Decision time on ACDF - Spinal Cord Disorders Message Board

Sam43 · 12-20-2004, 03:29 PM

Hi,
I’m close to making a decision on ACDF surgery. I have a herniated disc C6-C7 that is pressing against my spinal cord. I also have stenosis and degenerative disc disease with several discs in not-so-good shape.
I originally had a lot of pain with this, but the pain is now more an annoyance and a hindrance than a real serious problem. What’s probably more troubling is some weakness in the left arm and a little in the left leg, along with numbness in two fingers on my left hand.
I had traction therapy, which seemed to help at first, then was finally discontinued because it didn’t seem to be helping anymore.
I’ve been trying things like PT for months in hopes of avoiding surgery. However, I’m meeting my neurosurgeon this week for another MRI and consultation.
I expect him to recommend surgery again (He’s the second surgeon to recommend it, mostly because of the stenosis).
I am having trouble making the decision, in part because although my life is affected, I am not in constant agony or even unable to do most day-to-day things. The condition does cause problems for me, but surgery seems like such as drastic step.
The second concern for me is that it may affect my voice. I am a semi-professional singer and the thought of having my voice affected is very troubling. I’ve heard that in most cases it is only temporary but I personally know of one case where it was permanent, and I see from these boards where other people have had troubles with their voice for months ongoing after the surgery.
One final concern is whether a fusion at one level will simply hasten problems at other levels. The surgeon I see (who is the head of neurosurgery at a major University, so I figure he knows a little!) says the evidence of this is "anecdotal." However, it seems people on this board feel it does happen.
If anyone in this community has some experience that they think might be helpful to me in making a decision, I would appreciate their input.

kellyv · 12-20-2004, 03:56 PM

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aspen2cody · 12-20-2004, 03:59 PM

I wish I would have found these boards before I had surgery. I would have loved to ask the question you just did. I had acdf on c5c6. I started out with pain in my shoulder blades that was unbearable. I went to chrio which I think made it worse, the pain started in my shoulder and down my arm. I couldnt get in to see any NS for 3 months. The second month of pain was worse than the 1st month. I never developed numbness or weakness in my left arm. I was ordered a MRI which showed a bad herniation with cord contact at c5c6 and bulging discs at other levels and disc degeneration (everyone has that). By the 3rd month the pain was very tolarable but both NS said that I was walking a fine line with how the disc was sitting on my cord. I wish I would have waited personally since I didnt have weakness or numbness. In a week that could have happened but it could have gotten completly well. I will never know. I just dont like waiting for my life to resume while I wait 6 months. On these boards it seems all the people were much worse than I was in symptoms since all I had at the end was pain. Good Luck. My voice was horse for couple of weeks and sometimes it still feels weird when I bend over at the waist sometimes.

rob_zzz · 12-20-2004, 08:17 PM

Sam,

I can't offer any advice except to say that I'm pretty much at a similar point to yourself in terms of decision making - symptoms in legs and arms but nothing severe enough to impact normal day to day activity - just prevent me from risking sports/physical activity.

No real pain apart from 'burners' in the dermatomes of the hands at the time of injury which have settled down and mechanical neck pain, so I'm lucky in this regard.

But the neurological symptoms in arms/legs have appeared and seem to be progressing. The main things I have are feelings of heaviness/weakness in arms,legs and other muscles, as well as overall tingling and prickling on skin plus some intermittent numbness.

After all the reading I've done the main two worries I have are the same - voice problems (I enjoy playing guitar and singing) and also adjacent disc problems down the track - fusion can't be undone.

I know there are risks with surgical complications and pseudarthrosis, but I'm thinking they are probably balanced by the risks of deteriorating to a point of permanent neurological defect as well as the risks of a minor car accident etc. causing major problems.

If you are not doing it already it may help to start keeping a detailed record of your symptoms each day and maybe even get someone to video you doing some different things (dexterity exercises) so that you can compare in a month or two how much worse you've gotten.

Something I've noticed is that I'll get a new symptom appearing and panic and want to go for surgery - then a couple of days later I've gotten used to it and am undecided again. The notes are helpful in this regard because I can look back over them and see how much things have changed (or haven't).

There's that fine line between overreacting and jumping too soon vs waiting for a permanent defect that won't be corrected by surgery before deciding to go for it. Just wish someone could tell us where it is ...

chitowngl · 12-21-2004, 08:25 AM

sam,
I am having a one level fusion on Jan 6. I do not have serious pain but have a lot of muscle weakness in my left arm. I saw both a neuro and an ortho and they both agreed that my nerve impingement could become permanent if I did nothing about it. That scared me enough to schedule the surgery. Sometimes I think it all boils down to a quality of life issue. I am nervous about the surgery, but when all is said and done I feel I have made the right decision. Good Luck in whatever you decide to do.
Carrie