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  • Spinal fusion ... Anterior Cervical Discectomy

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    Old 11-17-2007, 07:08 AM   #1
    Julie1119
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    Spinal fusion ... Anterior Cervical Discectomy

    Looking for advise ... My husband was diagnosed with 3 herniated/bulging discs affecting C3-C7 (Extensive detail can be provided, if needed). C5 is the major culprit, bulging "moderate to extreme" to where there is no fluid passing on one side. The other buldges are "moderate".

    His symtoms are numbness/tingling on right side from right nipple to the toes; this has been since May '07. Initial diagnosis was MS, they did an MRI of the lower back and brain. Which then eliminated MS theory. They finally did and MRI on his neck. When the neurologist first saw the MRI, he recommended surgery "immediately". Then the neurosurgeon came in an said, well let's schedule for Dec. 18th where they plan to remove the disks, place spacers, then titanium plate and add bone graft, then add a halo. In the mean while, they decided to schedule a meeting (11/19) with the physical therapist for possible traction. (Holy crap, first it's drop everything and surgery is today, then it's "okay" to have a therapist touch "try". Sounds risky?!)

    Given the symptoms, shouldn't someone have been looking at the neck vertebrae initially? ... This has caused me to lose faith in these Drs. and our heads are spinning trying to find the right path for the best care. The main questions we have are: 1) Is it safe to wait with the bulging c5? 2) Is traction therapy safe? 3) What facility is the BEST in SE-Wisconsin in working with spinal issues? 4) What risk factors are involved with the procedure?

    I'm trying not to get too detailed so I'm probably missing something ... So any other advice would also be appreciated!

    Thanks in advance.

     
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    Old 11-17-2007, 08:02 AM   #2
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    given the situation,personally,and this is just strictly my opinion,but i would think even trying traction on him to be potentially dangerous,not that surgery isn't,but anytime you start moving a disc around(espescially when the compression is so heavy as with your hubby)using traction,it would be considered a 'blind' adjustment?meaning they cannot actually see what is truely going on within that area or if the traction could be making things worse,you know what i mean?i,myself,just having actual spinal cord injury(just knowing what can happen when the cord gets damaged),this would really be too scarey for me to even think of having.there are just too many uncontrolled random things that could take place within that spinal area that would not be seen while doing type of thing?if all he had ws a herniation without the spinal compromise going on to the extent he has,it would be a whole different story.but this is kind of a dangerous situation for hubbys cord right now.i can totally see why these docs have you wondering.

    my best advice to you would be to go to the nearest university teaching type hosp and get a second opinion before anything actually gets done on him.you DO need to have more than just these docs opinons on something like this.for my spinal cavernoma i went to the U of MN here and was sooo thankful i did.i ended up with the head of neurosurgery doing my surgey and it was a huge thing for me since the other two NSs i had seen before him really did not understand about how freaky these little globs of vessels could be when they are in your spinal cord.this man had over 30 years of experience with what i had. that is what you really do need here the most,knowledge and experience with whoever you decide to go with.but you DO definitely need more than this these docs opinions.its just something anyone should do for a more in depth type of surgery.but honestly,if you can get to a university teaching hosp,they just really know their stuff at these facilitys and are usually on the more cutting edge when it comes to procedures and the less invasive types of surgical intervention.

    just wondering what your hubbys MRI states exactly about that area where there is no CSF flow?any myelomalacia?if you could just state what the summary states at the very end of that report,it really would be helpful.just trying to understand the extent of compression.

    i would really try and hold off on that traction til you have at the very least,consulted with another experienced knowl;edgable neurosurgeon.once certain things are done,they just cannot be undone,you know what i mean?you just really need to find out the full story of risks and how this could go if not done exactly as they plan.or if it should even realistically be attempted.please let me know that info,it would help alot.thanks,marcia
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    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 11-17-2007, 10:32 AM   #3
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    MRI of the cervical spine with and without contrast:
    C2-3 Small to moderate sized left paracentral disk protrusion with a small inferiourly extruded comonent. This does not compress the cord. There is bilateral moderate hypertrophic facet arthropathy and mild bilateral neural foraminal stenosis. The midline AP dimension of the spinal canal is 10 mm and there is not appreciable cord flattening.

