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Need 4-Level ACDF but have NO SYMPTOMS

Hi Everyone,

Been reading the discussions and can't find anyone with a case resembling mine.  Desperate to get some thoughts/suggestions.

I'm in my mid 40s and had a lifetime of severe lumbar issues (college and semi-pro soccer in my teens and 20s really messed up my back).  Last year I finally had an L5S1 Laminectomy and it was successful.  This is the best I have felt in over 20 years.  I got back to soccer, tennis, mountain biking, skiing, etc.  Feeling great.  I still have other lumbar issues, but they don't bother me as much anymore.  Nothing 2 Advils and a hot shower or ice pack can't solve.

About 6 months ago, I noticed an occasional tingle on my right index finger.  It would go away after a few seconds or after I shook my hand.  Occasionally, I would get a mild burning sensation around my right elbow.  This was in the summer, so I assumed I missed a spot with my sunscreen and had a mild sunburn.  I also had soreness in my shoulders (that my PT suggested was from muscles finally working after most of my back being so rigid for 20+ years).  Just before Xmas, I went to a leading Sports Med Ortho because the shoulders were starting to be annoying and I was about to go on a big ski trip. He thought I had a pinch nerve and gave me some prednisone but ordered MRI and CT just in case because I had so many spine issues.  When the imaging came through, he called me and said "Don't you dare go skiing.  Cancel your trip and see a surgeon IMMEDIATELY!"

Turns out I have SEVERE cord compression at 3 levels and minor compression at 2 levels.  How severe? Two surgeons suggested a big sneeze might cause paralysis. Every surgeon I have seen (5 so far) were amazed that I had no pain, numbness, tingling, or weakness.  They ran all the tests and said my strength, reflexes, etc., were all perfectly normal.  Occasionally there was a hint with the Hoffman Sign, but even that was not consistent.

I've seen so many doctors because, I live within easy driving distance of some the best spinal centers in the country and each doctor i see has proposed a different solution.  Some suggested posterior but most want to go anterior. Some suggested 4 level fusion, 1 suggested 3 levels plus corpectomy, and one suggested a hybrid - 2 levels plus a replacement.  All of these are complex (a lot more than just a single level).

I know I need to do this... sooner than later.  However, as I sit and type this out, I am feeling perfectly healthy.  Aside from the compression, I am literally in the best health of my life right now.  All the doctors said that since I have no symptoms, there is nothing that will be improved... just "securing my spine" and there is a fair chance that even if the procedure is 100% successful, I may actually develop new symptoms.

I'm going crazy.  I'm not afraid of surgery. I can't get my head around the fact I need to do this despite how great I feel.  Has anyone gone through a similar situation?  If I had pain or numbness, I would have been under the knife by now.

I do have one more question... Neurosurgeon or Orthopedic surgeon?  I have seen both and of course the Neuro guys say that this close to the spine you want a Neuro.  The Orhto guys are saying it's a mechanical bone and disk issue and you want an Ortho.  The guys I have seen are all tops, so I am struggling to pick... especially since they all propose different solutions.  I don't need a warm doctor to give me a hug, I want the most badass expert in the field who will just do an amazing job.

Thanks in advance for any thoughts/suggestions.




  • memerainboltmemerainbolt IndianaPosts: 6,475

    hi ilr!
    welcome to spine-health

    a severe cord compression is not something to take lightly. you might feel great but...my thought on it is do your research and only you can make that decision. as far as neuro or ortho, i have heard in these cases they have both in surgery anyway. but you can ask your surgeon.

    please click on the welcome link below as well as the tutorial to get you started on the forum.
    welcome to spine health

    take care and keep us posted.
    Veritas-Health Forum Moderator
    Please read my  Medical History
  • @ilr I didn't know I had a severe herniated disc in my cervical spine at level C6-7 until I got a bad cough. It made my whole upper back, chest, and arms hurt. I was losing function of my arms and hands. Tingling, numbness, and weakness started in my arms and whole upper body. I had went to the doctor on and off for a month trying to figure out what was going on, I was told it was pinched nerves. After it all hit my legs an MRI of my full spine was finally done. That is when I was told to stop everything. Had surgery 10 days later. Neurosurgeon said we need to get this done now, because I was at very high risk for paralysis. Over 50% compression on my spine. It caused cervical myelopathy, which even 8.5 months after surgery I can still feel, but not even half as strong. I was told for how bad things got that I may not see more than a 70% improvement. I still have muscle weakness on my whole right side. My spinal cord and nerves were damaged and only time will tell if they heal anymore than they already have. I was also just diagnosed with degenerative disc disease and another herniated disc at C5-6 discovered on a new MRI after seeing my neurosurgeon, because of still having so much neck discomfort. You may not have a lot of pain now, but I wouldn't take any chances. Definitely talk with the doctors you trust the most, ask lots of questions, and if you haven't, ask to see the images so you understand more of what is going on. Hope you figure it all out and make the right decisions.

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