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  • Cervical Fusion VS Non Fusion: Opinions please

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    Old 12-26-2007, 04:37 AM   #1
    roy15
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    Cervical Fusion VS Non Fusion: Opinions please

    While I have the greatest regard for the skills of the Orthos and NS,it must be noted too strongly that the opinions they hold regarding the treatment of my condition is more than a little biased towards the skills they have honed in their years of practice. I realize that there are many approaches to solving any given problem, but it must also be realized that for ME, I must make the best decision regarding the various techniques for the treatment of my condition without regard to the personal predudices of the surgeon.
    Fifty percent of opinions, I received from orthos and ns, were Fusion and no fusion, majority agreed posterior laminectomy while two anterior. I was left with the opinion, these physicians who decided on posterior vs anterior , were the procedures of their choice as opposed to what the patient needed. They are all experienced in their field, How does one decide? How successful is one over the other? I am new at these boards, and trying to read every posts.

    I have cervical stenosis moderate to severe uncovertebral hypertrophy with cord impingement versus mild compression in C4-5. Mild to Moderate disc osteophyte complex. Mod to severe bilateral neural foraminal narrowing. Mild to mod left paracentral spondylotic disc protrusion which contacts the cord in C5-6.Mod to sev right & left neural foraminal narrowing.I have no pain except for some very mild weakness in right arm. I have hyper reflexia.

    Last edited by roy15; 12-26-2007 at 06:23 AM.

     
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    Old 12-26-2007, 07:21 PM   #2
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    What was explained to me was that cervical laminectomy is the older procedure but the NS described it as the "gold standard" (not sure what that means) while ACDF is the newer procedure. Most of the few posters here with cervical laminectomy did not have fusion. I choose that (had three surgical opinions) because I was more comfortable with that NS and I felt that there was less risk of reduced mobility and as the NS said "can always fuse later if needed"

    You'll see as you read the posts that there are several variations on the ACDF and various opinions on needs for collars after surgery, etc.

    I wore a soft collar for three weeks before surgery "just as a precaution" per the neurologist who diagnosed me but no collar after surgery.

    -Gloria

     
    Old 12-27-2007, 01:26 AM   #3
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Hi Roy, in 2002 I had laminectomy onL4-5 and b/c of cutting through back muscles it took over a year to really feel decent. 3 months ago I had the ACDF on C5-6 and was up and moving quickly. I too wore a soft collar until the surgery b/c of chord damage and fear of more damage until they could put me back together. Kind of felt like Humpty Dumpty only they did put me back together....lol. I have no less movement issues with the fusion than the laminectomy. In fact I was trussed up like a goose for 10 weeks so scar tissue could form tohold it together after the laminectomy. I wore the soft collar for one day after surgery for protection (I am clutz), and then started PT for regaining range of motion 2 months later with the ACDF. Only thing they really don't let me do anymore is crack my neck which I enjoyed to relieve pressure build up. Good luck with your decision!
    MimGregg

    Last edited by mim; 12-27-2007 at 01:28 AM.

     
    Old 12-28-2007, 03:21 PM   #4
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    I had minimally invasive surgery- discectomy without fusion for disc herniations at C5/6 and C6/7 16 months ago.

    I'm no doctor, but I would hesitate having any type of surgery if you're not in significant pain. I exhausted all options before going under the knife. I did physical therapy, traction, chiro adjustments, epidurals, etc, all of which provided me adequate relief for awhile. I didn't undergo surgery until my pain-primarily in my right arm- became unbearable. In my case, I was told by several doctors that holding off on surgery wouldn't cause further damage in any way, that it really came down to my pain tolerance. Your condition may be a different matter.

    I consider my surgery a huge success, and for me, I am very pleased that I chose a non fusion option. If you search the archives, you should be able to find two of my posts from nearly a year ago now- STILL LOVING NON FUSION and NON FUSION OPTION- to get a better idea of what I went through.

    Let me say that I don't get on this message board very often any more, so I apologize in advance if I don't respond further. With it being the holidays, I had a little bit of free time to surf today...

    Good luck

    bw

    Last edited by bw67; 12-28-2007 at 03:22 PM.

     
    Old 12-28-2007, 04:29 PM   #5
    roy15
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Thanks bw, unfortuneately I have prominent anterior osteophytes(bone spurs) that narrowed my canal severely compressing the cord in C5-6 and in C4-5 impingement. Luckily I haven't had any pain, since my first MRI two years ago. After reading these great posts,on this board, I'm frightened to think I might wake up one morning with permanent nerve damage. A car accident causing whip lash,may damage my spinal cord, so I made my decision, for surgery. Pain is not the only symptom, in my case. I put this off for over two years, after one surgeon said to me I needed it yesterday. However, I don't have nine lives, and I'm not getting any younger, and while I'm healthy (gym goer daily), I decided to get the surgery. I've had six opinions and all said to have it done. I'm going next week to a neurologist, and this will be my last opinion.
    I'm still not convinced on fusion vs non fusion, ACDF vs Laminectomy.

     
    Old 12-29-2007, 02:30 PM   #6
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    I was 38 when I had the non fusion procedure. I had 5 doctors here in Nashville tell me fusion was my only option. I scoured the internet and actually found my doc- Dr. Merrill Reuter in Lake Worth Florida- on an archived post from this site.

    FOR ME, I felt like anything I could do that would relieve my pain and keep my vertabrae/discs intact at my age was the way to go. With continual improvements in medical technology, i.e. the advent of artificial discs, I chose to make fusion the absolute last resort. Once you remove the discs and fuse the vertabrae together, there's no other option. 16 months later and counting, so far so good.

