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    Old 02-16-2015, 08:37 PM   #1
    Lcuky13
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    Need Help - ACFD Surgery

    I fell going for a jog in the beginning of January and landed on my neck and shoulder area.
    I was temporarily not able to move my arms or legs for about 5 - 10 seconds.
    After that I was able to get up and thought I had hit my head.
    The next morning I realized my head didn't hurt but my shoulders and arms (bicep area) did (had trouble moving my arms due to pain) and my neck was a little sore.
    I had been moving furniture the day before and went to the gym later that night (night before the fall) and wasn't sure if the shoulder/arm pain was from moving furniture, the fall itself, or landing on my neck.
    I went to the emergency room where they took MRI and X-rays, put me in cervical collar, gave me pain meds and sent me home the next night.
    After resting for 6 weeks I have no pain or apparent neurological issues. A few days ago I had some residual slight discomfort in my shoulders and the very top of my left forearm near my bicep but it seems to have gone away.
    I met with two neurosurgeons the first one wanted to do a C3 - C6 ACFD. The second doctor recommended a C3 - C4 ACFD, saying the other disks were herniated but not as much a problem. He said its good that I have no pain but the C3 - C4 disk is herniated towards the spinal cord. He also said getting the surgery was optional.
    He was worried that if I were to fall down the stairs or get in a car accident the injury could become worse and I could be paralyzed. He also said even if that didn't happen 10 - 15 years from now the herniated disk could become worse off and possibly cause some damage and then I would have to get the surgery anyway.

    I was really hoping I wouldn't need surgery considering I have no pain.
    Does any one have any advice for me being the surgery is optional?

     
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    Old 02-16-2015, 10:24 PM   #2
    meri87
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    Re: Need Help - ACFD Surgery

    You may not feel pain now but you have a disk thats herniated and could get much worse.

    It is possible that your pain could come back 100 times worse. Then what? I would go with the second doctor who is focusing on C3-C4 if he is board certified and does ACDF many times per week.

    Get the surgery. Its not a bad surgery. But it will take patience and time to heal successfully.

    QUOTE=Lcuky13;5345859]I fell going for a jog in the beginning of January and landed on my neck and shoulder area.
    I was temporarily not able to move my arms or legs for about 5 - 10 seconds.
    After that I was able to get up and thought I had hit my head.
    The next morning I realized my head didn't hurt but my shoulders and arms (bicep area) did (had trouble moving my arms due to pain) and my neck was a little sore.
    I had been moving furniture the day before and went to the gym later that night (night before the fall) and wasn't sure if the shoulder/arm pain was from moving furniture, the fall itself, or landing on my neck.
    I went to the emergency room where they took MRI and X-rays, put me in cervical collar, gave me pain meds and sent me home the next night.
    After resting for 6 weeks I have no pain or apparent neurological issues. A few days ago I had some residual slight discomfort in my shoulders and the very top of my left forearm near my bicep but it seems to have gone away.
    I met with two neurosurgeons the first one wanted to do a C3 - C6 ACFD. The second doctor recommended a C3 - C4 ACFD, saying the other disks were herniated but not as much a problem. He said its good that I have no pain but the C3 - C4 disk is herniated towards the spinal cord. He also said getting the surgery was optional.
    He was worried that if I were to fall down the stairs or get in a car accident the injury could become worse and I could be paralyzed. He also said even if that didn't happen 10 - 15 years from now the herniated disk could become worse off and possibly cause some damage and then I would have to get the surgery anyway.

    I was really hoping I wouldn't need surgery considering I have no pain.
    Does any one have any advice for me being the surgery is optional?[/QUOTE]

     
    Old 02-16-2015, 11:11 PM   #3
    ChuckStr
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    Re: Need Help - ACFD Surgery

    Did you have an mri that helped evaluate the severity of the herniation(s)? If so what did it indicate? Given what you've said so far, I wouldn't even consider surgery at this point if it were me. The exceptions would be if the c3/c4 herniation was significantly compressing the spinal cord or you had severe vertebral slippage.

    With herniations, they can sometimes heal with proper conservative treatment such as PT/strengthening exercises etc. As a matter of fact, I'd be quite surprised if your insurance would approve surgery without a trial of conservative treatment unless there is evidence of significant spinal cord compression (which you don't mention). Without that level of compression, I just don't see what good surgery will do you at this point. Yes, you may need surgery in 10 years or whatever, but you may not as well, and cervical surgery carries significant risks of its own, including the need for additional surgery, and rarely even paralysis. One of my surgeons, who is nationally renowned, commented on the possibility of paralysis due to car accident, falling down stairs etc. He said that unless you have very significant compression of about 30% (so canal space of about 5-6mm) and/or a severe vertebral slippage, a person's risk doesn't really increase above the risk of others in a car accident, or falling down stairs.

