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    Old 10-20-2005, 11:49 AM   #1
    Read66
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    Cervical Discogram & Cervical Fusion

    I went to Dr. yesterday, he wants to do a discogram on my neck, most likely C5-6 and C6-7. I had a discogram on my low back, prior to surgery. It was soooo painful. I am really scared to get this one done. It seems like it could be even worse than my low back one.

    Anyone have this done? How was it?

    Also can anyone who has had a cervical fusion, share your story, wether it was a success, any problems and if you would do it again.
    Thanks
    Barb

     
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    Old 10-20-2005, 12:34 PM   #2
    motmcd
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    Re: Cervical Discogram & Cervical Fusion

    Hello Barb! I Had Three Level Cervical Fusion Done About 5 Years Ago. Been Through The Discogram And Everything Else And Believe The Knowledge Gained Outweighed The Brief Discomfort Associated With Such Tests. My Fusion Was Successful And My Recovery Was Easy. I Had The Three Bone Grafts Removed From My Hip And That Recovery Was Also Easy; Although I Hear Stories Where The Post Surgical Hip Pain Was More Problematic Than The Neck Part Of The Procedure. I Attribute My Speedy Recovery To My Determination To Get On My Feet Immediately, Avoid Pain Meds., And Sticking To The Therapy Regime The Doctors Prescribed. My Neck Problems Are Result Of Mt. Bike Crash Some 12 Years Ago. Make Sure You Get Second Opinion Before Undergoing Surgery. My Surgery Was Performed By The Tag Team Approach Where An Orthopedic Spine Doc And A Neurosurgeon Worked Together. I Highly Recommened This Team Approach. Good Luck.

     
    Old 10-20-2005, 01:33 PM   #3
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    Re: Cervical Discogram & Cervical Fusion

    I had a surgical consult today and the Neurosurgeon says he gets equal success with Allograft (Donor Bone) as Autograft (Your own bone). He does not use BMP in the cervical spine, but he does use Dynamic Plating. From what I have read about Dynamic Plating, if you are getting fusion insist on it and not Static Plating. It allows the plate to move slightly with the screws (I am probably explaining this wrong) whereas static plating the screws can break or come out. Anyways the important point is dynamic plating helps balance and distribute the stresses across the fused area better than static plating. I also asked about cages and he is not a fan of them in the cervical spine.

    The discogram is done as you know to determine if the disc itself is a source of pain. I have heard they are painful and I do not have so much pain that I have elected to do it. Have you had your facet joints tested? Usually Discogram is done after they test everything. It's my understanding (Could be wrong) that if the disc is the source of pain when they hit it with the needle and inject it you feel plenty of pain, if not then you don't. I find all needle proceedures uncomfortable but tolerable. But I could see no reason to do this one on me - yet.

    I agree with the second opinions. So far I have had 2 Orthopedic Surgeons and 2 Nuerosurgeons give me their opinion, and none were the same. I get my 5th and final opinon next week. Then I will make a surgical decision. How are we to know what to do when the doctors can not even decide what is best?

    I'm all out of 2 headed coins! If you choose to do the discogram make sure you have exhausted the other diagnostics first. Too bad there isn't one conclusive test they could do to isolate the source of pain.

     
    Old 10-20-2005, 04:34 PM   #4
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    Re: Cervical Discogram & Cervical Fusion

    motmcd and notpain

    Thanks for the input. Ya I know how painful the discogram is from my back, the two not damaged, no biggy, but the disc with the tear, hurt more than I can put into words.

    How do they test facet joints? Never heard of that before.

    My NS, same one that did my back fusion in May, is more against then for surgery, right now. He says because of the percentage for success is only 55%. It is frustrating, I am glad that I have a Dr. that won't rush into surgery. But a part of me feels like it is my last option. Over the past 9-10 years I have had numerous PT sessions, chiropracter, massage therapy, relaxation therapy, traction, injections, pain management and my pain is still at a 7 all the time and 3-4 times a week gets to a 10. Problem is my arm doesn't go numb or burn, but I do have pain down my left leg when my neck is at the pain level 10.

    If the discogram doesn't show a tear, my options are limited, I can try all the above again for the hundreth time, or take pain meds the rest of my life. Or I can push for the surgery and take my chances for it to be successful.

    I'm so conflicted with this, I wish someone could just tell me what's the right thing to do.

    Barb

     
    Old 10-20-2005, 04:38 PM   #5
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    Wink Re: Cervical Discogram & Cervical Fusion

    Hello, if your Dr. is suspecting surgery is needed, the Discogram is very good at giving them the exact cause of your pain. I had mine a few months ago and yes, it does hurt. But as the earlier post said, the benefits out weighed the pain, by far. My Dr. thought my pain was comming from my failed fusion and he was going to go back in and fix that area. The discogram showed it was the 2 levels above it that were causing the pain. Had I not had the it, I would have had the re-fusion and still come out with the same pain and had to go back for a 3rd surgery. The key is that you have to ask for "sedation". I say that in quotes, sicne they can't put you to sleep but they can give you a versed/fenatyl cocktail. (sp?) You really wont remember much of the pain, afterwards. The meds. relax you alot, but you are still awake. They also give you a temporary amnestia. (sp?)

