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Old 02-12-2005, 02:58 PM   #1
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kerry edwards HB User
My Journey to Cervical Spine Surgery

{REMOVED}


I’ve received so much help from this board that I thought it might be useful for other if I wrote up my experiences so others might learn from my thought processes.
I went to my PCP in May 2004 because I was getting electrical shocks down both arms when I coughed. He ordered an MRI. It showed minor disc bulges at a couple of levels in my cervical spine but a large herniation compressing my spinal cord about 50% at C5-6. My PCP told me to go to a neurosurgeon. I decided to see a neurologist first because to a carpenter everything is a nail. The neurologist first did a neurological exam and said I had no serious problems then looked at the MRI and told me to get to a neurosurgeon within 48 hrs as I had a neurological emergency. I was to engage in no activities in the meantime including no wild sex. I pressed him hard on how serious my problem was since I was not experiencing a lot of pain and wished to avoid surgery if possible. He was absolutely insistent I see a neurosurgeon, explaining that he had had a patient with a similar condition to mine that had ignored his advice and gone skiing. He fell, hit his head and was now a quadriplegic. I made an appointment with a neurosurgeon who squeezed me into his schedule the next day. He concurred that surgery was necessary although not within 48 hrs. He said I should let it go no longer than a few months. I also pressed the neurosurgeon on the necessity of surgery. He told stories of two of his patients with a similar condition to mine. One fell on ice, hit his head and was paralyzed; the other fell off his couch, hit his head and was paralyzed. One recovered after surgery, the other didn’t. The surgeon said I needed ACDF with cadaver bone and plate. I asked about other options. He said he knew of some endoscopic procedures but that he did not believe these procedures could resolve cord compression. I thought about if for a couple of days and scheduled the ACDF.
I then began researching in more detail. I learned of the domino effect and doubts began to arise in my mind. I already had a couple of bulges at other levels, which struck me as being an indicator of future domino problems. I also learned of ADR. I went for my pre-surgical consult with the surgeon’s nurse and raised my doubts. I got no satisfactory answers. Yes, ACDF could cause problems at other levels but I should be good for 10 yrs, and I wouldn’t want to be one of the first 500 who got ADR. More research ensued. ADR had been done for quite a few years in Europe so I wouldn’t be within the first 500 and I didn’t like the domino odds. At this point I came to {REMOVED}and asked people’s opinions. Opinions were split on the wisdom of ACDF but I realized I didn’t know enough and could not go under the knife given these uncertainties. I talked to the neurosurgeon, who in fact concurred that he would not operate on a person with my doubts He knew of Jho but thought his procedure probably couldn’t help me. I postponed the ACDF so I could look into it more and into MISS and ADR.

Cervical ADR was in clinical trials at this time in the US but available in Europe for $$$ since my insurance wouldn’t pay. I learned of MISS from Schiffer, Microspine and Jho. Microspine was not an option since their qualifications did not seem that strong (especially when compared to Dr. Jho’s) and I did not like the idea of undergoing major surgery in a facility other than a large hospital. Schiffer’s CED did not give direct visual access to the area in front of the spinal cord, so there was doubt in my mind as to how effective that procedure would be, especially given the fact that it seemed likely my herniation was about 16 yrs old since it was that long ago I’d suffered bad whiplash from a rear end collision in a car with poor head restraints. That left Dr. Jho. A number of people on{REMOVED} had had success with him. I typed my MRI report into an e-mail and awaited his reply. Within 2 hrs he responded that he thought he might be able to help me and to send him my MRI films. I Fed-Exed the films on a Thursday and on the following Monday he called. Yes he could help me and he agreed that surgery was necessary. He said his office staff would call. This was late June I believe. I decided this was the best option. It preserved most of my own disc and left open the possibility of ADR in the future.

