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  • Multiple Fusions vs Disc Replacement

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    Old 09-12-2014, 04:55 PM   #1
    Pain n the neck
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    Multiple Fusions vs Disc Replacement

    Hi everyone. Are you like me? Have you suffered a fusion and or spinal disease / disorder? Are you about to get surgery? Have you already had one? Perhaps you're a medical professional with expertise in the field?

    A quick introduction, I am a 52 year old male that has worked very hard and been very physical my whole life. I was always very healthy and rarely needed a Doctor. That all changed in my late 40's when I had a symptom of extreme pain in my left shoulder. One thing led to another and here I am today, looking at my second surgery, this time a double fusion on C4/5 & C5/6.

    I had my first fusion of C6/7 over 5 years ago. At that time, the disc immediately above showed some degeneration but Neurosurgeon and I agreed not to fuse that disc at that time. I was however, aware that it was a possibility. The rest of my neck looked good at that time with the exception of mild issues at C4/5 and the moderate issue at C5/6. I now find myself in a situation where I have something wrong with every part of my cervical spine. I have numbness, weakness, tremors and lack of dexterity in both arms and hands along with these same symptoms in my left leg. There is a lot of pain involved as well. Heck, I even have numbness and tingling on the left side of my face too!? My symptoms are getting worse, I struggle to do most everything including sleep. I have to use a CPAP mask which is quite difficult already.

    I have seen many Doctors, had many tests including MRI's, X-rays, CT, NCV and soon, I'll have an EMG. They told me I didn't have a stroke, MS or a brain tumor but they did discover that I have many issues in my neck like disc degeneration disease. There are two more herniated discs compromising my spinal cord, spinal stenosis with myelopathy, bone spurs and arthritis. The EMG is to rule out the possibility of a movement disorder such as Parkinson's so that we will know what we are dealing with moving forward.

    My problem is this, accepting that I have all of these problems and that yet another surgery seems to be my only option. I After the EMG, I plan to visit the Neurologist, the Neurosurgeon and Pain Specialist to review everything before proceeding with the operation, probably in October. I am afraid to do this again as I know from experience that although I did see some relief after the first fusion, it only lasted a few years then things got worse. I don't want to be slowly turned into a 2X4 with fusion after fusion. There is a fairly new procedure where they install replacement disc(s) rather than fuse them. This procedure comes with risks and benefits, but there are very few Doctors performing this in the USA and it seems that insurance Companies are reluctant to approve this. I am not as brave as I was the first time through. I appreciate any and all input. I have been avoiding this for several months. Finally, yesterday, my GP said, this could get worse! Why haven't you had the surgery? It looks like I'll be getting a double discectomy along with removing old hardware in mid October.

    Here's to better days and helping each other through this.

     
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    Old 09-12-2014, 05:42 PM   #2
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    Re: Multiple Fusions vs Disc Replacement

    I am very much like you but no surgery yet for me. Hopefully never, but that is most likely wishful thinking.

    If there is actual spinal cord compression causing progressive myelopathic symptoms, and it sounds like there is from your description, then surgery may be your only option. In my opinion, whenever surgery is on the table I would get multiple opinions from the best spine specialists you can find. People who work with folks with back problems all the time. You will often find a difference in opinion on when surgery is indicated and how to approach the surgery, and even how to interpret MRIs amongst different experts. Getting opinions from multiple spine specialists will help you get a "consensus" and help you identify the folks you are most comfortable with.

    Artificial Disc Replacement (ADR) is now FDA approved for a single level replacement and as such should be approved by most insurances. Unfortunately, 2-level and greater replacements are not approved. One of the surgeons I talked to is in the 28 best spine surgeons in the US list and performed just the 3rd two-level ADR in the US. He said that they were able to get the two-level surgery approved by the insurance company but I don't know how they did it. I'd definitely recommend a university affiliated surgeon if possible as they are most likely to be familiar with the ADR and do lots of surgeries in general. You are not that far, relatively speaking, from WA where there are some awesome surgeons affiliated with the UW (including the guy I mentioned), and Swedish hospital. I can PM you his name if you want.