    You will be sore for the next day or 2 afterwards, so plan on staying at home and using ice often. I remembered being scared to death and in tears while being prepped. (Then they put me into a deep sedation) and the next thing I remember was after the 1st injection feeling some pressure but no pain and going back to sleep. The second injection I felt more, and I remember after he was done w/ the 2nd shot (but before starting the 3rd) the Dr. asked me if I was still feeling any pressure and I was. So, he told the nurse to up the sedation and he wouldn't start the 3rd one until the pressure was completly gone. I remember the last disc was the most painful...but I don't remember the actual pain. (Just that out of the 3 discs, that one was the worst). Then I woke up and was in another room. I dont remember moving from one room to the other.

    If I had to do it again, I wouldn't look forward to it, but I wouldn't be as nervous and I would choose to do it.

    Good luck and keep us posted,

    Lorie
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    Old 10-20-2005, 05:45 PM   #6
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    Re: Cervical Discogram & Cervical Fusion

    Facet Joint Blocks are "Diagnostics". The do something called a sperling test (I may have spelled that wrong). Essentially the doctor pushes down on your head and twists to see if it causes pain. If it does then they suspect (No proof) the Facet Joints. Once they decide to do this proceedure it is essentially the same as the Discogram. It's done under Floroscopy (spelled wrong I'm sure). The physican sticks a needle into your neck deep enough to reach the facet joint itself (Needle to the bone). Then they inject anesthetic into the joint. You are awake but sedated during the procedure. For me they did only the right side (suprise joints on both sides) at C4/5 5/6 6/7. They stick the needles in one at a time and leave them. This is not pleasant but not as bad as a discogram hitting a source of disc pain. The whole process took about 45 minutes and was an outpatient proceedure.

    After the proceedure you are in outpatient waiting for about 3 to 4 hours. The doctor comes in repeatedly to ask you if you feel more or less pain. For me it was very little difference. My doctor also injected a "small amount of steroid" to help reduce inflammation in the joint if there was any. For me it made no difference, for some it can really help. Again this is only a Diagnostic like the Discogram and does not "fix" anything. If it does work for you - you may experience pain relief for a few days after the proceedure as well. Once the doctors are convinced it works (that means you tell them it works because you are in less or no pain afterwards) the follow up is called a Rhizotomy or Denervation. They burn the nerve by heating it to 90 degrees celcius. They can also freeze it I understand. This essentially "Kills" the nerve right at that spot. This will last anywhere from a couple of months to a year or more. Seems barbaric but so is slicing open your neck, chiseling out a spot and hammering in and ADR or screwing in a metal plate and someone elses bone.

    You would think with a multi-trillion dollar budget and an expected rate of 80% back problems among the population in general someone would be dumping some serious research dollars into spinal problems. Doesn't seem to be the case. Have you ever wondered why the wait to see a Neurologist or Surgeon can be months? Because there are so many suffering. And before each of us had our own unique spinal problem did any of us really know anything about it? Did we know we were hurting ourselves by our daily activities. Nope.

    So the important thing here is - back on the subject, to have a postive sperling test so you don't waste your money, time, and effort on a proceedure that may not work. If the doctor suspects your discs as the source of pain you are probably down to the discogram. And if it's postive you have two choices - live with it, or have the surgery. And those are choices none of us really want to make.

     
    Old 10-21-2005, 06:20 AM   #7
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    Re: Cervical Discogram & Cervical Fusion

    Read 66: I Find Your Neurosurgeons's Comments Interesting Regarding Success Rates For Cervical Fusion. I Know Lumbar Fusions, For Some Obvious Reasons, Have Much Lower Succes Rates Than Cervical Fusions; However, I Believe Your Chances For A Successful Outcome Are Appreciably Higher Than What The Ns Is Saying. Surgery Is The Right Choice Sometimes And That's Why I Emphasize Your Need To Follow Up With 2nd And Even 3rd Opinions. Don't Misunderstand What I Say. I'm Not Promoting Surgery As The Solution. A Conservative Approach Is The Best Way; However, Using Various Information Resources Such As Healthboards And Seeing Other Doctors Is The Best Way To Get A Full Understanding Of Your Individual Medical Needs. Surgery Wasn't Optional For Me And Hind Sight Being 20/20, I'm Glad I Didn't Have To Make The Go/no Go Decision On Surgery. Hang In There!

