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    Old 07-20-2011, 11:49 AM   #1
    sandycreech
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    Question Laser vs ACDF - please help me decide..

    I've read much of what is posted here. I'm scared to death. In a bad car accident in 1990 - did 3 yrs chiro that helped, could live with the occasional pain. Then 3 months ago woke up felt like I had knife in my back and no feeling at all in left arm. MRI shows bulging disks from C4-C7, compression of nerve root. I've done therapy, many drugs, 3 epidurals. Left arm better but tingles. Can barely move neck at all in any direction, constantly using icy hot (but it makes my skin peel). Neurosurgeon is recommending ACDF for C4 thru C7 and removing bone spurs. I've read of so many problems having this done. Considering the minimally invasive laser procedure instead. Does anyone have idea on which one is better for long term pain relief. Also with C4-C7 fused, how bad is it moving your neck? And I keep hearing swallowing after ACDF is terrible. I need to do something to help with the pain. My main objective is to not go thru this again, but I don't want to do a terrible procedure if I'll still hardly be able to move my neck. I'd really appreciate any responses! Sandy in Orlando

     
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    Old 07-21-2011, 10:56 AM   #2
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    Re: Laser vs ACDF - please help me decide..

    Glad you started a new post, hopefully you'll get a few more opinions. As you know, given your symptoms and problems an ACDF sounds more reasonable and complete in terms of treatment as opposed to laser which is treating just a small amount of problems. And the chain laser centers don't have a great reputation, your doctor will likely agree, and many are not covered by insurance.
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    Old 07-21-2011, 01:46 PM   #3
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    Re: Laser vs ACDF - please help me decide..

    Hi SpineAZ. I did just get a response from LSI in Tampa. They of course are saying they have 87% success rate. They do accept my insurance. Odd enough, wether I have the ACDF or the laser, my cost is the same. I've spent so much on medical so far for this, I have a total out of pocket left for the year of $1380 - they both quoted me that amount. Of course the laser one sounds much simplier, less evasive, less pain, I'll be able to completely move my neck where as with 3 levels of ACDF I will be limited. But with the laser it sounds like it will come back. With the laser they will remove the bone spurs, doe the laser on the 3 protruding disks and then do a Facet Thermal Ablation which removes the nerve on the facet joint.

    I am so confused what to do. I can barely move my neck now in any direction. Some think it is arthritus, so it will be like this no matter what I do. And of course when you furse C4-C-7, it will restrict movement. I wish I could see how much to know better. After my 3 epidurals I don't have much arm pain anymore (it varied from completely numb, to pins and needles which was the worst! to a deep burning pain). I do have constand neck pain, and cannot wear anything around my neck, even a simple necklace. I had to get all new bathing suits and summer tops because of this. I can't do my job - looking at a computer screen at any level is brutal, working on papers looking down at my desk is horrible. Scared to drive cause I can't really turn my head.

    My bottom line is #1 I do not ever want to feel the worst pain - the knife in the back pain which is what I initially felt - ever again. And #2, I want to be able to move my head again, do normal everyday things without constant pain.

    I think because the ACDF is forever, I should go that route (though even the doctor said that the disk above and below the fusion may herniate afterwards as they will have to do the work of the disks that are fused).

    I am VERY CONFUSED.. I'm trying to get a 2nd opinion with another doctor - waiting for my GP to give me another referral to talk to an orthopedic surgeon..

    Sandy

     
    Old 07-21-2011, 03:14 PM   #4
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    Re: Laser vs ACDF - please help me decide..

    Under many insurance plans you can self-refer to specialists. Call your insurance company and ask especially if you have a doctor in mind you's like tosee. I never have to get a formal referral from my GP, but I have asked for his suggestions on some specialists.
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    Old 07-21-2011, 03:31 PM   #5
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    Re: Laser vs ACDF - please help me decide..

    Great idea I will do that - you are so incredibly helpful. You've had many surgeries - are many of these for the back? Do you mind me asking why you had so many? Was it that one surgery caused others? Sorry if I am asking out of place. Thanks again..

     
    Old 07-21-2011, 04:32 PM   #6
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    Re: Laser vs ACDF - please help me decide..

    I have very lax ligaments so joints don't hold together well. So when something isn't aligned right or causing problems I opt to get it fixed. It's helped a lot to address stuff quickly when I can. My motto is I'll do any surgery any time if it will improve my comfort or functional level in any way.
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    Old 07-22-2011, 07:00 AM   #7
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    Re: Laser vs ACDF - please help me decide..