    C3-4 There is a minimal broad-based disc bulge and mild right and moderate left hypertrophic facet arthropathy. The midline AP dimension of the spinal calan is 10 mm at this level, and this level is notable for a small area of intrinsic cord edema eccentric left within the cord measuring 5x8 mm in AP and height dimensions, and best appreciated on teh sagittal T2 and STIR sequences.

    C4-5 Minimal posterior broad-based disc bulge and mild to moderate facet arthropathy with some unsovertebral spurring. There is mild bilateral neural foraminal stenosis, but no central canal stenosis at this level.

    C5-6 There is a large broad-based disc protrusion centered in teh right paracentral region with extension into the right interforaminal region as well as the posterior central disc area. There is also a small to moderate right paracentral inferiourly extruded component. The AP dimensions of theis disc protrusion is as great as 6-7 mm, and there is some moderately severe impingment involving the right c6 nerve, and there is mild to moderate mass effect on the cord with a midline AP dimension in the vicinity of 7-8 mm. THere is intrinsic cord edema involving the left aspect of the cord, there is the suggestion of very mild far left lateral enhancement.

    C6-7 Moderate-sized broad-based disk protrusion slightly eccentric right. The midline AP dimension of the spinal canal is 8 mm and there is mild cord flattening. There is mild impingement with respect to the right C7 nerve and its intraforminal course.

    There are levels of mild bilateral neural foraminal stenosis as discussed above.

     
    Old 11-17-2007, 11:28 AM   #4
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    i see no need for a halo....that's usually only for patients with fractures of the cervical vertebrae....seems to me from the mri that c5-6 and c6-7 are the problems....traction is not all that dangerous...i i actually knew someone who swore by it.....i'd say time to find a new surgeon...cause i don't know why your husband would need cages.....i had an acdf in june of 04 for c5-6/6-7 with donor bone and a titanium plate.....left the hospital the next morning no collar no meds......had a tough time sleeping but some xanax and ambien cured that right up.....my neuro symptoms are cured but i'm left with varying degrees of neck stiffness....please excuse my spelling i had one too many last night

     
    Old 11-17-2007, 11:52 AM   #5
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Thanks for the replies, your opinions are helpful.

    We have set up a 2nd review. Our homework (so far) indicated Froedtert to be a teaching institute; though we have to wait until Nov 30th to see them. I've also heard good things about the Bay Group that offers less evasive procedures...?

    In the mean while - the first doc has already set up the surgery, contacted the blood center, etc. They are recommending the acdf from c3-c7... but like I said, the current doc seemed insistent and hurried to do this, and we're questioning the whole deal right now; aside from the MRI evidence.

    Faubs110- Young and healthy I imagine, that sounds like an unusually fast recovery. Did you have a similar diagnosis with the body numbness?

     
    Old 11-18-2007, 07:39 AM   #6
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    what would increase or decrease any real risk or danger in having traction really comes down to the level of injury and the extent.if this was just bulged or herniated discs,it would be pretty straight forward,but with your hubbys issues.i really would hesitate to even go there.my father used traction on his neck and had no issues,but he only had one actual herniation that was not compromsing the cord either.what happens when that traction releases and that force gets placed back on the area of cord compromise?its things like this that you need to always be thinking about when any doc offers any types of interventions or treatments.traction just gently 'pulls" up on the spinal column so it IS changeing it to some degree and like i said,its that 'blind' aspect and the many factors your hubby has here that are just not controllable that would really make me stop and think very hard and ask one hell of alot of questions before i would let this take place.the better informed you are about what your hubby is actually dealing with the better for you and him.

    i would very very highly advise you to satrt looking at info on the cord and when edema is taking place so you have an idea of just what is really going on inside him at this point.its just that actual cord edema does not happen unless there is some level of small vessel compromise or even breakage.it is the fluid within the small vessels that actually create edema in any area of our bodies.or if there is just a constant pressure/irritation/inflammation,this will also cause edema.its just something that needs to be "gone" from his cord.there is also a very thin artery that runs on the anterior part of the cord that is right between the discs and the cord itself.it is the anterior spinal artery.this could possibly be compromised as well given where this compression is actually located.any edema more than 1 cm in size is considered a 'large' involvement of cord substance,but hubbys really sounds much smaller than that.when it states that it is actually 'intrinsic",it really just means(kind of good for him actually) that the edema is very localized and not widespread thru other areas of the cord.

