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Tough Neck Sugery Decision

Hi, I just joined this forum, not really ever believing I would face a 'have surgery or not' question. I always thought when I got to this point the surgery decision would be clearcut so I'm interested in anyone else who has faced a similar conundrum.

i'm a 61 year old male who injured my back in grad school and it's never been the same - although to date I have never had sugery - over time the neck took over as the other primary problem and I was diagnosed 4-5 years ago with a C6/C7 pinched nerve but surgery wasn't strongly recommended - I have muddled through with some left finger numbness and opioids plus nerve blocks and epidurals helped me cope.

The last 6 months the pain just completely blew up / I sleep on my side (when it's 'ok' half and half') to the point that I couldn't sleep at all on my left side because the pain would be staggering within 5 seconds - the last epidural did nothing and I'm now on 60mg of oxynorm a day as the only way to partly cope but the nerve compression hasn't gotten worse i.e. Same level of minimal numbness.

So full set of scans and my 'muddle through' has led me to a very worse place. The London specialist im seeing is tops but now I need 3-level ACDF From C4-C7 but I have degenerative facet joints on the right side from C2 to C7 and for that reason I can't get replacement discs so I guess the ACDF is 'remove and fuse' (I'm still somewhat unclear on this issue) the issue is the left side pinched nerve can be fixed with this procedure but the facet joint problems on the right (less so on the left) means my pain reduction will only be in the region of 50% not near 100% if it was just the fix for the pinched nerve.

so it seems my 'muddle through' approach took me too far because of the facet joint deterioration issue and now while I'm getting a second opionion im being told it's 'kind of up in the air' as to whether I should have surgery - this view seems to be related to 'expectations' that surgery would fix most if not all of the problem but that's not the case anymore. But if I'm honest clearly a 50% reduction is an improvement over the status quo.

I certainly can't live like this as it's getting worse and I'm barely coping at 60mg of oxynorm a day / and of course the more meds you ask for the more you get cock-eyed looks from GPs.

i must say I don't normally participate in forums like this but am hoping some 'shared experiences' may cheer me up 

So help ! Has anyone faced this kind of tradeoff decision ? 'Newbie Scott' - many thanks 
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1

Comments

  • SavageSavage United StatesPosts: 7,385
    hello sdasurrey!
    it seems you have been working with your gp....?
    have you been seen by spine specialist..?...or gp is talking surgery?

    of course, if you are unsure of anything, there is not anything wrong with a second opinion.

    i have never been a candidate for surgery, but with my pain management/neurologist doctor treating me with occasional epidurals and i am on medication...my pain levels are in half most of the time.
    my activities are limited, but since working with pm doctor, i've not had to visit er for uncontrollable pain, so that is great.

    for your many concerns and possibility of surgery before you, and while you are waiting for responses from members with shared experiences, search may be helpful to you, upper right on large.
    you may be led to current or older discussions.
    the main site has all the formal medical articles and videos for you you to research on. very informative!

    please click on link for helpful information!
    Sue
    Honorary Spine-Health Moderator
    -------------------------------------------------------------------------------------------------------------------------
    Please read my medical history at: Medical History

  • Many thanks for replying !! I am seeing a spine neurosurgeon specialist beyond my NHS and private GP - he's evaluated me in the last 10 days with new scans on top of scans 4 years ago and the second opinion is another london spine specialist, thanks again ! Scott 
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  • Bruce EitmanBruce Eitman Akron, OH, USAPosts: 1,510
    Scott

    Surgery is always a tough decision, even when it is cut and dried.  Surgery is a deeply personal decision.

    For me, I would have celebrated a 50% improvement.  Luckily I did better than 50%, and a second surgery fixed the rest.

    The problem is that there are risks associated with any surgery, no matter how minor the surgery.  So that has be included in the decision.  And of course delays in having surgery can lead to permanent damage and/or slow recovery.

    Good luck.

    Bruce

    Read my story at Bruce - My Story
    ACDF C4-C5-C6-C7, and getting better every day
    It has been a process of healing, learning, exercising, and resting - and figuring out when to do which.

  • Thanks Bruce, for replying - I'm actually in risk management so I'm assessing the pros and cons.

    i haven't looked back at your neck problems, which I assume you had if you're responding to me in the neck forum. I'm still learning the navigation.