    I took your advice and looked for an orthopaedic doctor here. I'm so happy I did. I found orlando orthopaedic. And they do much more than the neurosurgeons office. They do the laser procedures, and of course the ACDF. They also have the artificial cervical disk. I'm looking forward to talking to them. They are local so I wouldn't need to travel to Tampa and LSI. And since it is one local doctor he'll likely give me the truly best solution to my problem.

    I'm going to a chiro today (first time in 18 years!). Not for a complete fix but just for some pain relief until I can have the surgery done. It would be wonderful to be able to move my neck freely again. Only thing that helps loosen it (just for about 20 minutes) is when I liberally rub flex-all on the entire neck area.

    I'm so different than you - I'm scared to death of any surgery. But I am very sure I do not want to go thru that horrible pain I had 3 months ago whent he bone spurs met the nerve root! Thanks so much for your wonderful information..

     
    Old 07-22-2011, 07:31 AM   #8
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    Re: Laser vs ACDF - please help me decide..

    Please be careful of chiropractic care when you have serious cervical issues. It can do more harm than good. Also start the process of seeking doctor good Pain Management doctor.
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    Old 07-22-2011, 07:59 AM   #9
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    Re: Laser vs ACDF - please help me decide..

    Hi Sandy. SpineAZ asked to come on and talk to you about necks. I've had a lot of neck problems and 2 major neck surgeries. I am fused from C3 to T1 from the back of my neck(not an ACDF).

    I know you are scared but learning all the options and how they will affect you after is very important as the wrong procedure now almost guarantees you more surgery in the future.

    If you have the results of your neck MRI, could you post them? I'm pretty good at interpreting them so you can understand the situation and it helps to make a better decision.

    On the laser treatments, when they remove bone spurs from arthritis, they do grow back. It is not a permanent treatment. And oddly enough, sometimes removing them makes them grow back even faster and worse than before. And you won't know if you are one of the people who will have this reaction until after surgery. Trimming back disk bulges can be done by various methods, not just laser treatment and the laser can only get to what is exposed, not within the bone. So it is extremely minimal at best. In an ACDF, they can remove large chunks of the bulging disk. And the nerves of the facet joints can be burned off without surgery and they do grow back(ALWAYS) within 6-12 months. You would still need the nerves burned off at regular intervals.

    The ACDF, has it's problems in that you have plates and rods in your neck right up against the esophagus. Some people have problems swallowing after and some don't. But in the hands of a really good spine surgeon, you should be okay. This is a surgery that has been around for a long time. Does it need to be expanded as more disks go? Yes. Any fusion has that risk. And the same goes for laser surgery or posterior fusions. Only something like a laminoplasty will avoid that as it's doesn't have a fusion.

    You can also do a fusion from the back of the neck. It is a lot more painful as they have to cut muscles to expose the spine but you don't have any problems with swallowing and the rods they use allow for a stronger fusion than with the plates of an ACDF. So you trade off less post-op pain with the ACDF with no swallowing problems and a stronger fusion with the posterior fusion.

    And there are even more options. If you have a problem with spinal cord compression as well as nerve compression, a laminoplasty would really help. If you have badly closed up foramens where the nerves exit, they can only be reached from the back as well so a foraminotomy would be the best bet.

    I will caution you against chiropractic treatment for now. On top of everything else going on in your neck, you also have 2 major arteries that go to the back of your brain, going up to your head through the bones of C6 to C1. A bad adjustment can lead to a stroke. Here in CT where I live, chiropractors have to disclose to all neck patients that they can have a possibly fatal stroke from a neck adjustment. It has killed people. Be VERY careful.

    Again, if you can post the results of your MRI here, I can give you a better idea of what you need done and which way to go with this. But I can tell you one thing.....a bad surgeon or the wrong surgery is the best predictor of whether or not you'll be in pain the rest of your life and need additional surgery. My own surgeon has built an entire practice of fixing what others docs have messed up. There are a lot of bad spine docs out there. You want one who does spines and only spines be it an orthopedic spine surgeon or spine neurosurgeon. The best ones are those who teach at medical schools.

    The spinal cord is part of your brain so you choose the doc based on the seriousness with which you'd choose a brain surgeon.

