c6-c7 anterior cervical fusion

[Bruce]

I am a 39 year old male, 170 pounds, who works at a computer.  I have experience pain since last december in my left arm, shoulder, and neck.  Back in April, 2000 I experienced numbness and tinkling in my left arm.  I lost strength also.   My doctor sent my to PT, and I got better.  Most of my strenght returned, but not like before.  This condition has continued to nag me, and I decided to go back to the doctor who recommended I have a MRI.  I did.  The results showed a herniated disk at C6-C7.  I he referred me to a neurosurgeon.  The neurosurgeon after introductions said that I needed to have surgery, and that my condition would not improve only become worse. He said that I had spinal compression that would begin to affect other areas.  I was shocked, but I went ahead and scheduled the procedure for early December.  But I have reservations due to the fact that I do not hurt as much as before.  I am afraid that the surgery will open up complications that will be worse than my present condition.   Should I wait, and have surgery when this is unbearable or should I get this corrected now early on in the game?  I only have about 10 days before going to the hospital.  
Would more PT be effective, and as long as I'm not suffering much do I really need to go under the knife?  My doctor said see me now or see me later.  

Bruce

[CCF Neuro[P] MD, RPS]

Dear Bruce:

Sorry to hear about your problem.  It is difficult to tell you what to do over the internet.  If I were you, I would get a second opinion.  Surgery is the last option because often it has little effect and depending on the etiology of your problem, it actually not do much.  What does your PT say?  What is the neurosurgeon's reputation?  If your second opinion suggests surgery, then that might be an option, but only if all else has failed.

Sincerely,

CCF Neuro MD

[Peter]

Hi Bruce,

I'm a 37 yr old electrical engineer who spends a lot of time at a computer also. I also have a herniated disk at C6-7. I'm not sure what caused the initial damage but lifting a heavy marble coffee table by myself sent me over the top. I was in major pain with serious cramping back in Jan-Feb of this year. My right tricep and was very weak and sensations in my thumb,index & middle finger were pretty dull and weak. I went to three neurosurgeons. The first wanted to do a fusion but the other two said to wait and let the rupture heal and that I would get better. Well, I did get better. Most of my strength is back although the sensations in the tip of my index finger vary. I never did any PT. Although I'm not supposed do any strenuous lifting, I still do occasionally and pay the price by having aches and pains in my arm and neck. I don't know if you ever get full strength back. I guess it depends on the extent of damage done to the nerves while they were compressed. I did take a good month or two worth of hard core anti-inflammatories to help the compression settle down. Will I have problems later in life? Probably, but I'll wait.

Bottom line: I think going under the knife is a last resort.

Good luck!

Peter

[ChiroDoc]

Bruce,
I totally agree, surgery is a last resort. Healing takes time and it sounds as if it's already happening. Remember, surgeons do surgery, so thats what they think about. Plumber's think about pipes, so...take the time to make a get and make a qualified decision. As a chiropractor I think about spines. Allow yours to heal, then seek a qualified chiro to help you find out why you have this problem. Sitting at computers is becoming a very real problem for many of the new patients I see. Make sure your desk and monitor is setup correctlly for the long work periods involved to reduce the strain put upon your neck. This will reduce the incidence of spinal stress leading to deterioration of both the vetebre as well as the discs between them. Good Luck!

[Jim]

Another vote for avoiding surgery here.  I'm a very active 48 year old firefighter.  3 years ago had an acute disc episode at c-5,6 with a triceps strength loss of 50%  Two neurosurgeons and a neuroligist nearly insisted on surgery.  My pcp urged me to give it a month or so of p.t. and sure enough within 3 months I was back to 100%  This lasted until last year when a headplant skiing in a whiteout caused me to dislocate c-6 with some fracturing of the process's.  This time everyone agreed that surgery was necessary and I had an acdf of c-5,6,7 atalntis locking plate and screws with a corprectomy removal of the vetbraral body of c-6 with my own illiac crest used for the graft.  With my neurosurgeons approval I was conservativly skiing again at 6 weeks, rockclimbing at 8 (following only) and back to work at 9 weeks.  It was no fun but if something bad happens to you in the future and surgery is warrented, it's certainly not the end of the world.

[Bruce]

Thanks for the comments.  I am still debating surgery as an option.  I only have two days left to cancel the procedure.  
The surgeon says that he can fix most of my problems related to the neck and arm pain.  But, I am not convinced.  I am concerned with the side effects of the surgery being worse that the condition.  I am going to call the doctor to tommorrow and ask for a second opinion.  

