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  • Cervical Radiculopathy - ACDF - Pros & Cons of waiting

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    Old 05-14-2014, 08:34 AM   #1
    ldm919
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    Cervical Radiculopathy - ACDF - Pros & Cons of waiting

    BACKGROUND
    Following an MRI I have been diagnosed with cervical radiculopathy due to a herniated disc at C6-C7. While I have some mild pain in my neck, the majority of my discomfort is an aching/burning sensation in my right arm (especially forearm) plus numbness and tingling in the index and middle fingers on my right hand.

    ACDF
    A neurosurgeon recommended ACDF yesterday. He said I have a mechanical issue and that the only way to alleviate the pain and eliminate the CR is to eliminate the disc and nerve pinch. He said meds will only "buy me time" but surgery is the only long-term solution.

    MY QUESTIONS
    1) Is surgery really the only way to eliminate (vs manage) the pain in my arm and neck?
    2) Do I risk permanent damage to my right arm and hand if I wait too long to make this decision?
    3) If the answer to (2) is yes, how quickly do I need to make a decision before I risk permanent damage?

     
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    Old 05-17-2014, 09:59 AM   #2
    jeff557
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    Re: Cervical Radiculopathy - ACDF - Pros & Cons of waiting

    Quote:
    Originally Posted by ldm919 View Post
    BACKGROUND
    Following an MRI I have been diagnosed with cervical radiculopathy due to a herniated disc at C6-C7. While I have some mild pain in my neck, the majority of my discomfort is an aching/burning sensation in my right arm (especially forearm) plus numbness and tingling in the index and middle fingers on my right hand.

    ACDF
    A neurosurgeon recommended ACDF yesterday. He said I have a mechanical issue and that the only way to alleviate the pain and eliminate the CR is to eliminate the disc and nerve pinch. He said meds will only "buy me time" but surgery is the only long-term solution.

    MY QUESTIONS
    1) Is surgery really the only way to eliminate (vs manage) the pain in my arm and neck?
    2) Do I risk permanent damage to my right arm and hand if I wait too long to make this decision?
    3) If the answer to (2) is yes, how quickly do I need to make a decision before I risk permanent damage?
    1) Listen to your doctor - medications will only buy you time. You have a problem that is mechanical - bone spurs are compressing your spinal cord nerve roots (foraminal stenosis).

    2) Yes, you do risk permanent damage if you don't take care of the problem. In fact, you might already have permanent damage.

    3) Usually it is a long term process but no one can predict how fast you will decline. The trouble is you risk irreversible damage and the longer you wait, the greater the risk.

    ACDF isn't a big deal. Most people do really fine, including a friend of mine who had an ACDFand was back to work in one week.

     
    Old 05-20-2014, 03:31 PM   #3
    ChuckStr
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    Re: Cervical Radiculopathy - ACDF - Pros & Cons of waiting

    Well, how long have you had those symptoms? WHat is the severity of the impingement on MRI? It is not unheard of for PT, traction etc to cause the disk to shift off the nerve to a degree that eliminates symptoms. In addition, there are normally inflammatory processes that contribute to the impingement that can be controlled with steroids (shots or oral course) as well as proper alignment and physical therapy. This is what happened to me (although I still have other stuff going on).

    It is 100% true that it's not possible to predict that pattern of nerve damage, and it really depends on the degree of impingement/inflammation and your particular case. Acute injuries like herniations can sometimes have a more quickly damaging course.

    I will say that most of my Drs recommended trying conservative methods first as they can address some structure and inflammation problems and potentially buy a long term respite (and occasionally with herniated disk, like your case, a complete remission). In one study I read, about 86% of people that did conservative treatment with single disk radic, had pain resolution and only 29.6% of those required further intervention within 4 years.

    On the other hand, surgery generally does to a fantastic job on resolving the radicular pain. One study I read suggests > 92% had significant reduction or elimination of arm/pain, sensory symptoms following surgery. You do however open yourself up to adjacent disk disease and such with surgery and of course there are not-insignificant complications to the surgery in general.

    You may want to get a 2nd opinion from a spine specialist (either neuro or ortho). In the end, though, like my main spine doc said, it's kind of up to you how to handle it.

    Good Luck.

     
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    acdf, c6-c7, cervical radiculopathy



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