    And lastly, spine doc's don't operate for pain. When it comes to the cord and nerves, pain is a good sign. Pain means the nerve is alive and kicking even though it is hurting. Spine docs operate for numbness, tingling, loss of muscle function...........signs that the nerve is in danger of dying and leaving you with permanent paralysis.

    Here are a couple of warning signs that you have a doc who is not telling you the truth.

    1) no doc can guarantee you won't have continuing pain after surgery. Surgery to stop pain is successful only 30% of the time.

    2) no doc can guarantee that you won't still have numbness or tinging or muscle problems after surgery. Surgery for that is successful only 70% of the time.

    Anyone tells you that they guarantee you will be pain free or numbness free is lying to you. Run the other way.

    You have a degenerative disease in your neck....arthritis. It doesn't stop or get better. It will continue to get worse.......period. It requires management for a lifetime. Once you have a bad neck, you will always have a bad neck but the right surgery with a really good surgeon can help to make it much easier to live with.

    hugs.........Jenny

     
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    Old 07-22-2011, 12:04 PM   #10
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    Re: Laser vs ACDF - please help me decide..

    Jenny - you are WONDERFUL. I am so thankful I found this board and that spineAZ referred you to me. First I need to ask - you had 2 major surgeries and fused from C3 to T1 but not ACDF - can you move any part of your neck? (they recommending me C4 to C7). and you said not ACDF - I'm very new to all this - so what did you have done and what caused you to have all this?

    Quick history on me - major car accident in 1990. Chiro for 3 yrs after it, and then just learned to live with the pain. Until April of 2011 when I woke up from sound sleep feeling like I had a knife behind my left shoulder blade and complete numbness in my left arm. Dr's, xray, MRI, meds and more meds, Phys therapy, TENS (that I now own and love), and 3 epidurals later - I'm better. Left arm just a slight tingle occasionally, still some pain behind left shoulder blade. Biggest concern is very restricted neck movement left, right and up (down is fine), and continual pain in neck area. I put on flex-all 6-8 times a day (tried icy hot and it made skin peel over and over and gave up). I can't wear even a thin necklace around my neck. Working on a PC with monitor at any level painful for more than 20 min or so, looking up very painful at all, looking down to write for more than 5 min very painful. Scared to drive as I can't turn head but need to drive to get to work and back. I just found out that all I had done was temporary, even epidurals. I'm absolutely scared to death to go back to the knife in the back feeling. And I would love to be able to move my neck again.

    Went to neurosurgeon, wants to fuse C4-C7, moving disks, adding bone grafts and plate installed, going from the front, and he would remove the spurs. Completely floored had no idea I needed something like that! So now I'm looking for opinions of others. I talked to LSI re laser, much less invasive of course, but opinions is it too is temporary. I have aptm to talk to orthopedic surgeon next week for 2nd opinion. I know I'll need some surgery and I'm the biggest baby you ever saw for anything medical. They had to completely knock me out for each epidural. All this talk of not being able to swallow, having a scar on my neck, not being able to move my neck afterwards, and the fact that it might make things worse is making me think there is no real fix for my problem.. And ironically, I just came back from a chiro aptm. He tried to do an adjustment and said my muscle were very tight. And then I tried the decompression machine. I'm in a huge amount of pain and on ice right now! I'm not sure the aptm was successful at all.

    Here are my summary MRI results (this was taken early May 2011 before I had any of my treatments - so I have to believe it is at least a bit better now)

    C3-4 - minimal bulging and ridge without significant stenosis
    C4-5 - central protrusion with ridge contracts and mildly impressed cord
    C5-6 - broad based protrusion with left paracentral with uncinate spur with cord compression and compromise of C6 nerve roots - left greater than right
    C6-7 - left lateral recess protrusion with uncinate spur with cord compression and compromise of C7 nerve roots- left greater than right

    you mentioned with ACDF the plates hits the esophagus and causes hard time swallowing - isn't that scary, and then how do you eat? That would really scare me! Is this a life long thing, or how long does it last?

    You also mentioned spine doc operate for nerve issues or loss of muscles. For now, I'm guessing the nerves are not compressed as much as my left arm is so much better. for now the only real bother is loss of movement in my neck and neck pain - not muscles or nerve isues - so does it mean I shouldn't have the surgery? Or is it that after the 3 epidurals - which are temporary - I felt better and din't have the nerve or muscle issues and I should have surgery now before they wear off?

