I'll repost my original account:


I’ve received so much help from this board that I thought it might be useful for other if I wrote up my experiences so others might learn from my thought processes.
I went to my PCP in May 2004 because I was getting electrical shocks down both arms when I coughed. He ordered an MRI. It showed minor disc bulges at a couple of levels in my cervical spine but a large herniation compressing my spinal cord about 50% at C5-6. My PCP told me to go to a neurosurgeon. I decided to see a neurologist first because to a carpenter everything is a nail. The neurologist first did a neurological exam and said I had no serious problems then looked at the MRI and told me to get to a neurosurgeon within 48 hrs as I had a neurological emergency. I was to engage in no activities in the meantime including no wild sex. I pressed him hard on how serious my problem was since I was not experiencing a lot of pain and wished to avoid surgery if possible. He was absolutely insistent I see a neurosurgeon, explaining that he had had a patient with a similar condition to mine that had ignored his advice and gone skiing. He fell, hit his head and was now a quadriplegic. I made an appointment with a neurosurgeon who squeezed me into his schedule the next day. He concurred that surgery was necessary although not within 48 hrs. He said I should let it go no longer than a few months. I also pressed the neurosurgeon on the necessity of surgery. He told stories of two of his patients with a similar condition to mine. One fell on ice, hit his head and was paralyzed; the other fell off his couch, hit his head and was paralyzed. One recovered after surgery, the other didn’t. The surgeon said I needed ACDF with cadaver bone and plate. I asked about other options. He said he knew of some endoscopic procedures but that he did not believe these procedures could resolve cord compression. I thought about if for a couple of days and scheduled the ACDF.
I then began researching in more detail. I learned of the domino effect and doubts began to arise in my mind. I already had a couple of bulges at other levels, which struck me as being an indicator of future domino problems. I also learned of ADR. I went for my pre-surgical consult with the surgeon’s nurse and raised my doubts. I got no satisfactory answers. Yes, ACDF could cause problems at other levels but I should be good for 10 yrs, and I wouldn’t want to be one of the first 500 who got ADR. More research ensued. ADR had been done for quite a few years in Europe so I wouldn’t be within the first 500 and I didn’t like the domino odds. At this point I came to {REMOVED}and asked people’s opinions. Opinions were split on the wisdom of ACDF but I realized I didn’t know enough and could not go under the knife given these uncertainties. I talked to the neurosurgeon, who in fact concurred that he would not operate on a person with my doubts He knew of Jho but thought his procedure probably couldn’t help me. I postponed the ACDF so I could look into it more and into MISS and ADR.

Cervical ADR was in clinical trials at this time in the US but available in Europe for $$$ since my insurance wouldn’t pay. I learned of MISS from Schiffer, Microspine and Jho. Microspine was not an option since their qualifications did not seem that strong (especially when compared to Dr. Jho’s) and I did not like the idea of undergoing major surgery in a facility other than a large hospital. Schiffer’s CED did not give direct visual access to the area in front of the spinal cord, so there was doubt in my mind as to how effective that procedure would be, especially given the fact that it seemed likely my herniation was about 16 yrs old since it was that long ago I’d suffered bad whiplash from a rear end collision in a car with poor head restraints. That left Dr. Jho. A number of people on{REMOVED} had had success with him. I typed my MRI report into an e-mail and awaited his reply. Within 2 hrs he responded that he thought he might be able to help me and to send him my MRI films. I Fed-Exed the films on a Thursday and on the following Monday he called. Yes he could help me and he agreed that surgery was necessary. He said his office staff would call. This was late June I believe. I decided this was the best option. It preserved most of my own disc and left open the possibility of ADR in the future.

I eventually had surgery with Dr. Jho on 2/1/05. However, the communication with his office staff between 6/04 and 1/05 was not good. In fact, they never called me at all. I had to make repeated phone calls and e-mails to get any response at all. At about the end of July his office staff promised an early December surgery date. I did not hear from them and in about mid-November I began calling and e-mailing. No return phone calls and finally in early December I got an e-mail indicating the surgery would not be in December but it would be in January. By Xmas I still did not have a date and was calling and e-mailing. Twice I was promised that the date would be fixed—next Monday. No response on those days. Finally around 1/1 I got an e-mail confirming the date of 2/1/05. This was clearly the most frustrating part of my experience. I understand his office staff is busy and fields lots and lot of inquiries but a short return phone call, or e-mail would have made my experience much more pleasant. The communication with his office did improve once the surgery was scheduled but I never received a pre-surgical information packet like some others have reported. I was left with the impression it was lost in the mail.

I was scheduled for surgery Tuesday 2/1 with a pre-surgical consult 1/31. Eric, Dr. Jho’s PA, did a neurological exam on 1/31 and then I met with Dr. Jho. He inquired about my pain levels and if I could live with the pain. I said yes, but I wanted the surgery to reduce the risk of future paralysis. We then had a long discussion about the fact that there is no empirical data verifying the idea that seriously compressed spinal cords are at higher risk of damage than non-compressed cords. The concept is just ‘common sense’ and not verified. This had been one of the hardest parts of the decisionmaking process for me, since I had become aware of this fact during my research. But I had decided that it seemed wise to act on common sense, particularly given the experiences of my neurologist and first neurosurgeon (although those anecdotal cases don’t prove a lot). Dr. Jho agreed to operate under these conditions.

He operated on 2/1 for about 3 hrs. He initially had said he thought the surgery would take only one hr. I was in recovery for a little over an hour and was up walking around my hospital room by late afternoon with an hellacious sore throat from the intubation. I flew home two days after surgery and a week later; I have only had to take a few ibuprofens for discomfort, first for the sore throat, and since then for minor soreness in my neck. The ache in my left shoulder, which I had had for a number of years, was gone when I woke up in recovery and things seem to be going well. The best measure of success will be the 6 week MRI which I’m hoping will show a cord as nicely decompressed as the ones in the MRI’s Dr. Jho showed me in the pre-surgical consult.

I had read Dr. Jho’s published studies on anterior cervical microforaminotomies while making my decision. I had also read the studies of the same procedure by other surgeons who had much lower success ratios than Jho. I also read Jho’s replies to those studies. I have become very skeptical about reported surgical success percentages in the process of making my choice but had decided that Jho’s microforaminotomy had pretty reasonable odds of success (something better than 50/50). However, there have been no long term (15-20yr) studies of the results of this surgery so in many respects it is like ADR in that it’s benefits are theoretical, or ‘common sense’. I had decided in advance that if I came out of the surgery with similar pain levels to pre-surgery (not very high to begin with. 2-3 on a scale of 10) and a decompressed cord, I’d consider the surgery a success. While it is premature to make any judgment, so far things are going well. I’ll never know if ACDF would have been equally successful in the short term (although I do know that the recovery period is MUCH shorter for a microforaminotomy), nor will I know if the long term benefits for me will/would have accrued more to ACDF or ACMF. But given these limits and the limited nature of my problem (one level serious herniation with no instability and only minor problems at other levels), it seems so far as if the decision to have an ACMF with Jho was reasonable.
I welcome your comments.