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  • ACDF in a young person?!

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    Old 08-30-2013, 08:55 AM   #1
    travismyname
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    ACDF in a young person?!

    Hello everybody,

    I am turning to this forum because, like many of you, I am torn and have to make a decision. I have been under the care of two separate spine specialists and the most recent of the two is a highly renowned neurological institute. I currently have to take Celebrex and Lyrica religiously or the pain comes on strong. I have had two cervical MRIs 9 months apart and there has been no change between the two despite conservative treatment (2 epidural injections, traction, pain management, etc). Here are the findings:

    C2/3 - Unremarkable
    C3/4 - Unremarkable
    C4/5 - Small central disc osteophyte complex with no central canal or neuroforaminal stenosis
    C5/6 - Moderate to severe left paracentral disc protrusion which efface the left ventral CSF space. This results in moderate to severe left neuroforminal stenosis
    C6/7 - Small central osteophyte complex with no significant canal stenosis. Mild bilateral facet arthropathy. Right greater than left. With mild right neuroforaminal stenosis.

    IMPRESSIONS:

    1. Reversal of normal cervical lordosis which may be secondary to positioning and/or muscle spasm
    2. Mild spondylosis of the mid-cervical spine as above most pronounced at the C5/6 level in which there is moderate to severe left neuroforaminal stenosis.

    My symptoms are pretty accurate to the findings in that I have had moderate to severe pain in the shoulder extending down to my forearm at times and numbness/tingling in my index finger and thumb.

    The neurosurgeon i had a consultation with is recommending a one-level ACDF at the C5/6 level but, the thing is, I'm barely 27 years old and I feel like that leaves a lot of years for things to go wrong at other levels due to the fusion. Does anyone have any thoughts on this procedure at such a young age?

    I called my surgeon back and asked about a posterior foraminotomy or any other minimally invasive techniques but have yet to hear back from him. I thought the foraminotomy would be a good choice because it is less invasive, doesn't involve scars in the front of my neck or moving the trachea and esophagus, leaves the healthy portions of the disk intact, and my disc protrusion is lateral to the spinal cord. Thoughts on this? Any help is so much appreciated! I can't imaging living the next few years of my life with chronic arm pain but I also don't want to cause more problems. Thanks!

     
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    Old 08-30-2013, 11:17 AM   #2
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    Re: ACDF in a young person?!

    I would certainly urge you to follow up on the foraminotomy. I'm not saying it's the best option - I don't know that it can access that disk protrusion or, if it can access it, that it can permanently deal with it - but it's certainly worth looking into.

    And that may mean branching out to other surgeons. Unfortunately, some surgeons may sometimes prefer ACDF's for the wrong reasons, such as they make more money or that's all they know how to do.

    Anyway, it seems like you have a pretty good handle on it...

    Last edited by WebDozer; 08-30-2013 at 11:18 AM.

     
    Old 08-30-2013, 04:20 PM   #3
    teteri66
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    Re: ACDF in a young person?!

    I mostly post on the back problems board, and have lumbar issues mysel so perhaps this information is only relavant to lower down in the spine...but at least at that level, many surgeons no longer perform foraminotomies as a stand alone surgery because they tend to be a temporary solution -- in my case about a month.

    What does your other spine specialist recommend you do?

    Being 27 it also leaves a lot of time for things to go wrong even without a fusion. There is always the worry that without fusion, you will be unstable at that segment, which can be just as damaging to the nerves as worrying about the possibility that you'll be among the less than 10% who develop adjacent disc disease if you do have fusion.

    It is a judgment call. Sometimes it is best to go in and take your best shot at resolving your problems the first time. Each surgery after the first one increases the chances for developing secondary issues like dangers of infection, developing something like arachnoiditis, etc. so I do not necessarily take the attitude to do the least possible with a plan to go back in as needed. I say this as someone who has had three lumbar surgeries, all over the same incision...and I feel like I really lucked out! Had I known at the time of the first surgery what I know now, I probably would have done things a bit differently!

    Last edited by teteri66; 08-30-2013 at 04:49 PM.

     
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    Old 08-30-2013, 04:29 PM   #4
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    Re: ACDF in a young person?!

    fwiw, I had a C4-5 foraminotomy in 2004, and it has lasted so far. As I recall, though, the main problem was facet hypertrophy, that is, bone overgrowth from behind that could be shaved off. How foraminotomies would deal with herniated disks, or how long a fix might last, is something I don't know....

     
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    Old 08-31-2013, 03:54 PM   #5
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    Re: ACDF in a young person?!

    Travis, sounds like you are in the same boat as me regarding the consideration of neck surgery at a relatively young age. To echo a previous reply I had a few days ago to another poster on this board, I too am absolutely terrified about surgery because of the following possible factors:

    1. Complications during/after surgery can happen.
    2. Recovery is never 100 percent.
    3. There is a chance that the ACDF can lead to degenerative disc disease at adjacent discs at a later time. My understanding is that the chance of disc disease is higher depending on which disc is being taken out and fused. I supposed the more disc levels taken out, the higher the risk for disc disease? I'm sure there are others on this board that know more on the issue of adjacent disc disease after an ACDF.
    4. Also, once you do it you can never go back.