I eventually had surgery with Dr. Jho on 2/1/05. However, the communication with his office staff between 6/04 and 1/05 was not good. In fact, they never called me at all. I had to make repeated phone calls and e-mails to get any response at all. At about the end of July his office staff promised an early December surgery date. I did not hear from them and in about mid-November I began calling and e-mailing. No return phone calls and finally in early December I got an e-mail indicating the surgery would not be in December but it would be in January. By Xmas I still did not have a date and was calling and e-mailing. Twice I was promised that the date would be fixed—next Monday. No response on those days. Finally around 1/1 I got an e-mail confirming the date of 2/1/05. This was clearly the most frustrating part of my experience. I understand his office staff is busy and fields lots and lot of inquiries but a short return phone call, or e-mail would have made my experience much more pleasant. The communication with his office did improve once the surgery was scheduled but I never received a pre-surgical information packet like some others have reported. I was left with the impression it was lost in the mail.

I was scheduled for surgery Tuesday 2/1 with a pre-surgical consult 1/31. Eric, Dr. Jho’s PA, did a neurological exam on 1/31 and then I met with Dr. Jho. He inquired about my pain levels and if I could live with the pain. I said yes, but I wanted the surgery to reduce the risk of future paralysis. We then had a long discussion about the fact that there is no empirical data verifying the idea that seriously compressed spinal cords are at higher risk of damage than non-compressed cords. The concept is just ‘common sense’ and not verified. This had been one of the hardest parts of the decisionmaking process for me, since I had become aware of this fact during my research. But I had decided that it seemed wise to act on common sense, particularly given the experiences of my neurologist and first neurosurgeon (although those anecdotal cases don’t prove a lot). Dr. Jho agreed to operate under these conditions.

He operated on 2/1 for about 3 hrs. He initially had said he thought the surgery would take only one hr. I was in recovery for a little over an hour and was up walking around my hospital room by late afternoon with an hellacious sore throat from the intubation. I flew home two days after surgery and a week later; I have only had to take a few ibuprofens for discomfort, first for the sore throat, and since then for minor soreness in my neck. The ache in my left shoulder, which I had had for a number of years, was gone when I woke up in recovery and things seem to be going well. The best measure of success will be the 6 week MRI which I’m hoping will show a cord as nicely decompressed as the ones in the MRI’s Dr. Jho showed me in the pre-surgical consult.

I had read Dr. Jho’s published studies on anterior cervical microforaminotomies while making my decision. I had also read the studies of the same procedure by other surgeons who had much lower success ratios than Jho. I also read Jho’s replies to those studies. I have become very skeptical about reported surgical success percentages in the process of making my choice but had decided that Jho’s microforaminotomy had pretty reasonable odds of success (something better than 50/50). However, there have been no long term (15-20yr) studies of the results of this surgery so in many respects it is like ADR in that it’s benefits are theoretical, or ‘common sense’. I had decided in advance that if I came out of the surgery with similar pain levels to pre-surgery (not very high to begin with. 2-3 on a scale of 10) and a decompressed cord, I’d consider the surgery a success. While it is premature to make any judgment, so far things are going well. I’ll never know if ACDF would have been equally successful in the short term (although I do know that the recovery period is MUCH shorter for a microforaminotomy), nor will I know if the long term benefits for me will/would have accrued more to ACDF or ACMF. But given these limits and the limited nature of my problem (one level serious herniation with no instability and only minor problems at other levels), it seems so far as if the decision to have an ACMF with Jho was reasonable.
I welcome your comments.

{REMOVED}

Last edited by ms_mod; 02-12-2005 at 03:17 PM. Reason: Posting links to websites or other forums violates the board posting rules.

 
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Old 02-13-2005, 07:54 PM   #2
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Sam43 HB User
Re: My Journey to Cervical Spine Surgery

Wow, that's a very interesting story. I have shared some of your misgivings about ACDF, and ended up having a foraminotomy to resolve my symptoms (mainly because my NS decided at the last minute to go that route because of concerns about how fusion would affect other levels). {REMOVED} there's a lot there that is food for thought. Could you clarify a couple terms: ACMF? MISS?
Keep us posted on how things progress!

Last edited by ms_mod; 02-13-2005 at 08:35 PM. Reason: Don't make comments on actions taken by the Moderators on the board.

 
Old 02-14-2005, 06:14 AM   #3
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kerry edwards HB User
Re: My Journey to Cervical Spine Surgery

ACMF--Anterior Cervical Micro Foraminotomy--the procedure invented by Dr. Jho.

