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Old 06-16-2011, 04:29 PM   #1
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Need advice on whether or not to have ACDF surgery

Has anyone been told that they need ACDF surgery although they only had minimal symptoms. If so, did you or did you not have the surgery? What was the outcome? My MRI shows disc herniation pushing into the center of the spinal cord in C4-5 which is causing cord distortion, as well as some stenosis in C5-6 which is not causing cord distortion. The only real symptom I have is constant tingling in my fingers. Once in a while I have a little neck or shoulder pain that is relieved with Advil. Both the neurologist and neurosurgeon have said that I need ACDF surgery otherwise I could be paralyzed if I trip and fall or get in an accident. Because I have such minimal symptoms, I am wondering if I should wait with the surgery until my symptoms get worse. I am also a little concerned that if I go ahead with the surgery I will really develop bad symptoms and that the fusion will contribute to more problems as my discs show other signs of degeneration. This is turning out to be a very difficult decision to make. Any advice or experience with this problem would be greatly appreciated.

 
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Old 06-16-2011, 05:15 PM   #2
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Re: Need advice on whether or not to have ACDF surgery

Here is the problem when the spinal cord is involved. The less symptoms you have, the worse it is. You aren't in pain because the cord doesn't feel pain...the spinal nerves do....not the cord(like the brain doesn't feel pain). The pain of a bad neck that you hear about is caused by compression on the spinal nerves that peel off the cord at each vertebra and go out to the body.

BUT, if your cord is compressed/distorted and you accidently fall or get into a fender bender, you risk cutting off the blood supply to the entire cord and you instantly and permanently become paralyzed from the level of compression on down. And since your cord distortion is at C4-5, you would not be able to breathe as those muscles would fail. Your paralysis would be from the neck down.

So yes, unfortunately, you need surgery. I had the same situation from C3 to C6 and my surgeon couldn't get me in fast enough. I had no pain at all. But for a split second, while shoveling snow, I went numb from the head down and knew I was in big trouble. I headed to the doc and told him how I didn't hurt and the tests began...fast.

When you have a neck problem, the lack of pain is a big red flag that you may be close to paralysis.

good luck.............Jenny(fused C3 to T1)

 
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Old 06-16-2011, 07:14 PM   #3
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Re: Need advice on whether or not to have ACDF surgery

I can't thank you enough, Jenny, for answering my question. My husband and I have been agonizing for weeks over this problem, mainly because I have such few symptoms and am in such good physical shape. Although I am really not eager to have the surgery, your advice has reinforced that we need to take care of this problem before something catastrophic happens which would impact our whole family. Maybe, when you have some time, you can give me a little more information, like when you had the surgery, what it was like, whether you have any pain after the surgery, and how long it took to recover. Thank you again for your help. Erika

 
Old 06-17-2011, 12:44 PM   #4
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Re: Need advice on whether or not to have ACDF surgery

Hi Erika...I did not have an ACDF but I did have the spinal cord compression so that is why I know. So I can't really tell you anything about the ACDF.

I had what you have at 4 levels so I had to have much more extensive surgery and then had major complications and ended up with having my entire neck fused.

But many here have had an ACDF and hopeful they will chime in. If not, do some reading. Lots of help and ideas here.

hugs...........Jenny

 
Old 06-17-2011, 12:57 PM   #5
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Re: Need advice on whether or not to have ACDF surgery

My ACDF three years ago was about a 3 hour surgery, spent 2 nights in the hospital, wore the neck brace for two weeks, and was released to drive at that time. I had very little pain from the actual surgery. Most of the pain that I have is from the nerve damage sustained from the delay in having my problem addressed due to it not being diagnosed soon enough. I had PT at around 6 weeks after surgery to increase arm and grip strength. It was a successful surgery to stop further damage to my spinal cord.
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Old 06-17-2011, 04:03 PM   #6
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Re: Need advice on whether or not to have ACDF surgery

I've been dealing with the same thing since April. C6-C7 and my cord is "impressively" distorted there. The two discs above are also slightly herniated. I've had neck pain, weakness in my arm, and pain and numbness in my hand. A round of steroids seemed to help, but already today I feel worse than yesterday. I'm getting mixed signals from doctors. One suggested two rounds of steroid injections then if that doesn't help he would do a posterior foraminotomy. Another wanted to do ACDF in 2 weeks after I met with him. A third doc (a PA that I had to see in order to get into the surgeon I would want to do surgery) gave me oral steroids and neurontin for the arm pain and told me to deal with it with meds as long as I can. I'm seeing that third surgeon on July 1st. I am also afraid that if I don't get it fixed my nerve damage will worsen or I will get in an accident that will severely injure my cord. It's so hard to know what to do!!!!

