2013 - 3:12 PM
    Appreciate your comments! Headed back to the n/s tomorrow to discuss. Overall I don't feel any pain, but now just feel that something isn't right and my right arm/shoulder is fatigued all the time. Hope to get some answers...

    Katjonmadi, did you have difficulty finding a n/s that would do an ADR? Three of the n/s I have visited won't do it as they said the hospital surgery board is usually filled with ADR revisions. One n/s was a former mechanical engineer and he isn't sold on ADR for cervical since I am under 40. He is concerned that it could wear out by the time I am 60 and cause severe damage to the spinal cord??? I have tried to find people who have had cervical ADR to get their story. In your research, what have you found?

    Thanks again for the help!
  • Pain in the neck - no, 2 of the 3 surgeons I met with recommended the ADR specifically due to my age. My other levels are already bulging so they felt a fusion would be a guarantee for additional levels going out in the future. I can't list the website here, but there Is a website/forum dedicated solely to ADR - you should be able to find it through google.
    I was told my young age and only 1 level compressing the cord made me a perfect candidate.
    On the flip side, the other surgeon recommended ACDF. When I brought up ADR, he admitted to not having any training on it and therefore he doesn't perform that procedure. I have read that there are some insurance carriers that still aren't approving it which would also result in some doctors not offering it. Luckily mine did approve it, so I'm all set!:)
    I think as is always the case, just make sure you research your surgeon. One of my addl opinions was the O/S that led the FDA trial for ADR 10 years ago. I figured he would be the most experienced performing the procedure, but I was wrong. I found out through research and good ole question asking that my N/S has done triple the ADR procedures than him. Which of course was very reassuring to me and I could stick with the N/S I know:)
    Good luck!!
    March 2002 L4-5 open d/s
    July 2012 L4-5 micro d/s
    November 2013 L4-5 micro d/s
    December 2013 C6-7 ADR
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