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    Old 03-15-2005, 08:46 AM   #1
    coach606
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    surgery for arm weakness?

    Hello,

    MRI shows a large herniation at c6-7 and an osteophyte disk complex at c5-6 with a spondolytic ridge and moderate central stenosis. 4-5 has minimal bulging.

    I had acute pain and numbness down my right arm starting in mid December. Pain was really bad for several months. Did traction and soft collar. Prednisone helped, then I reverted back to pain. 2nd prednisone helped again and since then, pain has gone down a lot.

    Basically, I only have pain and tingling/numbness intermittently. Usually only when walking a lot, up stairs, in the car, and it worsens as the day goes on.

    My worry is arm weakness. I can lift 30lbs with left arm tricep extension and only 15 with the right. I am right handed and used to be stronger with the right arm.

    DOES ANYONE have experience with the weakness getting better without surgery? Again, pain and numbness are livable and seem to be improving. I'm doing PT (just started). My OS suggests that less pain and continued weakness = nerve damage (possibly permanent). He recommends surgery around 3 months or nerve damage could be permanent.

    I just can't bring myself to sign off on the surgery when it feels so much better. So can ANYONE relay experiences about weakness getting better or staying the same without surgery? IT'S TOUGH TO KNOW WHAT TO DO or how long to wait. Since I can walk around without so much pain (finally) it seems ludicris to have surgery now. But I don't want a weak arm that never gets better.

    Lastly, I have gotten 2nd opinion. He says wait 6-8 more weeks with PT. Guy was pretty reknown (the whole spine clinic was named after him) but he was kind of a jerk and his clinic was a miasma of contradicting handouts of info and bureaucracy. Both NS and OS agree that surgery should be acdf at 6-7. No other options. NS says to go in and do acdf at 5-6, too. OS says to wait and he can always go back and do it later. Doesn't sound wise to me.

    I appreciate the help and advice. Tough choices. I hope everyone is healing up who's had surgery lately.

     
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    Old 03-15-2005, 09:07 AM   #2
    whackedback
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    Re: surgery for arm weakness?

    Coach -

    Please do your online research for ACDF's and also look at minimally invasive procedures as a possibility. There are some surgeons like Dr. Jho that specialize in procedures that are the least invasive, and had I known about him or other specialists before I had a 3 level ACDF done, I would have looked him up.

    Also, even if you did have a single level, it should solve your weakness problem. More PT has a chance of helping and definitely should keep your arms in tip-top condition, but sometimes, you just have to have the surgery.

    You are doing the right thing by not entering into it lightly, and researching what your choices are. Be sure in your internet travels to search on the above mentioned doctor and "minimally invasive" to see what good information can be found. Good luck to you.

    whackedback

     
    Old 03-15-2005, 12:09 PM   #3
    Sam43
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    Re: surgery for arm weakness?

    Hi Coach,
    I had a pretty similar situation to yours. Left side, C6-C7. A lot of pain when the herniation first occured, then it gradually got much more manageable, pain-wise. What led me to decide on surgery was the weakness and also some numbness in two fingers on my left hand. After the initial diagnosis, I did PT, waited about three months to see if it got better. The pain got better, but the numbness and weakness persisted. My NS first recommended ACDF, then changed his mind and recommended posterior foraminotomy, where they go in from the back of the neck, drill through the bone, and remove the herniation that is pressing on the nerve. Because I am not crazy about ACDF, I was glad to go this route. It went well. I still have symptoms such as some pain, and the numbness has not yet changed (doc says it might with time) but the weakness has improved significantly. Also, I have better reflex responses on the left arm, which means the nerve is in better shape. So I am happy with the results so far, and it's still pretty early on (surgery was in Dec.)
    It may be that ACDF is the best approach to your situation, but I would ask about other approaches. The PF is less invasive and probably has a quickier recovery time. I took about two and half weeks off work (in retrospect it probably was not quite enough!)
    My surgeon also recommended dealing with the most serious problem first, and waiting to see how the other levels do. I have bulges at other levels but such things are not uncommon, and fusion is forever. Better to wait until you're sure you need it, I would say. Also, some of us are hoping that artificial discs will be available before too long.

     
    Old 03-15-2005, 02:33 PM   #4
    dennisgb
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    Re: surgery for arm weakness?

    Hi Coach,

    I had ACDF with donor bone and plate at levels C5-6 and C6-7 on 6/30/04.

    I suffered for many years with the symtoms that you describe only on the left side. I did PT, Chiro, took steroids and had shots into the neck twice. This relieved the pain in differing degrees, but the weakness continued to get worse.

    The last 3-6 months I would feel okay for about an hour when I woke up and then be in terrible pain for the rest of the day. My left arm was about 40-50% weaker than my right.

