ACDF help, do I or don't I - Spinal Cord Disorders Message Board

PDL57 · 09-13-2003, 05:44 PM

Two neurosurgeons and an orthopedist have advised ACDF. I have two cervical disc compressing spine cord by 40%. I have had nerve conduction tests, mylogram, and MRI's to confirm. They advise due to spinal cord compression and the possibility of some paralysis if I would fall or be involved in a accident. They termed it "very serious". Previously in 2000, I had lumbar laminectomy and discectomy, very successful. The issue is that I feel 90% well. Very little pain and that is sporadic. The worst I have is numbness in right forefinger and thumb. I cannot bring myself to go through with the operation knowing that no surgery is always 100%, nor do I want to suffer any paralysis from a minor fall. I have two kids, 6 and 8, male, age 46. I would like to here from others in this boat. Thank you, great board, I am new to it.

DepecheJan · 09-13-2003, 06:59 PM

Hi PDL57!

I am in the same boat as you. I have a moderate to severe herniated disc at C5-6, with spinal cord compression and nerve root impingement. My pain is also not that bad. I do have a minor loss of strength in my left arm, some shakiness in my left hand, and some occasional tingling in my left arm. All and all, very tolerable for the most part. I have been to two NS, both have recommended ACDF. I didn't like the first NS--made the surgery sound too easy. I liked the second--he told it the way it is. Problem is that there are so many different schools of thought. He said that some doctors like to do surgery at the first sign of symptoms (because they have the best and quickest rate of recovery) while others won't operate until the patient is in dire pain. The first NS scared me with the paralysis thing. The second said that yes, I am at an increased with, but it would have to be a serious trama for me to be paralyzed. The second NS said that in ~6 years, the disc could be reabsorbed back into the body. My other predicament is that I am a 33 year old female. My DH are ready to start a family and getting pregnant now could exacerbate my symptoms and force me into surgery. I am 33 so I don't have many years to put pregnancy off. Surgery is a hard call to make. As you may read here, a lot of people have had a very difficult time with it and took a long time to recover. Some people's symptoms have been made worse post surgery, although some surgeries have been successful. All and all, I guess you have to weigh everything out and figure out what is best for you and your family.
I assume at this point you have already tried conservative treatment and it was unsuccessful, correct? Have you checked into artificial disc replacement? It is only available in the United States right now in clinical trials. Sounds very promising. Rather than using donor bone or hip bone to replace the disc, they use a prothesis made of titanium and polyurethane. The prothesthetic disc is similar to your own disc. When they use bone, they want the bone to fuse to the vertebrae. To help the fusion along, most NSs use a plate with screws. When that area is fused, you lose a little flexibility and more pressure is put on that area so more people are at an increased risk of blowing the discs above and below. All of this is eliminated with the ADR. The 2nd NS I went to was part of the clinical trial. I wasn't allowed into the trial because I am not in enough pain. The ADR should be approved in the next 2-3 years. Anyway, just mentioning it in case you are interested. You can try to get into the trial and or maybe check into it if you have the option of waiting for surgery.
Anyway, I am sorry if this isn't helpful. I completely understand how you feel. I teeter all the time with surgery. I am actually going to an orthopedic surgeon on Monday to get a third opinion. If you decide on surgery, make sure your doctor is someone you trust and feel comfortable with. I would also check their credentials to make sure they don't have any lawsuits pending against them.
Good luck with everything and let us know what you decide. If you proceed with surgery, we are a great prayer and support group.

Take care.
Jan

luvwindnhair · 09-13-2003, 07:21 PM

Hiya and welcome PDL57~

I am now 4 weeks post op ACDF of C6-7. I Have no regrets. My pre-surgery pain was also minimal. I had a hard time justifing the need to proceed. But I was also afriad that I would get in that "accident" and end up with paralysis too. Now that I have had the surgery, which by-the-way, they did use my hip bone to graft, I feel great. I have severe compresion of my nerves in my lumbar spine also. This I have had the discectomy/laminectomy on 3 yrs ago. Now I am waiting for my neck to heal so I can have my lumbar fusion. I know its a hard decision to make, and I think that when you are ready, you'll be ok with it. The best thing to do is find the right MD, that can make all the difference in decision making. Some people are happy to not have it, others like me, will never look back. Good luck, oh and I am young too, 38 female. Terrible thing to feel so old.

Tah Tah Cindy

------------------
L5/S1 herniation 7mm 01/18/00
Microdiscectomy/Laminectomy 10/12/00
Thoratic pain began Dx buldge @ T-8 08/02
Had MRI on Lumbar because pain was returning, also scaned T spine 8/02, Dx recurrent L5/S1 herniation and new herniation @ level L4/5
Cervical pain began 2/03
Had MRI~Dx herination @ level C 6/7
Had anterior decompresion with hardware and use of my own hip bone graft to C 6/7 8/14/03

PDL57 · 09-14-2003, 03:38 PM

Jan and Cindy - Thank you both for the thoughts. I have been sitting on this fence for a few months now, and I probably will stay on it until something forces me off. Please post or reply how you are doing and Jan, if you do have it, pleae post. Best of luck!!

Sprytle · 09-14-2003, 07:37 PM

PDL57-

I had a 3 level ACDF just over 1 year ago. I had very little pain, but had no temperature sensation in my hands. The big thing my doctors told me was that if I was involved in a car accident or such, I could end up a quadriplegic.

There are some web sites I could point you to, but I can't, due to the rules. But there are doctors that perform minimally invasive surgeries, especially in the neck area. One of these that people from around the country go to see is Dr. Hae-Dong Jho (drjho for short) who runs The Jho Institute for Minimally Invasive Neurosurgery in Pittsburg, PA. He does review your MRI's at no charge and will tell you if he believes his minimally invasive procedures are the correct method of treatment for you.

I was looking at his web-site earlier, and the specific cervical procedures he offers are Cervical Stenosis Surgery without Bone Fusion ; Minimally Invasive Cervical Stenosis Surgery (The Jho procedure for cervical stenosis): Spinal Cord Decompression via Anterior Foraminotomy for Spondylotic Cervical Stenosis, or Ossified Posterior Longitudinal Ligament (OPLL).

BTW, it seems we are related. I had a lumbar laminectomy back in 2000 as well. It was my first back surgery and it went off without a hitch. Then I had this neck procedure. I wish I knew about the minimally invasive surgeries before I did it.

I would offer to you that you should investigate any opportunity to avoid fusion, if possible. If you can't avoid fusion, come back to this site, and let us know when you're having the ACDF. You will get at least a dozen lists on "what to do" before and after the surgery. I will tell you that the lumbar sugery is a piece of cake compared to the cervical.

We wish you all the best in your research. Know as much as you can before going into this.

Sprytle