    i am just wondering if they have him on any steriods in trying to manage that edema in some way?they realistically should be attempting to keep this to a minimum and something like prednisone or medrol would at least possibly help with the inflammation that is actually causing the edema.if he is not on any now,i would really ask his NS about it.just something to consider that 'could' help.but removing the compression would of course be the best possible way to do this.

    i am very glad you are seeking out another opinion,you/he really DO definitely need to do this.you just need to speak with other NSs about possible surgical interventions that will cause him the least amount of future and current problems.is you hubby having any brain or neuro symptoms other than what you have already stated?

    you know,what you asked originally about them probably have gone to looking at the spinal possibilities first?i do agree on that one.i am a bit suprised they didn't start there given his symptoms.there are just sooo many people out there who do have some pretty bad spinal issues and some don;t have a clue as they have not 'presented" themselves yet,you know what i mean?realistically,i know my primary would have sent me for at least an MRI of my c spine for my types of symptoms cuz thats what he did(with neuro symptoms,certain types,the spine is usually the first place to look.then the brain).i just didn;t have a freaking clue that there was this little glob of blood vesels lurking inside my cord at the c 8 nerve level,kind of right under where my herniated disc was,so luckily it showed up on that MRI as an incidental finding.i had no idea what was going to actually end up from that little incidental crap.its been a road.

    good luck at that appt and i hope they can offer him some better ways of doing things for him.but i do highly recommend to you that you get as much info on your hubbys situation as possible right now,so you can prepare questions for this doc and just to really understand the risks and implications of what he is dealing with.believe me,it keeps you from feeling completley left out of the loop when the docs start talking about things you really have never heard about before.this really is what helped me the most while i have navigated thru one medical nightmare after another with me and my youngest son as well. inform yourself,K?i do wish you luck and please keep me posted on how things go.Marcia
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    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 11-18-2007, 05:02 PM   #7
    faubs110
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    young and healthy yes but i will not lie to you....my recovery was long....i didn't feel normal until the 2 year mark....to be honest i still am always stiff...if i had to do it again i'd run straight off that operating table back home....my neuro symptoms was major strength loss in my right arm mainly the tricep.....had my surgery 1 month from my initial dr visit...i've had to give up certain things i loved and have to be careful with every thing i do...plus the dr's did something to my nerves cause i pee every 1-2 hours and no medication has worked....i've seen drs all around nyc and they're still scratching their heads.....if he can live with the pain do so....if not try the endoscopic way or artificial disc.....i went into this surgery with eyes half open doing no research whatsoever and i paid the price 4 it

     
    Old 11-19-2007, 12:19 AM   #8
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Julie - lots of people try traction, in general, it is most successful with smaller bulges. It won't fix hypertrophic facet joints, facet arthropathy, nerual foraminal stenosis (and in fact might actually irritate the nerves more from my experience). With a significant nerve impingement like he has - traction might increase symtpoms terribly - I lived to tell about it :-0

    I too don't understand the halo, ( hard collar yes) for lots of weeks to couple months. Only doc knows what he needs. I would not run from surgery, looks like there are some serious problems looming and just go in understanding he may not be pain free at end, but at least they can prevent a major problem and hopefully reduce pain or symptom levels.

    Usually when there are so many levels involved less invasive options get ruled out. Try a phone consult first with them evaluting MRIs, my guess is its a no, but I am not a doctor.

    Finally, I am fused with plate C3-7. I am not pain free, but better than originally. I have minimal loss of range of motion - almost unnoticeable unless they measure it.

    If he does procedure - conservative action is good after. No matter what surgeon says - especially that first year. An ounce of prevention is best, that means treat your spine with care, you only get one.

    Keep in touch.

     
    Old 11-19-2007, 05:28 AM   #9
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    This site is amazing and your replies have been very insightful - THANK YOU! As I read through the threads, it's obvious to gather as much knowledge as possible so we can make objective-informed decisions. You should all feel wonderful that you offer your time and cumulative knowledge to others ... obviously it has been a long road with your own recoveries; your pain, life-lessons, and pay-it-forward attitudes are a blessing to people like us starting this crappy journey.

    If anyone has decent list of the "right" questions to ask the NS, we would appreciate some help -- there's always that line where don't know what you don't know .... ya know?? And what type of answers do you run from??

    My husband will be seeing the PT today for evaluation; with caution!! With the advice you've given he will likely decline notions toward traction therapy, but he (duh!!) looks forward to some other remedies to interim relief.