Bruce

[Peter]

Bruce,

Good luck and give us an update on what you decided, what the other doctor said if you get a second opinion. If you do go through with the surgery, let us know how it went.

~~~~~~~~~~~~~~~~~~
This is for JIM

I just got back from skiing. I'm always concerned about getting too agressive and having an accident like you did and reinjuring my neck.

Before your reinjury, what kind of PT did you have? I never had PT. 10 months after my episode I still get numbness in my index finger. I wonder if PT can help me at this point?

Secondly, your surgery sounded horrible. How long has it been since your surgery and how do you feel now?

Peter

[Bruce]

Peter:

Thanks for responding.  I am glad you asked Jim that question?  One of main concerns is that I am a very active person.  I love to hike, play tennis, and to snow ski.  I would rather have a little pain than to end these activities.  It is late in the day, and I know that I have this condition because I feel it.  I have visited with two folks who had the surgery, and have never regretted it.  They said they felt like new people when they woke up.  I'm trying to be positive about this.  

Bruce

[Joe]

Thanks for this thread.  It's very timely for me as well.  I've had tingling and numbness in both hands and my right arm and shoulder for the past 6-9 months.  Neurologist said I have mild/moderate carpal tunnel syndrome in both arms, and right ulner nerve problems.  Also had torn rotator cuff in right shoulder three years ago, but that's apparently healed. Ortho. surgeon sent me for cerv. MRI.  

A cervical MRI done two weeks ago revealed a moderate to large HNP toward the right at C4-5 with cord compression, moderate to large HNP at C5-6 with cord compression and moderate to severe left foraminal stenosis at C5-6.  In two weeks I got three separate opinions from neurosurgeons.  All say it won't get better and chiropractic or PT wouldn't really help much...could actually cause more damage.  

They recommend surgery of an ACD C 4-5 and C5-6 and arthrodesis with aliograft and instrumentation.  My family doctor agrees, as does the ortho. surgeon.  I'm scheduled to have it done Dec. 13th.  I'm a 45 y.o. male, fairly active.  Wonder if I'm making the right choice.  Surgeons said "see me now or later" as well.   Email me at ***@**** if you have any suggestions.  Good luck to you, too!

[Bruce]

Thanks Joe for the comments.  I now decided to go ahead with the procedure on the 5th.  I spoke with the surgical nurse today with questions related to the post operative recovery.  I have been told that the neck collar is a requirment 24-7 for the first two weeks. And after that I will need to wear it while driving or riding in a car.  I have spoken to other folks who have had to wear the collar nonstop up to 10 weeks.  I am beginning to think any doctors have different views.  What has your doctor said?  I greatest fear is that things after surgery may be more instense that expected.  My experience with doctors is that they give information on a "need to know basis".  

Bruce

[Peter]

We can all give advice related to our individual situations meaning that one persons situation might not apply to anothers even though they seem similar. For example Joe said that he had a moderate to severe case where as mine as shown below is not as severe.

(The C6-7 level reveals broad minimal, posterior disk margin bulge. Additionally.. there appear to be extruded disk fragments in the right neural foramen, largely filling the neural foramen.)

It's your job to get several opinions if possible and use forums ,like this one, solely as avenues for information. The bottom line is that each case is unique and you have to make your own informed choice.

Peter

~~~~~~~~~~~~~~
Bruce and Joe:

I'd really like to hear how your operations went. I'll be looking for your posts! Good Luck!!!

[Jim]

Sorry it has taken me so long to respond, been away from this site awhile.  The p.t. I did was mainly gentle stretching and some strange hand pedaling device that I never did understand.  The back doc. that I saw told me if he had to pick between p.t. and time he would say that time was the more important element.  I was also continuing with a moderate upper body work out and aerobics from various sources.  Was never really awhile from my outdoor recreation activities during the entire episode, and that is the real therapy!  Good luck to all,  Jim

[Jim]

I now see there were a couple more questions directed at me.  I'm 11 months post op and feel great, climbed or windsurfed everyday I didn't work this summer, and I didn't work much!  I feel the plate in my throat at times and get an occasional twinge in my neck but have never had true pain since a few weeks after the surgery.  I have taken 25 foot leader falls climbing, and bailed from big air windsurfing with no apparant ill effects. I progressed slowly but steadily back from being pretty conservative to letting it go with the lack of pain being my guide.  A couple neurosurgeons concurred with my plan, but I don't think there thinking is the norm for the profession.  If it hurts dont do it, but if it doesn't, live your life.   Jim

[Bruce]

Jim:

Thanks for the info.  I am excited to hear that you are living life to the fullest.  I am planning a trip to Hawaii in the fall, and I plan to learn to surf, if able.  And I want to be able.  It sounds like you have not experienced very many limitations.  

My procedure is next Tuesday.  I keep everyone informed.

Bruce

[Bruce]

Jim:

Thanks for the info.  I am excited to hear that you are living life to the fullest.  I am planning a trip to Hawaii in the fall, and I plan to learn to surf, if able.  And I want to be able.  It sounds like you have not experienced very many limitations.  

My procedure is next Tuesday.  I keep everyone informed.

Bruce

[Bruce]

Jim:

Thanks for the info.  I am excited to hear that you are living life to the fullest.  I am planning a trip to Hawaii in the fall, and I plan to learn to surf, if able.  And I want to be able.  It sounds like you have not experienced very many limitations.  