Let us know how it goes. You're in my thoughts!!!!

 
Old 06-18-2011, 08:17 AM   #7
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Re: Need advice on whether or not to have ACDF surgery

Thanks for writing and sharing your story. Sorry to hear you are having to deal with the same problem. It's such a difficult decision to make for various reasons: you are getting conflicting information, while I have so few symptoms. So far no doctor has suggested any options other than surgery to me. The neurologist, as well as the neurosurgeon he referred me to, and an ortho spine surgeon have all said I need surgery. I have set up an appointment with another neurosurgeon at UCLA, to see what he has to say. However, I am beginning to think that I will have to have the surgery as I don't want to take a chance and get paralyzed, which would have a terrible impact on my family. Guess I have to keep positive thoughts in mind and not worry. Take care and let me know how things proceed for you. You are in my thoughts, too.

 
Old 06-18-2011, 08:29 AM   #8
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Re: Need advice on whether or not to have ACDF surgery

Thank you so much for sharing the story of your surgery. I have read such horrible things about people who had problems with the surgery, that it really makes me all the more reluctant to go that route. Unfortunately, all the professionals seem to agree that I need the surgery soon, so it is very encouraging to hear of your success.

 
Old 06-19-2011, 08:07 PM   #9
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Re: Need advice on whether or not to have ACDF surgery

Ead, I had ACDF in 2007 and haven't looked back. Upon waking up the terrible nerve pain I had radiating down my arm to my fingers was gone, and the pain I had was from the surgery itself. I wore a neck brace for 12 weeks ,not pretty or comfortable. But I followd my neurosurgeons orders to the letter and now I am virtually pain free. The only pain is if I rotate my head too far. Everyone has different experiences and my just happened to be great\
Right now I am waiting for PLIF, L4-L5, I have the same surgeon and I have great faith in him.

Don't be afraid to ask questions.

 
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Old 06-22-2011, 06:03 PM   #10
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Re: Need advice on whether or not to have ACDF surgery

Ead43 - so.... what are your current thoughts? Do you think you're going to do it? I meet with my surgeon on July 1st..... I'm so torn and hoping he will help me make the decision.

 
Old 06-23-2011, 12:19 PM   #11
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Re: Need advice on whether or not to have ACDF surgery

Quote:
Originally Posted by mahoney67 View Post
Ead43 - so.... what are your current thoughts? Do you think you're going to do it? I meet with my surgeon on July 1st..... I'm so torn and hoping he will help me make the decision.
Hi mahoney67 - Still not definite about what to do. I have an appointment with the neurosurgeon and plan to ask lots of questions. I understand how torn you are feeling -- I feel the same. Hopefully, everything will work out well for both of us.

 
Old 06-24-2011, 04:20 AM   #12
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Re: Need advice on whether or not to have ACDF surgery

Good luck with your appointment! Let us know how it goes. My appointment with the surgeon I've been waiting to see is this coming Friday.

It's so weird... yesterday I was in moderate pain most of the day. Then from about 5:00PM until going to bed I felt great. Perhaps because I was standing..... I slept well and now this morning, hello pain. Anyway, it's hard to get my head around 1) feeling this way possibly forever, and 2) undergoing surgery when I have periods of time like last night when I felt pretty good. ARGGGHH.

 
Old 06-25-2011, 01:44 PM   #13
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Re: Need advice on whether or not to have ACDF surgery

Erika - It sounds like you have the radiologist's report there. Specific words can be quite meaningful. For example, the radiologist usually classifies conditions as "minimal" (don't worry), "moderate" (keep an eye on) and "severe" (fix). I guess he used "distorted" to refer to what the disk herniation is doing to the cord? That may mean that you have enough spare room in the spinal canal for the cord to bend, and it's better than "compressed", which means there's nowhere for the cord to go, and it's getting mashed. If there's even one aspect of the report, even one word, you don't understand, there are people here who have seen plenty (too many) of them.

It's not just a question of whether or not you need surgery, but of which surgery is best. There are five kinds: ACDF, laminectomy, laminotomy, laminoplasty and foraminotomy (although I hesitate to include laminectomy, as that procedure should probably be considered obsolete). Your tingling fingers may require nothing more than a foraminotomy, which is a simple procedure, probably outpatient. If your spinal cord is severely compressed, then a laminoplasty may be a better long-term solution than an ACDF.

Although I'm inclined to agree with Jenny's conclusion that you need surgery, I have to say I'm pretty skeptical about this whole trip-and-become-paralyzed thing. I personally would not give it much weight. There are better reasons to have surgery, the best of which is that these nerve problems do not have that long a window in which they can be corrected. After several months, you run the risk that they will be permanent.