    He has started taking the steriod therapy - a course of Methyl Prednisolone for a week was prescribed by the NS. Neck and foot massages also offer some relief; though his major symptom is numbness, headaches are coming on more and more. The foot massages seem to "awaken" his feeling to some extent; hopeful this helps re-sensitize the nerves... cuz it kills my hands - a small price to pay.

    About my husband: He is 44 and has always been in decent shape; other that suffering from IBS for the last few years. They were never able to diagnose why he has this... We know in most cases they don't; but now I'm wondering if ISB might have been his initial symptom from the spinal issues??

    Until May he was active -- workouts 3/4 times a week in Taekwondo, then the numbness suddenly (really, just one day he raised his arms up and tightened his body during a salutation type-form and it happened). Since that moment he is finding himself unable to comprehend what his right side doing. The physical atrophy has prob taken the biggest toll; he has also always lifted weights regularly and found his strength and balance are limited greatly, so now he isn't touching them.

    Before the MRI diagnosis, I tried to get him into some tai-chi and yoga exercises - but again he was frustrated with the lack of balance and comfort doing these. It will be interesting to see what the PT says: my thoughts lean toward him doing whatever he can to get stronger over the next 30-day (preop time) to help with postop ... (this is presuming he DOES have surgery) But he makes all teh calls - I'm not the one physically living through this. He's simply overwhelmed at this time dealing with the doctors, getting things in order, etc. and needs people to help dig for more knowledge/power over the situation. Eventually, I'm betting he will pipe-up and write himself ... for now it's just too much - so I'm his advocate, I relay the threads to him then he's like "okay", "interesing", "good".... "chit" ... "figures", "yup", "nope" etc...

    Thank you all again for the thoughtful and logical responses; WE much appreciate this !!
    Julie

     
    Old 11-19-2007, 08:49 AM   #10
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    i really am so sorry you two are in this situation.it does just suck.what you asked about the possible IBS stemming from his spinal issues?that is a very good possibility,it all depends on just what cranial nerves and spinal tracts have become involved.you have to remember that all signals from all bodysystem functions just DO run thru that spinal cord ya know?i am willing to bet just based on what you have described as signs and symptoms,his balance issues could very well be stemming from some level of affectation of whats called the spinocerebellar tract within his cord.i had 'prioperception' issue with my legs and was also told by my NS that because of where the little glob of blood vessels sat within my cord,i would probably wake up from surgery not being able to tell where my legs were.scarey crap there.this was becasue they had to go thru the spino cere tract to get to my cavernoma.my main area of damage was in the spinothalamic tract which affects body temp regulation and you actually being able to tell hot from cold or feel surface pain?tho i retain the ability to actually feel even fine touch in my affected area,i just cannot tell those things anymore.really creepy actually.but this all stemmed from specific types of spinal tract damage and specific nerves that were damaged.

    unfortunetly i don;t have alot of time here this morning but will try and get backhere tomorrow with more info and the question stuff,K? just take everything slowly here and ask questions,always ask questions,you are entitled to the answers espescially when dealing with what your hubby currently is.any NS who wont take the time to answer the questions for you,honestly,i wouldn't go there.i am glad to see they at least have him on the medrol.i am actually taking this as we speak for my torn rorator cuff(new nightmare to deal with now).it should help the edema some.if it doesn't there are higher doses of pred availiable for him to take too.sorry i have to go now.but i will be back.hang in there.Marcia
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    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 11-26-2007, 09:03 AM   #11
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Faubs110--

    Sorry to hear of your ordeal.....I am too am in NY and checking NS's in NYC and closer to home (nassau county)...I am getting as many options as Dr's visited, fusion, artifical disc, dissolveable plate....and noone can explain my symptoms----muscle twitches (fissiculations) and left side weakness, but no pain....I am curious as to who you saw, and who performed the procedure...

    I hope you start feeling better real soon-----stay positive, and check in to this site often---it's extremely helpful.........Take care .....Doug

     
    Old 11-26-2007, 05:41 PM   #12
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Julie:

    The numbness is a signal, from what I know, that you need to act fast. If PT does not relieve it surgery is necessary to stop any permanent nerve damage. I had numbness in my left hand and let my bad primary care try to treat me with pain meds. Long story short it took 3 years for me to get to the surgery point and the numbness got better but never totally went away.