    The loss of movement in my neck could be from tight muscles (how they react since they sense full movement would be painful) or is it arthritus? Am I right that there is no cure for arthritus, so no matter what I do I may have this the rest of my life?

    Lastly, if I do have the C4-C7 fusion, is there anything I can do to slow down problems with the disk above and below it. At this rate I feel that eventually I'll be fused from head to toe (ok not quite that) before I die and be one solid spine!

    Again - I definitely appreciate your thoughts and comments. I found out I have an max out of pocket of $1,400 no matter who I see and what surgery I have. So financially it won't matter either way..

    Sandy

     
    Old 07-22-2011, 03:56 PM   #11
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    Re: Laser vs ACDF - please help me decide..

    Let's start with some good news. Since you have less pain and tingling in your arm, you have time to find the right surgeon and the right surgery. If your arm had stayed numb, you'd be looking at urgent surgery.

    You have 2 major problems that can happen in the neck...one is compression of the spinal cord and the other is compression of the nerves to the arms, neck, head etc(there are others but not noted in your MRI report so I won't go into them). The "uncinate spurs" are bone spurs on tiny joints on the outsides of the vertebrae themselves. Strange but your laser guys wanted to burn the nerves off the facet joints(more tiny joints on the outside) but you don't list bone spurs there. Hmmmm. But the uncinate joints don't seem to be the cause of your problems. Herniated disks and arthritis is your major problem.

    You are correct when you say arthritis doesn't go away....it will be with you for life, slowly getting worse. In theory, the bone spurs that develop from the arthritis only develop where there is movement and that is why they fuse the vertebrae....to stop bone spurs from forming. But that is not necessarily true...I have bone spurs growing inside of my fusion where is no movement at all. So even a fusion is no guarantee of the arthritis slowing down or stopping. And removing bone spurs can make them grow back faster.....ask anyone with major knee arthritis....docs almost never remove bone spurs in the knees as they grow back bigger and faster.

    As for the disks, as we age, they tend to dry out and get fragile so they tear and the inside contents bulge out. The backside of the disk is right up against the spinal cord so pressing on that can do a lot of damage. And if they bulge to the back sides, then they block where the nerves go out to the body. Even in an ACDF, they don't actually remove the entire disk but the part of it they can reach but it's enough to relieve the pressure. Then they but a piece of bone into the space where they took out a section of disk and that acts to fuse the bones together, stopping movement and hopefully slowing the arthritis. So bad disks is a pretty common problem as you age.

    But I'm concerned that they don't say more on the MRI report as to how much the holes for the nerves are blocked(they use words like minimal, mild, moderate or severe) or how much the cord is indented. Was there anything like "thecal sac indented" or "mild cord compression" mentioned? We think of them as descriptive words but they are actually medical terms when it comes to the neck. The reason I ask is that if your spinal cord is compressed to a certain level, you need to have that addressed as well. Spinal cord compression shows up in the legs or feet, not the arms. Any problems with your legs?

    Some people like to go with the least possible option for a problem even if it means more surgery down the road. That is when laser surgery is helpful. If you are scared of surgery, then have as much done as possible in one big surgery in hopes you'll never have more done. Laser surgery almost assures you of more surgery.

    In an ACDF, the scar goes up and down on the side of your neck with maybe a short sideways scar. They have to push your windpipe and esophagus to the side to get to the neck and that is why lots of people have trouble.....it can bruise them and make them hurt for a while. The plates they use will be in between the spine and the esophagus but most don't feel it unless they swallow something big. And with time, all the swelling from surgery goes down and it slowly goes away as the body adjusts.

    Then you get someone like me who had major problems with compression of my spinal cord, not just the disks and nerve problems. My surgery was done from the back of my neck as that is the only way to resolve cord issues. The first surgery re-built the bone over my spine, making room for the cord. The second was a full neck fusion as I had some complications after surgery(broke some of the tiny bones in my neck). It is an option for someone who needs a lot of vertebrae fused or needs to make sure the voice and esophagus are not damaged(like a pro singer).

    Just so you know, I can move my neck pretty well and I'm C3 to T1.....1 vertebrae longer on each side from what is being proposed for you. Initially I lost about 50% of the movement of my neck in all directions but now that I am 4 1/2 years out from surgery, I have gotten more movement back. I can drive with few problems. Yes, I can't look up a the sky without leaning backwards and I can't put my chin on my chest but I get along quite well. Side to side I can almost get to my shoulders. A C4-C7 should leave you with at least 75% movement....or more than you have right now.