    I would get under the care of a spine specialist, either a neurosurgeon or orthopedic surgeon with specialty training in treating spine conditions and a practice limited to only spinal issues. Given that you've seen neurosurgeons, I'd consider another opinion from an orthopedic surgeon spine specialist. They can help you determine if you have any of the issues that would indicate a more emergent need for surgery such as severe vertebral slippage and/or severe cord compression. Barring that they can help set you up with conservative treatment and monitor your condition over time.

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

     
    Old 02-16-2015, 11:58 PM   #4
    Lcuky13
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    Re: Need Help - ACFD Surgery

    Quote:
    Originally Posted by ChuckStr View Post
    Did you have an mri that helped evaluate the severity of the herniation(s)? If so what did it indicate? Given what you've said so far, I wouldn't even consider surgery at this point if it were me. The exceptions would be if the c3/c4 herniation was significantly compressing the spinal cord or you had severe vertebral slippage.

    With herniations, they can sometimes heal with proper conservative treatment such as PT/strengthening exercises etc. As a matter of fact, I'd be quite surprised if your insurance would approve surgery without a trial of conservative treatment unless there is evidence of significant spinal cord compression (which you don't mention). Without that level of compression, I just don't see what good surgery will do you at this point. Yes, you may need surgery in 10 years or whatever, but you may not as well, and cervical surgery carries significant risks of its own, including the need for additional surgery, and rarely even paralysis. One of my surgeons, who is nationally renowned, commented on the possibility of paralysis due to car accident, falling down stairs etc. He said that unless you have very significant compression of about 30% (so canal space of about 5-6mm) and/or a severe vertebral slippage, a person's risk doesn't really increase above the risk of others in a car accident, or falling down stairs.

    I would get under the care of a spine specialist, either a neurosurgeon or orthopedic surgeon with specialty training in treating spine conditions and a practice limited to only spinal issues. Given that you've seen neurosurgeons, I'd consider another opinion from an orthopedic surgeon spine specialist. They can help you determine if you have any of the issues that would indicate a more emergent need for surgery such as severe vertebral slippage and/or severe cord compression. Barring that they can help set you up with conservative treatment and monitor your condition over time.

    Good luck and let us know how you get on...
    Thanks so much for the replies.
    Sorry if I wasn't clear, I'm still learning about this stuff.
    Yes I had an MRI done which the second neurosurgeon looked at and said I had a herniated disk compressed against my spinal cord between C3 - C4.
    I do have an appointment for a third opinion with his colleague who would perform the surgery with him. I believe he is an orthopedic surgeon spine specialist. I will ask him the level of compression and how much canal space there is like you said to see how severe it is.
    It's hard for me to easily accept that I definitely need surgery without having any noticeable lingering neurological symptoms or pain.
    I want to gather as much information as possible to help me make the right decision.
    Thanks again for the info, I will continue to post with any updates...

    Last edited by Lcuky13; 02-17-2015 at 12:05 AM.

     
    Old 02-17-2015, 12:04 PM   #5
    ChuckStr
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    Re: Need Help - ACFD Surgery

    Yeah, I would find it hard to accept surgery without any noticeable neurological symptoms as well. As a matter of fact I *do* have symptoms including muscle twitching, tingling and slightly "heavy" legs which can be early symptoms of myelopathy which is functional disturbance of the spinal cord. Possibly caused in my case from the slight compression of my spinal cord by bone spurs. Even then, for me and most of the surgeons I spoke to, there isn't necessarily a clear improvement to be gained from surgery. A couple weren't convinced that the symptoms were due to the compression, for instance. I get checkups every 6 months and I'll have a new MRI at my next one to make sure nothing is progressing. I don't know if that is the right decision or not, but so far at 10 months things are going pretty well with my exercises and such.

    I would consider going outside the practice where you got the original opinion just to get a completely unbiased view. If it were me, I'd also make sure you get an accurate picture of the risks. ACDF is a pretty commonly performed procedure and is generally safe given someone is poking around in your spine a couple of milimeters from the cord. Complications do happen though. Generally, there is a 3% risk of infection, 29% risk of temporary swallowing difficulty, 25% risk of adjacent segments requiring surgery within 8 years, a roughly 5% chance of non-fusion which may require more surgery, and rarely serious complications such as paralysis. Even in complication free surgeries, there is normally some pain from the surgery itself and possibly some nerve pain also due to moving things around to get access for the surgery. This is generally temporary, but many folks feel some amount of relief of their previous symptoms which helps balance this whereas it is quite likely you will feel worse after the surgery for a while because you are having no symptoms now. Also recovery can be long and hard, taking up to a year or more to be fully healed/fused. I'm definitely not trying to talk you out of the surgery, I just want to make sure you get good information on the risks involved.

