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xxxx 3 or 4 level cervical ADR? What was your longterm outcome?

Faith981Faith981 Posts: 78
edited 05/01/2015 - 7:38 AM in Back Surgery and Neck Surgery
Hello there,
I have had an MRI of my neck that found:
spinal canal developmentally small
C2/C3 mild endplate changes, no stenosis
C3/C4 mild disc degeneration, small left herniation, abuts but doesn't touch the cord
C4/C5 moderate disc degeneration, large herniation indents the thecal sac and touches cord, causes severe narrowing
C5/C6 moderate disc degenaration, small osteophytes, endplate changes, moderate herniation indents the thecal sac and compresses cord, moderately narrows canal.
C6/C7 mild disc degeneration, osteophytes, currently my largest hernaition, indents the thecal sac and compresses the anterior aspect of the cord, severe stenosis
T2/T3 mild disc bulging but no stenosis
I have myelomalacia, nerve pain and tingling, numbness in left arm and hand. I also have sharp pain that has increased in my mid back. I'm not sure if it is radiating from the neck or I need a thoracic MRI.
I have seen 2 ortho and 1 neuro surgeon who all recommended a 3 Level Anterior Cervical Disc Fusion C4/C5, C5/C6, C6/C7.
I have researched Artificial Disc Replacement and have found 3 level success stories and horror stories. A 3 level is very different that 1 level in a very healthy spine in my opinion. The USA states multi level issues, osteophytes, dissqualifies you for ADR but not in Europe. I'm also very allergic to nickel which may be an issue with a fusion or an ADR. I'm 41 year old female who is afraid of fusion causing more herniations and surgeries down the road, but also concerned of ADR if it fails as well I have been told it is a painful revision if you can even get it or be a candidate for it.
Any advice from people in a similar situation would be greatly appreciated.

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  • LizLiz Posts: 7,832
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  • Faith981Faith981 Posts: 78
    edited 05/01/2015 - 5:24 PM
    Thank you Liz, I didn't read the rules till after my first post, I apologize.
    I feel such a sense of urgency to get my surgery since I have myelomalacia, numbness in my left arm & hand (my dominant arm/hand) and a great amount of pain where I can't find relief. I have been researching a lot, reading this site and am torn between risking going to Europe for ADR surgery or getting a 3 level cervical fusion C4-C7 at 41 years old. I'm having a hard time finding a doc near me that would do a hybrid surgery that has a great reputation. I feel very frustrated as I've been suffering since 1996 but most recently have had this increase in pain since January 2015 and have heard it is very dangerous to wait too long for surgery with myelomalacia. I have no choice but to have the surgery as soon as possible as I would eventually be paralyzed. I now have a 3 level fusion scheduled for 5/18/15 but I'm fearing that the limited mobility will result in herniating the other levels of my spine, even the lumbar since I will be turning more from the low back with a fusion. I'm looking to find other people in similar situations and hear about what they have done for themselves.
  • I will be following you with great interest. Our problems seem similar. I ave numbness hands/ arms and will have 3 level 6/9. Healing thoughts and prayers coming your way.

  • Thank you for your reply. Sorry to hear you are going through this too. Relatively speaking 3 level cervical (and up) fusions are not too common, even the surgeons mention that, especially when you are young. Do you have any thoughts on Artificial Disk Replacement vs. Fusion?

    Sending healing prayers to you too.

  • and although I am by no means an expert, artificial ones seem to do well at least in the studies I have read about. There is one that allows you to keep some movement (which sounds really great to me.) I think it is Mobi-c? (spelling?) Anyway my guess is that each surgeon has their own personal bias' based on their experiences with artificial, cadaver, autograft. I think I would maybe research the three then ask your NS' preference and why. And please let me know what he says. I didn't ask because I didn't know too much when I started on this journey. I guess next time I will see him will be on the date of the surgery.

    Please keep me posted Faith. Good luck to us both.

  • Since we aren't to give medical advice or names on the site I won't go into detail here, but from what I have come up with in my non medical research, is that if you need a multi level ADR it should usually be a semi-constrained artificial disc that is not elastomer. This way the discs are restrained somewhat in mobility (but not as in fusion) so they don't cause the device to shift out or cause more arthritic pain. In my personal layman opinion, the doctors in Europe seem more experienced in this than even some of the great doctors in the USA. It has been around there longer there, they have done more procedures and they have a different way of approving devices. That is not to say there may be wonderful doc's in the US that could do them successfully. I have had a terrible time getting one near me that is in my insurance network. The cost for surgery in Germany would also be a hardship, but so would be being so sick I couldn't function and earn a living. I don't know if one can ever know they did the right thing until it is over and done with since there are so many possible outcomes either way and each one of us is made differently. At some point after my choice is made, I must make peace with it and be grateful for the good things I have! Life is too short.