     
    Old 10-21-2005, 09:40 AM   #8
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    Re: Cervical Discogram & Cervical Fusion

    Keep in mind Successful Fusion doesn't mean relief of symptoms it only means the bones fuse. So 90% fusion is a good rate, but the better rate would be 100% relief of symptoms in 90% of cases. And that doesn't happen. Stats are just stats, what matters is if you heal and if you resolve sysmptoms.

     
    Old 10-21-2005, 11:26 AM   #9
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    Re: Cervical Discogram & Cervical Fusion

    Thank you all for your imput. Ya my NS gave me better percentage for success on my back then he is giving on my neck. I am thinking about another opinion, This NS is supposed to be one of the best in Phoenix. I have also heard from other docs and my PT that the cervical fusion is much easier to recover from and better success rate than back, so I am a little confused. And heck I made through the back fusion, this one seems like a piece of cake. That is if I knew 100% it would help. I really hate this decision, guess we will wait and see what the discogram shows.

     
    Old 10-21-2005, 11:51 AM   #10
    motmcd
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    Re: Cervical Discogram & Cervical Fusion

    Notpain: What Are You Saying? You Lost Me.....90% Fusion.....the Fusion Of Bone Material Isn't The Cure For The Pain. It's The Proper Spacing And Geometry Established By The Surgeon And Maintained By The Bone Placed Between The Vertebrae. The Plates And Screws Are Added For Stability Until The Bone Fuses. This Hardware Could Be Removed Once Fusion Is Achieved, But Is Left In Place To Avoid The Additional Surgery That Would Require. A Successful Procedure Is One Where Complications Are Avoided -- Or Successfully Resolved -- And Relief Of Symptoms Is Achieved For The Patient.

     
    Old 10-21-2005, 05:49 PM   #11
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    Re: Cervical Discogram & Cervical Fusion

    The studies I've read say 90% or maybe just above 90% of fusions are sucessful (Meaning the bone will fuse). And yes it's my understanding they can remove the plating later. I read that the rate without plating is in the 70% range. So plating is a good thing.

    What I meant was 90% fusion does not mean 90% relief from symptoms. Success to me is relief of symptoms not just fusion. I have been told I can have the fusion and even if I fuse my symptoms may not go away because they can not pin down the actual cause. It's probably my neck but not guarnteed. Nerves cause pain and hopefully opening up the spaces and restoring normal disc height will take the pressure off of nerves. But it isn't a guarntee. Hope that makes sense.

     
    Old 10-22-2005, 07:17 PM   #12
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    Re: Cervical Discogram & Cervical Fusion

    Hi, thought I'd put in two cents, due to Scoliosis my spine has both front to back rotation and 'S' curvatures, the worst being in the cervical and thorasic areas, the lumber was about 7 degrees less.

    I suffered the most pain in the cervical and thorasic areas including headaches and radiating pain, tingling and numbness down my arms. Tho, at times when it was greater then a 15 (pain level) there was lower back and leg pain along with numbness, too.

    The MRI showed bulging and herniated disks, in both the neck and through the thorasic areas, along with the twisting of the spine: bulging at C2, C3 & C4, herniated at C5, multi-levels in the thorasic...)

    So, to make a long story short, in 1994, I had a spinal fusion from C7-L4, using bone grafting from my hip. The Orthopedic Surgeon, chose to leave the neck alone, stating after surgery, the reason and also, "I can't guarantee that you won't be back again for a cervical fusion."

    My initial recovery was 2 years, after there was remnants of pain in the neck and upper back area, I found muscle relaxers worked to eliviate it. But it seemed like periodically, I would be put down again.

    I did work out and was in great shape, I no longer popped my spine, that is good. But, still endured the cycle of pain (that I thought surgery would take care of).

    I orginally thought maybe atrophy set into my neck and upper back muscles from lack of use during recovery. But, it lasted for 10 years!

    After getting sick and dx'd with FMS/CFS and then CMP (Chronic Myfascial Pain) in 2004, I found out the real problem, CMP. It also may have caused the Scoliosis. I started PT and Massage Therapy, haven't taken a muscle relaxer in a year and my therapy team never have put me to bed (additional pain bc of treatment.) that used to happen every time!

    My neck and back are doing great, now, even have more rotation then prior to the fusion, unbelievable, huh!

    I wish you the best, and hope that it isn't too late for a complete recovery, I'll pray for God's healing hand to be with you. uvm

    Last edited by ukiahvalleymom; 10-22-2005 at 07:22 PM. Reason: correcting sentence

     
    Old 10-23-2005, 12:16 AM   #13
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    Re: Cervical Discogram & Cervical Fusion

    Wow, you've been through alot. I am glad you are doing so well now. I can't imagine recovery from that many levals fused.
    And thanks for the prayers, I need all I can get.
    Barb

     
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