    I have been doing strength training on my neck, shoulders, arms and lower back for about two months (supervised PT for six weeks, now on my own), and both arms are equal in strength, with reps increasing every day.

    I am essentially pain free, with some muscle spasms in my right shoulder coming and going when I over do things (especially long drives in car). Docs feel this will go away with strengthening and time.

    I feel 20 years younger and am very glad I finally did the surgery to fix this.

    Hope that helps you.

    Oh, I forgot to say, that I lived with this for almost 20 years. It wasn't diagnosed until an MRI about 10 years ago. It never go better, only worse.

    You can go for quite a while with non-invasive approaches, but this will depend on your age, how bad things are in there and how much pain you can take. When I came out of surgery, it felt so good that I couldn't feel where they went in. I only took one hit of morphine and they sent me home. The pain from the nerves was so bad that my body tolerated the pain from the surgery like it was a small cut on my finger. This is not true in all cases, but your body adjusts to pain, to the point that your really not aware of how bad it is. I could not take most pain killers due to alergies, and didn't want to take heavy duty stuff for fear of doing more damage.

    Dennis

    Last edited by dennisgb; 03-15-2005 at 02:42 PM.

     
    Old 03-15-2005, 07:10 PM   #5
    coach606
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    Re: surgery for arm weakness?

    Thanks for the info everyone.

    Sam,

    Can you tell what made the your NS change his mind from the acdf to the posterior approach? Two doctors said this wouldn't work for me because it's only in cases where the herniation occurs enough to the side.

    Sounds a bit like the arm weakness may hang around and get me to do surgery. Fusion just sounds so medievil. I think I'm too worried about having two levels fused. I'm only 33 years old. I'd hate to have a domino effect on my other levels.

    I think I'm going to look into Dr Jho and Dr. Schiffer. Minimally invasive, no fusion techniques would be great.

    ANYONE out there do Dr. Jho or Dr. Schiffer in San Fransisco?

    Thanks for all the advice.

     
    Old 03-15-2005, 07:57 PM   #6
    Sam43
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    Re: surgery for arm weakness?

    Hi Coach,
    My doc did say that my herniation was in a place where he could get to it with the PF approach. I believe that he also was taking into consideration the fact that I have problems at other levels. As you know, a fusion is thought to put more stress on other levels. I think he believed that the PF would address the immediate problem and postpone fusion, which might be necessary at some level in the future.
    It's a tough call. When I was considering ACDF, I certainly agonized over it, but I was set to OK it, until the other option was offered. I'm ten years older than you, and I thought I was too young for this! As these boards show, it happens to people of all ages. All I know is that the surgery I had did seem to help a lot with the issue of weakness.

     
    Old 03-15-2005, 09:05 PM   #7
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    Re: surgery for arm weakness?

    Hey Coach,
    On your arm weakness ask yourself--during the months you were in pain, did you favor that arm, do less, imobilize it and offset activity with the other arm doing more of the work? Sometimes people do that and the weakness presents because we subconciously take care of the hurt side. This could be one possible cause, aside from the regular conclusion that the nerve was the cause. I suggest this because you are so against surgery. If you can answer yes, maybe it is worth a wait to see if you can improve your strength. With reduced pain are you able to up your activity and progress each week? Most likely its the compression, but one can only hope!

    I also noticed you have moderate central canal stenosis, you didn't say if you have a congenital problem. I had a combination of problems, I have congenital stenosis, with a bulge, a herniation, forminal narrowing at the nerve root, cord compression and growing osteophytes all over. I ended up acdf C4-6. The stenosis jumps out at me as a question to talk to the docs about. If you don't fix the disk, there is potential to continue to grow osteophytes and further clog up the central canal and risk real permanent damage? Isn't that equal to worries you expressed about doing the disk, fusing and causing problems at other levels? Is the stenosis the worst at the level of the bad disk? Its like a crap shoot either way isn't it??

    Sorry, last question. What is your issue about fusion? I kind of looked at it like a broken bone healing, I didn't lose any range of motion so i am just more worried about it fully healing and permanent or long term relief from that horrible pain. The jury is still out, but I expected that with the combination of issues I had. The surgery itself was a piece of cake.

     
    Old 03-16-2005, 07:47 AM   #8
    dennisgb
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    Re: surgery for arm weakness?

    Coach,

    While the domino effect is a concern due to the fused levels putting more pressure on the others, my docs have told me that if I strenghten the neck and shoulder muscles, this will improve the chances that this doesn't occur.

    I am not one to like to do all of these excercises, but so far have been very dilligent and the results seem to be helping. I am in the best shape I have been in years, and getting better. It only takes a few minutes every other day, and makes me feel so much better.

    I was terrified of having the surgery, but now, I wished I had done it sooner.

    Everyone is different, but, it comes down to quality of life. I lost a lot of years that I could have felt much better.