    If you do decide on surgery, the next most important decision is the surgeon. There are studies that indicate outcomes vary quite a bit based on the experience and skill of the surgeon. As an example, the surgeon I would have do surgery on me should I ever feel that necessary (heaven forbid), has done more than 3500 surgeries not including his residency, about 95% ACDF. He has tracked his own success and complication rate over the years and is much better than the average in terms of fewer preventable complications like infection, and has a lower non-union and re-surgery rate than average as well. The point is to make sure you have the best you can get, and that you feel totally comfortable in the person's skill, follow-up plan etc. Ask lots of questions too: will you need to wear a collar, if so what type? How long do they expect recovery to take and how long will they give you off work? When will the Dr see you after surgery? if the Drs/support staff aren't forthcoming that tells you something.

    Hopefully the above helps you think through your decision... Good luck!

     
    Old 02-17-2015, 02:19 PM   #6
    Lcuky13
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    Re: Need Help - ACFD Surgery

    I'm glad you're making good progress without surgery and hope you continue to do so.
    I have a friend who works in the medical field and am going to see if they might know someone qualified to read my MRIs for another opinion.
    Thanks so much for the information regarding surgery risks, they are things to be considered.
    The surgeons seem to be pretty experienced and am feeling comfortable so far with them performing the surgery should I have it done.
    I will wright down those questions and others I can think of to ask for when I go to see the orthopedic spine surgeon this week.
    Thanks for your help!

    Last edited by Lcuky13; 02-17-2015 at 05:16 PM.

     
    Old 03-06-2015, 04:04 PM   #7
    Lcuky13
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    Re: Need Help - ACFD Surgery

    I went to see an orthopedic spine surgeon who agreed with my neurosurgeon that I need surgery. He originally wanted to do a C3 - C4 ACDF. But I asked him about the C5 - C6 area on the MRI (taking advice from chuckstr to ask) as it looked compressed on the sagittal image. He said it might be a good idea to do that area also. If he did this he would do a posterior cervical fusion and fuse C3 - C6. No bone graft would be needed because he would use my own bone in my neck...crushed and sculpted (not sure how this works, I'm having trouble finding info on this)? He ordered me a contrast CT Scan (which I just did) so he could make sure he does only the surgery needed. I go back to see him with the CT Scan Films on Monday.

    I'm still in no pain and the slight discomfort I had in some areas has completely subsided. My arms and more so my hands however started slightly tingling a few days ago. The orthopedic spine surgeon said I also have hyperreflexia, although I did have a large coffee before I went in to see him so not sure if that made a difference.

    The good news is that he said I can return to any and all activities I chose once the bones or fused weather he has to do one level or three. This is great news for me because I lift weights, run, and am a fencer. He said I will still be able to do all of these things and take up alligator wrestling if I wish : ) This is great news for me, I was starting to get depressed thinking my sport days were through (big part of mt life), thank god.

    He did say there is a chance of additional surgery being needed. Three percent per year for up to ten years up to thirty percent, then after that the chance for additional surgery reduces significantly. So sounds like a better chance of not needing it. The only thing I was thinking is that what if I did need additional surgery? Then that surgery required additional surgery, etc? Would my entire spine end up being fused over time?

    Thanks For All The Help!

    Last edited by Lcuky13; 03-06-2015 at 11:41 PM.

     
    Old 03-07-2015, 12:24 AM   #8
    ChuckStr
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    Re: Need Help - ACFD Surgery

    Did he say why he'd do the surgery posteriorly? You trade one set of possible problems for another but the main issue with posterior surgery is a relatively high incidence of potentially persistent neck pain due to the large amount of muscle and other tissue you need to cut through to access the spine. My surgeon mentioned he no longer does posterior surgeries because of this issue.

    The way I've seen the crushed spine material work is it is fitted into a "cage" of various material (titanium, ceramic and others), usually along with some other stuff to encourage bone growth.

    Hyperreflexia, if symmetric (the same on both sides) is often normal, especially if there you are anxious when they check (due to anxiety, caffeine or both).