I hope you get opinions from at least four surgeons. I realize they charge what seems like a lot for something that takes them five minutes, and your insurance may pay for only one or two opinions. Think of it as an investment in your peace of mind.

Good luck... and let us know what that report says!

Last edited by WebDozer; 06-25-2011 at 02:01 PM.

 
Old 06-26-2011, 04:06 PM   #14
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Re: Need advice on whether or not to have ACDF surgery

Hi Mahoney and others,

The doctors will always leave it up to you. Im a 9 level fusion C2-T3 congential. Had laminectomy in 1994 on C3-C4 for the same symptoms reported tingling in fingers, ect.
I had the 2nd surgery in 10/10 where they did ACDF to fuse the front of C2-C4 and to add hardware in posterior from C2-C5 to get my head back up a bit. Head was falling from the laminectomy. Found out today my grandmother was bed ridden at 43 with severe arthritis and partially paralyzed.
The ACDF was not too bad, I am having problems 7 months later with a tight feeling in my throat, they are working to find out what's going on.
The spine is a very sensitive area, if any damage to the point of possible paralysis should be dealt with immediately. I waited not thinking anything was wrong from 19 to 37 years old. Had a car accident at 17 was told at 19 had 2 fused and 2 years later 4 fused, never dreamed this would be the result of non action. Its a long story but I wanted to add my 2 cents for the surgery.
Good luck to you,
Saucer

 
Old 06-26-2011, 04:10 PM   #15
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Re: Need advice on whether or not to have ACDF surgery

Hello Webdozer,
Thanks for your detailed response. In looking over the MRI reports, I could not find any mention of the classifications you stated. Here is what the actual reports said:
March 4, 2011 MRI:
Alignment of the cervical vertebral bodies is unremarkable. Minor marrow degenerative changes are noted. The intervetebral discs show multilevel degenerative changes. This is most marked in the mid cervical region. Primary problems are centered at C4-5 and C5-6 with other levels being generally uninvolved.
At C4-5 a 7.3 mm central disc herniation is identified with the cord markedly distorted and with a 4.5 mm AP diameter. Fat suppression sequences also reveal abnormal signal within the cord over a very short distance overlying the C4-5 disc. The neural foramina are normal at this level.
At C5-6 there is left-sided foraminal stenosis due to zygapophyseal hypertrophy primarily. The AP diameter is 7.1 mm but the cord does not appear to be significantly impacted.
Conclusion: The primary problem is at C4-5 where there is a large central disc herniation with cord distortion and abnormal cord signal. Separately there is left neural foraminal stenosis at C5-6 due to zygapophyseal hypertrophy. There are other degenerative changes as described above.

June 8, 2011 MRI:
At C4-5 there is normal cervical lordotic curve. The most prominent abnormality is a large 4.95 mm soft tissue disc herniation indenting and displacing the cervical cord posteriorly with underlying cord signal change suggesting some degree of myelomalacia. In the axial view, this disc herniation measures 7.9 mm. These measurements seem somewhat higher than the prior scan of March 4, 2011.
At C5-6, a minor 2.5 mm soft tissue disc is noted with disc space narrowing at C5-6 but does not impact the cervical cord. All other levels appear unremarkable. There is facet hypertrophy but no significant neural foraminal stenosis.
Conclusion: 1. Questionable increased size of the C4-5 disc herniation when compared to the scan of 3/4/11. 2. No significant change at the C5-6 level other than facet hypertrophy and minor disc bulge. No significant central or lateral canal stenosis or neural foraminal stenosis, even though there is moderate facet hypertrophy. There may be some underlying myelomalacia as a result of the compressing C4-5 disc.

So far I have seen both a neurosurgeon (with whom I have another appointment this coming Tuesday) and an orthopedic spine surgeon. You suggest that I should get opinions from at least four surgeons. Should that be with neurosurgeons or orthopedic spine surgeons? What are the most important questions I should ask?

I agree with you that the trip (or get in an accident) and become paralyzed argument may be scare tactics, but that does worry me. What I really still don't understand is that although the MRI reports seem quite serious, I don't have much in the way of symptoms other than the weird sensations in my hands, mostly my left hand. That also seems to get better depending on what position I am in.

Although I do not have many symptoms, is it possible that I am having nerve problems that will not be correctable if I wait a while?

My concern about having the surgery is that there is a possibility that if I have the ACDF the fusion will cause more problems, such as accelerated degeneration in the adjacent discs and maybe even more pain than I now have.

Thanks again for your input. I look forward to hearing from you again.
Erika

 
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