    Are you near the UW? If not, and you are more central, what about Marshfield?

    I can tell you that from what I see in all your informaiton an ACDF is appropriate but the halo seems unnecessary. I had an aspen brace for 6 weeks and I highly reccomend some type of neck brace after surgery.
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    Old 01-08-2008, 06:45 PM   #13
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Thank you for your input, this site/information helped us greatly in getting the right care and providers. Reading all the other posts was incredibly educating and I truly wish everyone the best recoveries.

    Update... surgery was performed Dec.17th.'07. c3 through c6 fusion. The neurosurgeon determined to go through the back and straighten everything from there (genetic straightening of the neck that needed to be put back into a curve would resolve most issues), remove spurs, add a plate/screws, etc. If necessary they would "flip him" and continue through the front - ultrasound during surgery showed they did not need to this.
    The immediate response after surgery was amazing - the numbness on the right side completely subsided ("pinch me" one hour out of recovery). No more burning feet. They released hubby the next morning. Pain management: includes: 2 morphine slow-release per day, valium every 4-6 hours, oxycotin every 4 hours, patches for direct relief, and tylenol as needed.

    {I left out all the dreary details on this ... it has not been easy as most of you know. But if anyone really wants/needs to know, ask ... I'll try to check the posts and answer somewhat timely.}

    It has been a l-o-n-g three weeks. The meds are still needed constantly for the stiffness/pain in the neck; I worry about addiction. The incision is healing nicely. Sleep is a favorite pasttime and atrophy is seemingly a necessary part of the healing process. Therapy is scheduled to start in a few weeks.

    On January 27th, we'll see the ns for an eval and find out exactly how "successful" this was. In the mean while, I'll continue my education reading the old/other posts... Thanks again!

     
    Old 01-08-2008, 09:22 PM   #14
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Thank you for posting your status, I remember everyone I talked to. I hope you are getting a little rest yourself.

    However, it is time to get hubby moving. If he had no complications, I think it is time. Nothing dramatic, but he needs to get up and sleep less and take on a little more activity like very short walks to mailbox etc.. The longer this gets postponed the harder the road back. His meds are on the heavy side and not helping activity. He should do whatever the dr. allowed him to do. The posterior surgery is a little more difficult than the anterior (front), but by three weeks, I would imagine he should be a little further along and need a little less meds. I hope someone that has posterior recently will comment on this.

    Have you tried cutting out the morphine slow release? Oxy is strong and with valium on top might be able to handle the pain. Actually by now I bet he is feeling more spasms than stabbing or burning type pain and bone pain in neck should be starting to feel better, etc. You can't just stop the morp, he has to wean off it, but I am a little worried that the medication list is a bit stiff - especially hearing about the great results already noticed. I took Kadian, a slow release morphine and it absolutely put me out, and I was at a low dose. I didn't like it at all, I weaned off over a couple days by slowing increasing the hours to dose and eventually stopping. The other meds should kick in and be enough by now - I would hope? Comments from a posterior surgery person!!!!!

    Just because they prescribed it for the whole time doesnt mean you take it for the whole time. You might try a gentle conversation with your husband - he might have some fear of not using the meds. The pain is horrendous and that puts a little fear in our minds that it will come back. Even if you just get rid of one that would be an accomplishment before the next dr. appt.

    Good news Julie1119!

     
    Old 01-10-2008, 02:49 PM   #15
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    Re: Spinal fusion ... Anterior Cervical Discectomy

    Quote:
    Originally Posted by the hittman View Post
    Faubs110--

    Sorry to hear of your ordeal.....I am too am in NY and checking NS's in NYC and closer to home (nassau county)...I am getting as many options as Dr's visited, fusion, artifical disc, dissolveable plate....and noone can explain my symptoms----muscle twitches (fissiculations) and left side weakness, but no pain....I am curious as to who you saw, and who performed the procedure...

    I hope you start feeling better real soon-----stay positive, and check in to this site often---it's extremely helpful.........Take care .....Doug
    sorry doug haven't been around for awhile...i saw dr. bederson who is the vice president of neurosurgey from mt. sinai in manhattan. he was cool in the beginning but after the surgery he turned into a real dick....i'd check into the hospital for special surgery or hospital for joint diseases...plus the nursing care at mt. sinai is something left to be desired

     
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