    But if you can comment on dkneobev use, having 3 level ACDF without disc replacement aside from various success runs the risk of reduced neck mobility a friend of mine mentioned short term or enough long run reduced mobility that you can't legally drive anymore. Can you or anyone else comment on how often this worst case on mobility happens with the kind of surgery being proposed ? Many  thanks  !! 
  • nutcase007nnutcase007 United StatesPosts: 947
    sdasurrey - I'm also a 61 year old.  I've already had fusion at  c3/C4 and C6/C7.  My neck was "all messed up" back in 1978 with very severe whiplash.  When I was found at the "accident", they thought I was dead.

    It's about quality of life.  I sounds like you had I currently have a lot in common, no quality of life.  If the estimate is 50 percent improvement. I'd be going for it.  Your neck is only likely to get worse.  As for not being able to drive after you heal from surgery, I question that statement.  Most of the rotation of your neck is at C1/C2. 

    I wish you the best whatever you decide to do or not to do. 
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  • Many thanks nutcase007 ! I agree with you for sure that  roughly 50% pain reduction is beneficial everything else the same - it's just the assessing the risks as my general appoxch to date has been, as mentioned in the lead post, 'middle through' sonas not tonget surgery - now I have to seriously consider it - so I'm assessing the risks as it was mentioned 'worst case' with very limited mobility that it's possible I can't drive. 

    Looking through post-ACDF multi level Aubrey posts here I haven't found anyone yet saying they can't drive - what I'm reading is the PT in mobility recovery ia very key and that even at the best, with 3 level surgery there is some mobility loss ... thanks again ! SDAsurrey 
  • AWMAAWM NebraskaPosts: 75
    sdasurrey

    While I have not experienced a decision involving cervical issues, I have had my share of lumbar issues.  I can tell you, that for me surgery was never an easy decision.  I can tell you, nobody knows better than you, what you can tolerate as far as pain.  For me, when the pain got to a point that I couldn't tolerate it any more, I chose surgery.  I have no regrets.

    As Bruce said, "surgery is a deeply personal decision."  He is absolutely right.  

    Getting a second opinion is always a good option.  If you have loved ones that will help, I always found there input incredibly helpful when I was making my decision for surgery.

    I hope you find a solution for your problems.
    Dec. 28, 2015 - Laminectomy L3 - S1 (Due to congenital stenosis.)
    Dec. 28, 2015 - Discectomy L3-L4; L4-L5; L5-S1 (L3-L4 & L4-L5 were bulging and L5-S1 was herniated.) 
    May 20, 2016 - Selective Nerve Root Block Injection L5 Nerve Root.
    July 15, 2016 - Epidural Steroid Injection L5 & S1 Nerve Roots.
    Oct. 31, 2016 - Microdiscectomy L5 - S1
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    Hey Scott - Welcome to Spine-Health!

    I can't drive - couldn't drive - won't drive - anymore.
    This is for the safety of myself - and anyone who maybe around me.

    You can read about my rather extensive cervical adventures in the "My Story" link below.

    I have around 10% remaining "range of motion" in each quadrant.  

    My standard answer for when I knew surgery was required -
    When strongly advised by multiple spinal surgeons to do so......
    When the pain and associated symptoms were debilitating and unable to be controlled by medication ....
    I have been in the unfortunate situation of begging for surgical intervention before.

    Many people consider the "DDD" part of the problem only - This is (for me) degenerative spinal column degeneration not 
    "DDD".  Yes discs are involved ..... but so are facet joints - osteophytes - area(s) of stenosis - etc.

    It is a progressive failure of this fantastic bit of architecture.  Certainly one area can be repaired to reduce further damage but what and where may it present itself next??  

    What and how might this repair affect you?  Unfortunately like snowflakes - each patient - surgery - outcome(s) - post-op recovery time and potentially disabling factors are unique and varied.

    Best Regards,

    MN

  • I'm getting by right now with a successful C5, C6 RFA treatment done last summer. My pain level has drastically been reduced. I still have minor finger numbness mostly when I wake up. If the RFA was a bust, I would be looking at surgery and may need it eventually. With my pain level, I would have had it done if I was deemed to be a surgical candidate. Like I said, I'm not there yet but the surgery topic is no longer taboo with me.
    Diagnosis: Thoracic facet syndrome & cervical and thoracic radiculopathy from car accident trauma.
  • Bruce EitmanBruce Eitman Akron, OH, USAPosts: 1,510
    Scott

    I would expect that with your fusion that you would be able to drive after a several weeks.  It sounds like you have a friend who is trying to scare the heck out of you - that isn't such a bad thing, but share your new concerns with your surgeon.

    Bruce

    Read my story at Bruce - My Story
    ACDF C4-C5-C6-C7, and getting better every day
    It has been a process of healing, learning, exercising, and resting - and figuring out when to do which.

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