    Good luck

    bw

     
    Old 01-02-2008, 04:45 PM   #7
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Hi Roy,
    I ended up having ACDFs because they sounded less scary to me and at the time I was looking to get back to work and life fast. This was a decision I made before I spent the last 3 years learning and dealing with spine issues.

    I was presented with the lami option in the very beginning by 2 of my 4surgical opinions. It makes me wonder if I had the lami first if I would have stopped at only one surgery! Who knows. Now, I have permanent problems, that make me wonder if I chose the other course if I would be in a different condition. I still have some level of congenital stenosis, I grow spurs like crazy (some in central canal - some in foramins) and I wonder if they had done the lami if my spine would have had enough room to keep me symptom free of these things.

    Everything I read about laminectomy recommends a fusion with it. If a posterior laminectomy is done without a cervical fusion, there is a post-operative risk of developing instability that may lead to pain and deformity. There is a risk that a fusion will be needed at some point in the future.

    For the older crowd, with multiple problems , lami's seem to be the favored surgery. Looking at your problems you might be setting yourself up for more the same if you only have the ACDF.

    Good luck with whatever you decide.

     
    Old 01-02-2008, 05:12 PM   #8
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Hey Roy--
    Glad you found the post --- I am fairly new here as well, and like you have found it invaluable--great people here...I am getting opinions from neurosurgeons as well..I have many of the same issues as you..Stenosis, cord compression, bone spurs, and 2 herniated disc's. I have no pain, just difficulty walking (legs feel heavy and tired), lefthand is weak and with a loss of dexterity, I also have fasciculations (muscle twitching)....so far 3 NS's, reccommend surgery, 1 said "there is someting else going on" causing some of the symptoms..2 neuro's agreed, and said to wait a while on the surgery...I am afraid to wait too long and do permanent damage.....Since you are from NY too, I was wondering which surgeons you've spoken with.....I've seen; Michael Lavyne, and Michael Kaiser (Columbia), Michael Le**owitz(North Shore,LIJ)...I saw another DR at NSLIJ, but he was mainly a brain surgeon.....I am seeing Dr Mullins in West Islip in 2 weeks (12/14)...So far Lavyne was the best, but he was the one who wasn't 100% sure the surgery would solve all my issues, and declined to operate. Kaiser was the next best--but he doesn't take my insurance.......
    I'm sure you will find the right surgeon, and start to feel better---hang in there...
    Doug

    Last edited by Braveheart07; 01-02-2008 at 05:14 PM.

     
    Old 01-03-2008, 03:10 PM   #9
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Doug - I didn't look to see if you ever posted MRI results but your symptoms sound similar to mine pre-op. In my case they pretty much "rushed" me in to surgery within three weeks of diagnosis. Luckily I was able to get three surgical opinions in that time and I even showed my MRI to a chiro who said I needed surgery. Please don't wait too long. Two years+ post surgery I still have problems and the MRI shows "signal intensity" in the cord which was explained to me as permanent damage - I also still have some compression but my current neuro isn't rushing me to the NS but we will discuss it in March.
    -Gloria

     
    Old 01-07-2008, 03:26 PM   #10
    roy15
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Hi Doug,
    Good luck to you. I have been getting opinions from Hospital Sp Surgery in NYC. Spoke to a Neurologists and a NS, and both agreed on Posterior Laminectomy due to the location of my osteophytes in the central canal. I'm going in this week for an EMG, due to the weakness in my arms. I have another appointment with Dr Albert at Rothman Institute in Philly, where I'm leaning towards him, to do the surgery. He wants to do a post laminectomy with fusion. I'm leaning towards him because of his backround and experience(has been doing this procedure for years) and comfort level. Spoke to a few patients who had the surgery with him, and they were very pleased.

     
    Old 01-07-2008, 03:35 PM   #11
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Hey Roy,
    Glad you found a Dr you like and trust----Best of luck!----keep us posted
    Doug

     
    Old 01-21-2008, 07:47 PM   #12
    roy15
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Quote:
    Originally Posted by the hittman View Post
    Hey Roy,
    Glad you found a Dr you like and trust----Best of luck!----keep us posted
    Doug

    Last edited by roy15; 01-21-2008 at 07:50 PM.

     
    Old 01-21-2008, 07:52 PM   #13
    roy15
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    How does a NS or Ortho decide on whether a patient is a candidate for non fusion vs fusion, in a post laminectomy procedure? If one elects non fusion what are the symptoms for a destabilized cervical or deformity? How successful are post lami's without fusion in the cervical spine?

     
    Old 01-22-2008, 03:24 AM   #14
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Roy - my impression is that lami's are rarely done with fusion - the purpose is to preserve the disks and just clean out and free up the spinal cord to reduce compression - at least this is what I was told.

    Yes - there is the risk of deformatity down the road but if this should happen fusion can be done later (not that any of us want more surgery) - for me it was worth this risk. even though my surgery wasn't 100% cure I consider it successful. Remember too many people read this boards and if successful they often go away - mainly those of us with ongoing issues hang around. (and a few very helpful long term contributors)

    -Gloria

    Last edited by sunshine221; 01-22-2008 at 03:27 AM. Reason: add thought

     
    Old 01-22-2008, 01:01 PM   #15
    roy15
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    Re: Cervical Fusion VS Non Fusion: Opinions please

    Hi Gloria,
    It would be nice to find out the percentages of failures to success stories of the people who had lami's without fusion. How many needed fusions after the decision to not have fusions, and how many years later. Your probably correct in saying most left this board after successful surgeries. I'm leaning towards post lami without fusion, after two orthos suggested I didn't need the fusion. I guess if some pain, deformity or lessened integrity of the cervical arose, I could go have the fusion later on, hopefully forty years later and I'm 58! At the moment, I need to decompress the chord and post laminectomy was the choice by the majority of their opinions.

     
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