MISS--Minimally Invasive Spinal Surgery While the ACMF is usually billed as a MISS, I would probably consider it a moderately invasive spinal surgery since, while it does preserve the disc, does involve the removal of bone.

 
Old 02-15-2005, 08:25 AM   #4
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pete0735 HB User
Re: My Journey to Cervical Spine Surgery

Kerry,

Your story is very interesting and promising. I did have a fusion C6/C7 in 1/2003. Since then I now have a bulging disc at C5/C6 pressing the nerve on the right side. This generates pain from my shoulder, bicep to my index finger and thumb. Minimal neck discomfort as of now, pain level is at a 4 or 5, but not consistent, can get relief based on positioning. I actually go for a steroid injection and nerve block this afternoon to see if that helps.

Knowing that any shots are only temporary I have seen a NS who does microscopic surgery here in Atlanta. I also have sent emails to Dr. Schiffer and Dr. Jho. All three will do a microscopic type prodedure and only remove the herniated part of the disc. All three surgeries will require a very small opening (say a half inch).

Through your experience do you have any opinion on which avenue I should choose? Obviously the Altanta NS is local and things can probably happen quicker. He says this is his area of expertise. I also know Dr. Schiffer and Dr. Jho are a much larger scale in terms of performing these procedures.

What's your thoughts, what should I look for or ask? Any help is appreciated.

Hopefully your still doing well from the procedure.

 
Old 02-15-2005, 08:32 AM   #5
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ZANMEISTER HB User
Re: My Journey to Cervical Spine Surgery

PETE0735
Just a note - I found by accident that Imitrix (used for migraines) works wonderfully for nerve/neck pain and numbness and it doesn't make you loopy like other drugs. I take about 50mg periodically as needed. As your doctor for a prescription. The downfall is that it is expensive.

 
Old 02-15-2005, 08:47 AM   #6
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kerry edwards HB User
Re: My Journey to Cervical Spine Surgery

For me it would depend on the exact procedure the local NS was going to use and how many times he has performed the surgery successfully. Schiffer and Jho have different procedures, although I see that Dr. Jho has added Schiffer's CED to the list of procedures he does (I think). Schiffer goes thru the disc typically while Jho goes thru the bone. I thought Jho's procedure was capable of resolving more problems than Schiffer's. Schiffer's doesn't deal with bone spurs whereas Jho's does.
It would be hard to find someone as experienced in cervical procedures as Jho. He spends two days a week doing cervical procedures almost exclusively.
It's been two weeks since my surgery and I am still doing well, although I'm still getting a knot at the base of my neck sometimes.

 
Old 02-15-2005, 09:55 AM   #7
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pete0735 HB User
Re: My Journey to Cervical Spine Surgery

Thanks for the feedback. Looks like Dr. Schiffer probably won't be an option if he doesn't deal with Bone spurs. I need some cleaning up at C4/C5 for moderate spurs. Dr. Jho says he can do my C5/C6 bulg as well as the spurs. He can do a bilateral for my spurs at C4/C5, but not in the same surgery. They have to be 3 months apart. So I have hope, we'll see how my steroid shots work.

 
Old 02-15-2005, 09:57 AM   #8
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pete0735 HB User
Re: My Journey to Cervical Spine Surgery

Zan,

Thanks for the the drug reference. I'll look into and see if I can get a prescription.

 
Old 07-25-2007, 10:42 AM   #9
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dolores216 HB User
Re: My Journey to Cervical Spine Surgery

I had sx. in May, 2007. It was called a 3 phase surgery. First, The pressure on my spinal was released by removing the vertibrea that was pressing on my spinal cord. This was done from the back of my neck. Secondly, They went in from the front, separated the disks and placed a titanium plate. Thirdly, they rolled me over and went in from the back again. They placed a cadabre bone, 2 rods and 4 screws. This was done over a 3 day period. The surgery was done this way because they thought that taking the pressure off of the spine first was important due to the possibility of causing more damage to my spinal cord by the separation of the disks from the front. Anyway, It's been 3 months now and I have very little pain. Nothing that Tylenol won't help. I went into the hospital on a Monday morning and was released on Friday. The first 2 months after the surgery was very difficult but I'm glad it was done. I know I was very lucky and would probably end up in a wheelchair if I had not had the surgery.

 
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