    BTW, numbness and tingling in your face is pretty common. Look up "cervicogenic facial pain (it doesn't have to be pain, but numbness and tingling as well)".

    Why would anyone think you have a movement disorder with the presentation you have? I would think the severe radicular pain along with the MRI should point far enough away from MD that they wouldn't bother...

    Your GP is correct that it could get worse but you do want to make the best decision you can. The two most important things are "do you need surgery", and "who should do the surgery". You want to make sure you get these questions answered in the best way possible.

    Good luck and let us know how you get on...

     
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    Old 09-12-2014, 05:54 PM   #3
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    Re: Multiple Fusions vs Disc Replacement

    I forgot to mention that having c4-c7 fused wouldn't be that horrible in terms of neck motion loss. There was a lady on this board that had C3 - T1 fused that still had about 50% loss of motion so you'd have a long way to go before being a 2x4. Estimates I've read for c3-c7 fusion (since that is where my issues are as well) indicate ~20% loss of motion. I've read stories of peoples neck ROM improving after the fusion because pain and arthritis had reduced their ROM so much. Just food for thought...

     
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    Old 09-13-2014, 04:11 PM   #4
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    Re: Multiple Fusions vs Disc Replacement

    Thanks for the input Chuck. It looks like you are doing your homework. Its important to educate yourself before having a surgery. I believe that I saw the Doctor you mentioned in Los Angeles? Dr Yee? There is a double level device recently approved by the FDA. Depending on who I speak with, I am told I am not a candidate for this procedure due to an existing fusion? My Surgeon didn't seem to have a favorable opinion of the artificial discs at this time. Personally, I'd prefer to maintain as much mobility as possible, especially when considering the condition of the adjacent discs.

    http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm367809.htm

    As for interesting symptoms, yes, I did find out that facial pain and numbness can be caused by Cervical cord compression as well as breathing issues and even a mild sore throat. This digression has been tough. I sure hope I see relief and recover some of my feeling after the next surgery.

    I have reviewed several fellow poster's and their comments. I hope they all have success with their surgeries and recovery. I am preparing for mine both physically and emotionally right now. Lots of protien and vitamin supplements.

    Last edited by Pain n the neck; 09-13-2014 at 04:20 PM.

     
    Old 09-14-2014, 11:47 AM   #5
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    Re: Multiple Fusions vs Disc Replacement

    The guy I saw was Richard Wohns from neospine in Washington. He's a bit of a renaissance man, in that he has a law degree, and is a world class climber and master level martial artist. I'm not sure about the double level, but from what he said at least a single level would most likely be doable with an existing fusion. That came up because he wanted to do a 3 level fusion in my case, and I asked him about adjacent segment disease and he said he'd most likely attack that with an ADR if it came up.

    There is another thread going on with a different poster talking about osteophytes causing swallowing difficulties. These neck problems can cause such systemic issues.

    It sounds like you're doing what you can to prepare for your surgery and I wish you the greatest success with it.

     
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    Old 09-14-2014, 02:51 PM   #6
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    Re: Multiple Fusions vs Disc Replacement

    Sounds like a cool Surgeon. As for the combo fusion disc replacement on multi levels, yes that is done too. I saw a guy that had a fusion on one level and a disc replacement just above during the same procedure. There is a Surgeon in Reno that does inovative surgeries. I believe the practice is called Sierra Spine?

    If I had a choice and felt confident about the durability of the divices available, I'd be happy to have an artificial disc installed. Just seems to make sense when a person conciders the unfortunate possibility of adjacent disc failures. If you are looking at three levels, I'd definitely try an artificial disc Chuck.

    Thanks for the tip on the other thread. This mild sore throat and Sleep Apnea seem to be related to my cevical problems for sure. Certain medications can also have an effect on breathing too.

    Last edited by Pain n the neck; 09-14-2014 at 04:06 PM.

     
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