    You obviously also need to weigh how your quality of life will be impacted if you put off the surgery, not to mention possible neurological degeneration/issues that may not be reversible. Check out my thread regarding thought process based on options and recommendations given to me by a reputable neurosurgeon. One thing I was told by the doctor regarding having the surgery when you are younger is that recovery is typically faster. As long as you do not participate in any mid-high contact sports such as wrestling or football, you should not have any issues after surgery (quote from the doctor).

    Just my thoughts.

    Last edited by Geespec; 08-31-2013 at 03:57 PM.

     
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    Old 08-31-2013, 04:14 PM   #6
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    Re: ACDF in a young person?!

    Regarding your question on a less invasive procedure, I would definitely keep on top of it with your current doctor and also see about getting another opinion to see what he recommends.

    Keep in mind that a less invasive procedure may not address your specific issue. The doctor should be able to explain why he is choosing the specific procedure as opposed to the less invasive. Also, I have read a few threads when someone chose to do a less invasive procedure, only to go back months or years later to get the original (more invasive) procedure done to fix the problem. Read up on NFL quarterback Peyton Manning and why he ended up having 4 neck surgeries.

    IMO, the size of the incision scar should not be a reason to do a less invasive procedure. Definitely ask the doctor and have him explain why it can or can not be an option.

    Last edited by Geespec; 09-01-2013 at 08:17 AM. Reason: So much for relying on autocorrect to take care of bad spelling... thx WebDozer!

     
    Old 08-31-2013, 06:48 PM   #7
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    Re: ACDF in a young person?!

    Yes, you have to be careful with those evasive procedures. They can get away from you....

    Last edited by WebDozer; 08-31-2013 at 06:49 PM.

     
    Old 09-03-2013, 02:26 PM   #8
    travismyname
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    Re: ACDF in a young person?!

    Thank you all for your thoughtful replies!

    The reason the doctor said that he recommends the ACDF over any less invasive procedures is because the other procedures typically don't relieve neck pain as well as the ACDF; however, honestly, that confused me because the majority of my pain is in my left shoulder and arm. The only time I have neck pain is when I am looking upwards. So, that may be what he was referring to but I still have yet to hear back from him regarding that.

    I know they are very well respected and, in trying to get a second opinion, I found out that 8 of 10 top neurosurgeons in my area are all from the same practice. I found another one that is an expert in minimally invasive surgical techniques but I mentioned an accident I had over a year ago (thought to be completely unrelated to my problem) and now the appointment setter said I might not be seen since she has to disclose that I was in an accident despite it being unrelated and over a year ago (CAN YOU SAY RIDICULOUS?!).

    Anyway, I'm at the point now where I am considering the ACDF but I'm just so intimidated by the thought that I could mess something up and end up dealing with chronic problems, pain, and numerous surgeries. Everyone I talk to says spine/neck/back surgery is a "slippery slope" and had a chiropractor tell me once to avoid any and all surgeries on my spine. So, honestly, his words are stuck in my head and I wish he never said that!

    I appreciate all of your input and I would love more if anyone has any! Some positive outcome stories would be nice too but, alas, much of the internet has a negative information bias.

     
    Old 09-03-2013, 02:30 PM   #9
    travismyname
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    Re: ACDF in a young person?!

    Hahaha evasive procedures always get away from me ;-)

    Last edited by travismyname; 09-03-2013 at 02:32 PM.

     
    Old 09-03-2013, 03:17 PM   #10
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    Re: ACDF in a young person?!

    << I found out that 8 of 10 top neurosurgeons in my area are all from the same practice.>>

    One might wonder how such a result occurred...

    << had a chiropractor tell me once to avoid any and all surgeries on my spine>>

    The surgeons would probably tell you to avoid chiropractors.

    Anyway, I don't see anything unreasonable about a C5-6 ACDF, assuming you decide to go ahead with surgery. I have to say that I don't understand the response on foraminotomy, though. I don't see why a foraminotomy would be any worse at addressing the neck pain that you don't have than an ACDF, but I'm certainly no expert.

     
    Old 09-05-2013, 09:02 AM   #11
    travismyname
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    Re: ACDF in a young person?!

    Hey! Just a little update but my surgeon agreed to a posterior foraminotomy as long as my symptoms are limited to radicular pain and numbness in the shoulder, arm, and fingers.

     
    Old 09-05-2013, 03:19 PM   #12
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    Re: ACDF in a young person?!

    I guess that answers my question, that is, can a foraminotomy access a disk protrusion.

    Good luck with this, and post results....

     
    Old 11-20-2013, 03:01 AM   #13
    travismyname
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    Re: ACDF in a young person?!

    Hello everyone who has reached this forum,

    I am posting the story of my spinal fusion here on Health Boards so you can read the full outcome for those looking at having this procedure. Link is below.

    Namaste

     
    Old 11-20-2013, 03:06 AM   #14
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    Re: ACDF in a young person?!

    Healthboards may not allow a link. Why don't you just c&p? Inquiring minds want to know...

     
    Old 11-20-2013, 03:09 AM   #15
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    Re: ACDF in a young person?!

    Did you ever find out if that "protrusion" was a herniation or not?

     
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