    The biggest problem with necks is the muscles. They try to protect your neck and in doing so, spasm, painfully. Fixing the neck may or may not help. My muscles still spasm and I am still doing PT to help relax them.

    Since your arm is doing better, I'd keep working with whoever is doing the epidurals and learn how to relax those neck muscles. Don't do surgery until you are really ready and then do as much as you can to fix it in one surgery. I'd avoid the laser stuff....you'll have to keep doing it over and over. They love people who are afraid of doing the real fix. Then search for the doc you feel comfortable with who will do a full fix. Yes, you always end up putting stress on the disks above and below the fusion but that can't be avoided. But it also doesn't mean anything will happen. I've got a bigger fusion and so far, so good. Being careful after surgery can keep you out of the OR.

    ACDF surgery is not very painful. Most go home within a day and are in a hard collar for about 6-8 weeks. The surgery from the back of the neck is very painful and you are still in a hard collar for about 6-8 weeks.

    Either way, the quality of your surgeon is the biggest factor in how well you'll do. I've had a lot of major surgery and this is one case where the doc doing the surgery means everything. A sloppy doc will end you up with more surgery and lots of pain. A really good doc and you'll have a much better outcome. Experience and ability are #1. I can not stress that enough.

    Ask me whatever you want to. I have been through a lot. I try to be fair when I answer although I do have my own opinions.

    hugs........Jen

     
    Old 07-22-2011, 04:32 PM   #12
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    Re: Laser vs ACDF - please help me decide..

    I have the typical ACDF afar that goes horizontal about 3". When people saw me after the surgery they'd say "ACDF or thyroid surgery" as both scarslook the same. With SPF 45 lip balm on the scar daily or when in the sun it's barely visible.
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    Old 07-24-2011, 09:33 PM   #13
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    Re: Laser vs ACDF - please help me decide..

    hello Sandy. First of all, never go to any chiropractor. They are not for neck pain, period.

    Second, If if I was you I would do the laser surgery because I would want to swallow food.

    At least laser surgery is not invasive.

    Your decision.

     
    Old 07-24-2011, 10:24 PM   #14
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    Re: Laser vs ACDF - please help me decide..

    I should also have mentioned I had no swallowing problems. The first night I was hoarse but that was it. I also polled some ACDF veterans and all said their scar was horizontal only and the surgeon used solely a horizontal incision of 2-4 inches.
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    Old 07-25-2011, 11:53 AM   #15
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    Re: Laser vs ACDF - please help me decide..

    Thanks for all the information and thoughts on this. One day I think the laser is the way to go, the next day I think the full ACDF. I did go to the chiropractor last Friday. He had a hard time adjusting me since my neck muscles are so tight! But then I tried the decompression table aimed at low neck where my problem is with 27 lbs. I hurt when I got off, and I hurt all night long. I was on ice until midnight. So I've decided no more decompression for me. And I'm going to hold off on the chiro until I talk to the orthopedic. And in the orthopedic office is someone that does the laser as well so hopefully I can also talk to him.

    Jen - I typed what was on the MRI in the summary and it was same words in actual report. No problems with my legs at all. My left arm was very weak but it is much better now. Movement in the neck varies by day. Always better in the morning and very painful and on ice at night. And I can't wear anything around my neck at all.

    Can any of you recommend any neck exercises to do to help loosen these muscles? I have a gym membership and tried some of the machines aimed at the neck/upper back, but not sure if it helped or hurt me worse!

    I'm wondering if I can strengthen my neck muscles maybe some of he pain and tightness would go away. And then maybe I could just live with this as it and really hope I never experience that knife in the back feeling again.

    Speaking of that, I had been told that pain was caused by the pinched nerve - when the bone spur hit the nerve root. is that really what does it, or does the pain have to do with the bulging disk? I have a feeling all this has been inside me a long time. I hadn't been in any accident or fell recently. Really wondering what caused it to hurt so bad all of a sudden? Would it be the bone spurs got long enough to cause the pinched nerve?

    Any ideas one exercies and where that initial pain came from would be great. Oh and btw I really appreciate the info on scars and being able to swallow. That is 2 big things that scare me a lot! I'm glad for many it is not a big deal at all!!

    Sandy

     
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