My procedure is next Tuesday.  I keep everyone informed.

Bruce

[margie]

Surgery is the last option.
I just went through the series of 3 epidural steriod injections
in my neck.  I have had relief.  I have also been living with this problem for almost 5 years.  I am back in Physical Therapy and getting stronger by the day!  I know in the beginning, the shock and pain are so intense we would do anything to get well again.  Go to many doctors, asks lot's of questions, research, research and ask and research somemore.  Surgery is irreversable, and can leave you in worse condtion.  This is our brain stem that sits in this c5,6,&7 areas!

Good LUCK!  There is a lot of healing out there, it takes a lot of patience and endurance!

Margie....still not under the knife!

[margie]

Surgery is the last option.
I just went through the series of 3 epidural steriod injections
in my neck.  I have had relief.  I have also been living with this problem for almost 5 years.  I am back in Physical Therapy and getting stronger by the day!  I know in the beginning, the shock and pain are so intense we would do anything to get well again.  Go to many doctors, asks lot's of questions, research, research and ask and research somemore.  Surgery is irreversable, and can leave you in worse condtion.  This is our brain stem that sits in this c5,6,&7 areas!

Good LUCK!  There is a lot of healing out there, it takes a lot of patience and endurance!

Margie....still not under the knife!

[stephen]

Bruce,

My situation is extremely similar to yours.  Two years ago a neurosurgeon told me I needed an ACDF and I was shocked because I simply wasn't in THAT MUCH pain.  It has been annoying and my right hand is a little scrawny, but I haven't regretted a day that I've spent staying away from the knife.  

The way my GP puts it, you have to be in enough pain that you're willing to take the chance that the surgery might leave you in just as much or more pain.

I'd say your neuro is much too eager to cut and all your misgivings are warranted.  You don't want to jump into it and then find that THESE are the good old days that you wish you had back.

Good luck.  

Stephen

[Bruce]

I am scheduled for surgery tommorrow.  Wish me luck.  I have read all of naysayers opinions.  I know that surgery is the last resort.  I have spoken with many who say that they should have had surgery years ago.  I am positive that I will get a good result.  Will keep you posted.  

Bruce

[Bruce]

I am scheduled for surgery tommorrow.  Wish me luck.  I have read all of naysayers opinions.  I know that surgery is the last resort.  I have spoken with many who say that they should have had surgery years ago.  I am positive that I will get a good result.  Will keep you posted.  

Bruce

[George]

I had a C5/6, C6/7 ACDF in August...right arm pain was unbearable, couldn't sit, walk, sleep or get into "any" comfortable position. Finally after 20 plus years of neck pain, etc..I found a NS that would do the surgery.
I had the ACDF with own hip bone used for fusion. I'm back in the gym 3-4 days a week. My hands still clamp up on me and I get some pain in my fingers once in a while but overal I'm much better, at least for now. I'm also in PT which helps.

[Joe]

Sorry I've been away from the board for awhile.  Had my preop. testing Thurs/Fri and scheduled to have the operation this Wednesday, Dec. 8th.  I can't say I'm in constant pain.  Just periodic numbness, tingling, and hotspots in should and arms, primarily right.  As all three of my neurosurgeon consultations noted, the possibility of further injury to the nerve root is the main concern.  I'm not prepared to live the rest of my life worrying about a slip on the ice or someone rearending me while sitting at a stop sign and becoming a paraplegic, as that's how the doctor's put it to me, including my family doctor.

According to the neurosurgeon, I'll be in the hospital overnight and then need to wear the collar for about two weeks...no driving.  Then ok to go back to work and begin a PT program.  At this point, I just want to get it over with!

Bruce, I hope your surgery went well on the 5th.

[Bruce the Survivor]

Hello,

Tommorrow will be one week since the surgery.  The procedure went very smoothly.  I experienced pain in the recovery room, and received pain killer once in my room.  I arrived in the room about 5:30 PM and left the Hospital around 10 AM the next day.  My arm and shoulder pain are gone, but I am still dealing with post operative conditions such as stiff neck, and incision pain.  But now I am only taking motrin for the pain.  Last night I slept the whole night from 10 PM to 7 AM.  Which did wonders.  
The drugs from the surgery have taken a while to work out of my system.  I plan to take it easy for the rest of the week.  Things are looking better.  

Bruce

[Bruce the Survivor]

Hello,

Tommorrow will be one week since the surgery.  The procedure went very smoothly.  I experienced pain in the recovery room, and received pain killer once in my room.  I arrived in the room about 5:30 PM and left the Hospital around 10 AM the next day.  My arm and shoulder pain are gone, but I am still dealing with post operative conditions such as stiff neck, and incision pain.  But now I am only taking motrin for the pain.  Last night I slept the whole night from 10 PM to 7 AM.  Which did wonders.  
The drugs from the surgery have taken a while to work out of my system.  I plan to take it easy for the rest of the week.  Things are looking better.  

Bruce