    Many blessings to you Ivy and all people who deal with chronic pain and face surgery!
  • itsautonomicitsautonomic LouisianaPosts: 1,802
    Doctors in the US don't hve the exp with multi level ADR as they do overseas. Facet degeneration is usually what can disqualify you from ADR. There are several sites dedicated to overseas ADR and I would advise those for these questions. Some amazing stories and horror stories like anything , but choice of surgeon, type ADR and correct usage mean the world. Also cervical ADR easier to revise compared to lumbar
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Hi itsautonomic,
    I found an overseas doc that recommends for me a 4 level cervical ADR. It would cost about $56,000 plus airfare. I can't afford that kind of money upfront and I don't think I have any other resources to make it happen. I'm sadly facing a 3 level cervical fusion in a week and looking for a last way out. No surgeon in the USA feels strongly about doing it that I have met, plus my health insurance restricts me to my state. I think the best doctors, in my opinion, are over seas as they have decades of experience. I have heard though revision surgery is very painful. I have also been told that the 4th disc that I have that is a herniated, but not pressing on my spinal cord, will hurt a lot if/when it presses on my spinal cord in the future because it will have to be done from the back. So frustrated!
  • and pressing into my spine and my NS will be going from front. I'm glad there seems to be some good news out there for people like me that have a hot mess of a neck. I am to have 3 level plus removal of c4 because it is broken.I have numbness in hands so already some cord issues so really no choice for me. So thankful that I have insurance. $56,000 would be out of my league too Faith.
  • itsautonomicitsautonomic LouisianaPosts: 1,802
    Faith I am sorry it's just not a good situation for you. I wish you the best whatever route you take. The best multi level ADR surgeons are overseas but fusion wise there are great ones here in US to
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • southernerdssouthernerd Posts: 5
    edited 05/09/2015 - 8:39 PM
    I was in a similar predicament until my ACDF on Monday. Luckily I have access to many fantastic surgeons and I had this very discussion with several of them and this is what they told me:

    ADR is not effective in situations like mine where the neural foramen and spinal canal needs to be cleaned out due to stenosis, spurring etc. All they do with ADR is get out the disc and insert the hardware. They don't get behind the longitudinal ligament or clean anything out. Evidently the tools take up more room and prevent this additional work that can be performed with ACDF so those osteophytes stay where they are at. They explained to me that they tend to use ADR on fresh disc pathology that hasn't become arthritic and where bony changes are minimal. They said that where ADR is used in scenarios where compression isn't solely from the disc there should be an expectation that many symptoms will remain and a subsequent fusion will be necessary.

    But don't take my word for this, ask your Dr.
  • Faith981Faith981 Posts: 78
    edited 02/13/2016 - 8:48 PM
    Thanks southernerd,
    Sorry for my delayed response, it somehow didn't show up that I had more responses before. It helps to hear what you have heard from your doctors. Mine never explained it like that, they just said 41 is too old to try to preserve motion for the risk, plus no one does 3 levels in US (although I have found some half way across the country that do, I have not personally seen them.) I sure hope my surgeon cleaned everything out like you described. I chose my surgeon because they said his work was meticulous, but he is not one to explain a lot of detail about anything even regarding my surgery, but he is very respected with a highly regarded hospital in my area so I went with him.
    I have noticed though by taking my x-rays/mri's and looking at doctors videos on youtube (I can just hear people slapping their foreheads, I know the internet is not a reliable source) I seem to have markings that never get mentioned on my reports. I know I'm not trained but when you see on your xray an all white space where your facet joints are and all others are clear to somewhat clear, you can see something is not right. I did have one surgeon tell me my reports were "under read".
    On my follow up xrays after my fusion the only comment is that the hardware is intact. No reference to any osteophytes, bone spurs, even on the levels not operated on. Sometimes a certain radiologist will remark my lordosis is straightened, that's all. I would like anything that shows to be referenced on the report. I wish you could choose your radiologist like you pick a doctor.

  • SukhreSSukhre San Diego, CAPosts: 181
    I am in the same boat. I have stenosis on C4-7 (severe on C4-6).  This discussion would greatly help me as well.

    So far this is what I have went through

    1) My regular surgeon is very conservative. he is asking me to wait. He has great reputations in Fusion. I trust him a lot.
    2) I did communicate with one foreign surgeon about ADR and one local. Both of them a lot of ADRs. The foreign surgeons can use Mc6, local surgeons use MobiC. My local ADR surgeon recommended me to do laminopasty. Theoretically it makes sense to me... I will still have my discs. He will create space by enhancing bones in the back. Unfortunately I have not seen much data on laminopasty. 
    3) While US only have two level ADRs, US surgeons have published a lot of information on their findings.
    4) I hardly see any publications on long term results of M6c,

    If anyone can add more information, I would be greatly benefited.

    MRI shows C4-C7 severe steonosis. Pain in hand.
  • Interesting Sukhre. I just looked up Laminaplasty. It is used to open up the spinal canal due to stenosis. I saw 6 surgeons and none of them recommended this procedure for me. I had 3 discs pressing on my spinal cord and the only answer was to remove them. My surgeon did say that he filed down bone spurs as well while he was in there. If you only need one level replaced I would look into ADR too.
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