    The choice will come to you at some point, particularly if things continue to get worse. There is nothing wrong with taking the time to see if the non-invasive appoaches can help you. In some cases they can.

    Dennis

     
    Old 03-16-2005, 07:53 AM   #9
    coach606
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    Re: surgery for arm weakness?

    Hey, thanks for the further input.

    My arm weakness seems to be just the tricep muscle. Bicep is fine so that's why I'm worried. But I think I may be having some weakness in my right foot now. It kind of flops a bit when I walk and I can push it down fairly easy. My father in law had a bulge in his lumbar and recently had surgery because of that problem. I guess I'll talk to the doctor again.

    My concern about fusion is really just the domino effect and the permanence. If you get a problem there after fusion it seems like you just have to deal with the pain. I read a few things about inoperable arthritis afterwards. And really, there are just too many people here who seem to have more fusions after the first one because of domino effect. I feel fairly certain that if I am fused at two levels at 33 I'll be having the surgery (pain, etc.) again.

    I'm really going to look into Dr. Schiffer and Dr. JHO. No one has responded as to their experiences with these minimally invasive techniques. So if you're out there, please drop me a line. I know Dr. Jho is pretty reputable and has helped some people. Don't know so much about Dr. Schiffer. But it sounds like it could help me.

    Man, the leg symptom is really scaring me. I'll have to make a decision soon. Hopefully I have some time to contact those other docs without too much worsening.

    Well, any info is appreciated! Thanks.

     
    Old 03-16-2005, 09:26 AM   #10
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    Re: surgery for arm weakness?

    Coach -

    Dr. Jho has a lot of positive outcomes. Don't know how many of them look at this site, but his site should pop up quite easily. There are other back sites that have a lot of people that can tell you about him. I know a lot of people fly daily to Pittsburgh to make use of his surgical team. I understand he has a tremendous waiting period for surgery. Also, he does examine your MRI films, etc. free of charge and will tell you flat out whether or not he thinks his MI procedures are a solution for you. I say it's worth the $ to FedEx the films for a consult, but I'd contact him first.

    My 3 level didn't work as well as I had hoped. I still have narrowing at C5/6 which is why my triceps are in pain all the time. I'm doing some light weights to keep them up as much as I can. I've got some spurs that were left or had formed during fusion.

    Another thing that might help you while you are doing your research is deep tissue massage. My NS recommended it, and it has helped me tremendously.

    Let us know how your research goes and the decision. Good hunting.

    whackedback

     
    Old 03-16-2005, 01:20 PM   #11
    dennisgb
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    Re: surgery for arm weakness?

    Coach,

    Consider that most medical web sites are hit by those who have problems they are trying to find solutions to. Those that have been fixed and on with their lives, probably don't come here (present company excepted). You are going to see and hear mostly bad results searching the web.

    The success ratios for ACDF are high. In the 98.5 to 99 percent. These surgeries are pretty well known and there are very good surgeons and techniques for this. I posted some studies on this some time ago, and could post again if you are interested.

    Dennis

    Last edited by dennisgb; 03-16-2005 at 01:21 PM.

     
    Old 03-17-2005, 04:16 AM   #12
    coach606
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    Re: surgery for arm weakness?

    Could you post them again? Sorry to be a hassle, but It'd really help me to decide if minimally invasive techniques don't pan out.

    Those are some pretty good statistics for success. I'm not so much worried about the rare problems, but about the domino effect stuff. My doctor says most people don't domino. I hear rates of up to 30-60% need surgery again within 10 years.

    Any stats would be great. Stats are really helpful to me.

    Thanks everyone. I think I just need to look into everything and then I can feel good about surgery if that's what I need to do.

     
    Old 03-17-2005, 08:48 AM   #13
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    Re: surgery for arm weakness?

    Coach -

    Dennis is right about the surgical outcomes. We are on these back support websites for one or more of the following reasons:

    1. New to back problems, being proactive in researching our condition.
    2. Proud owner of a failed back surgery. Looking for sympathy and possible solutions to the situation.

    I think that the majority of back surgeries go just fine. 95% of the stuff on the websites is because the people here have run into problems and are looking for solutions. That's what theses sites are here for, and they do help a lot of people.

    In my case, I've had a bad 3 level ACDF, but I've had 2 lumbar laminectomies that rocked. One of my childhood friends needed a single level ACDF like you, due to lifting her son quite a bit. She had the surgery, bought the t-shirt and has moved on, doing just fine.

    Coach, I think that since you are probably in the sports area (due to your handle) you will probably do better than most people. You will do your post-surgery physical therapy with dedication, and you will pay attention to what the doctor tells you not to do.

    But definitely look into not having to do a full blown ACDF if Dr. Jho's alternative minimally invasive cervical disc surgery (Percutaneous endoscopic anterior cervical discectomy) might do the trick.

    Good Hunting!

    whackedback

     
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