    If you fuse properly there is no inherent reason why you shouldn't be able to return to whatever activities you like. In practice, I know several people, though, that have had to give up activities that require a lot of twisting and such not because it's dangerous, but because they don't feel good when they do it. Keep in mind too that complete fusion is likely to take up to a year or possibly even more.

    Yes, additional surgery is unfortunately a risk. The most common issue like this with a fusion surgery is called adjacent segment disease, where segments above or below the fusion degenerate quicker due to the additional pressure placed on them. THe other problem is various types of problems requiring revision to the original surgery. Issues here include hardware failures, non-fusion etc. The risk of things like non-fusion increase with the number of levels of surgery (although the difference between 1 and 3 levels, isn't enormous). You hit on the main issue which is that surgery can be a slippery slope. Some people do indeed end up with many segments of their spine fused over time.

    Good luck and let us know how things go...

     
    Old 03-07-2015, 05:08 PM   #9
    Lcuky13
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    Re: Need Help - ACFD Surgery

    He didn't mention why he wanted to do it posteriorly. He said that would be the way he would to it for C3 - C6, but C3 - C4 would be anterior. I will ask if the operation could be done anteriorly if possible to avoid the pain and recovery issues associated with the posterior operation.

    That type of bone grafting sounds okay...

    Yes the hyperreflexia was symmetric and I was nervous and just had coffee. My balance seemed to be okay when tested. Maybe I'll ask if he could check my reflexes again on my neck visit.

    "If you fuse properly there is no inherent reason why you shouldn't be able to return to whatever activities you like" This is a big relief for me because I enjoy sport and being active. Hopefully all my activities will still be comfortable to do. I will be extra careful until I'm completely fused, going to need patience.

    Hopefully this will be my first and last fusion surgery. I will definitely let you guys know how everything goes. I'm do back to the doctor on Monday to find out more about my surgery. I hope to post back here often over the years with good news and success following my surgery.

    Thanks!

     
    Old 04-13-2015, 07:10 PM   #10
    Lcuky13
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    Re: Need Help - ACFD Surgery

    I had my surgery about four weeks ago today. The surgeons decided to do a multilevel fusion after reviewing the MRIs and CT Scan, C3 - C6. After awakening from my surgery I was told they found they only needed to do a single level fusion : ), C3 - C4. I was in the hospital for two days recovering, then sent home with pain pills. I have been resting and am not to drive or do any form of exercise for another two weeks. I also had two follow up visits since the surgery with x-rays and all is well. There is some tingling in my arms and hands which my surgeon expects to go away on its own. Besides the arm/hand tingling I am no longer in pain. The incision area has minimal scaring at only four weeks post surgery. The incision area is numb, under my chin but has been slowly regaining feeling. So, so far my surgery has been a success and I hope to soon return to all of my activities.

     
    Old 05-23-2015, 11:18 PM   #11
    Lcuky13
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    Re: Need Help - ACFD Surgery

    I have started physical therapy three weeks ago and have three weeks left. I'm getting some body strength and mobility of my neck back with PT. I have also been going on almost daily long walks or walking up and down the stairs in my house for exercise. The incision area is still regaining feeling but is a little better. The tingling sensation I have throughout my body/hands seems to be getting better. The tingling seems to linger in my hands a lot of times, even now as I type. The tingling sensation throughout my body is much more intense but only happens for about a second at a time. I noticed it happens often when I look down, especially while walking. I asked one of my surgeons about this and he said it is a result of my spinal cord injury and may or may not go away : ( I had some hand tingling about a week before the surgery but not the body tingling (my arms also started to fall asleep while sleeping about a week before the surgery, but have not again after). But my surgeons were electronically monitoring my spinal cord during surgery and there showed to be no issues from the surgery. My right palm side up forearm also seems to have a slightly different sensation in an area than it did before I was injured. On the plus side I do not appear to have any muscle weakness from the injury (although my muscles have atrophied from inactivity). Does anyone know if this tingling is bad? My physical therapist told me it was okay as long as there is no muscle weakness.

    Also, my surgeons have told me once fused I will be able to regain all activities with no precautions, I am getting teary eyed as I type this : )

    Last edited by Lcuky13; 05-23-2015 at 11:19 PM.

     
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    Old 05-28-2015, 12:50 PM   #12
    Hillcrest
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    Re: Need Help - ACFD Surgery

    'm sorry you are having the problems and pains your experiencing.
    I think you may want to see a neurologist or a neuro surgeon so you can get some answers to your problems. Even having to travel a bit, it's worth it.
    I wish you good health & good luck.

     
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