Surgery for Degenerative Disc Disease - Cervical
 

Hi all:

So, I have a confirmed dx of DDD in C2-C7. "Worse than moderate" degeneration in C4-5 and C5-6.

I'm actually getting agreement from the WC doc that surgery (and probably more than one) will be required. Probably the first within the next year or so.

I have a deep prejudice that I want the surgery done by a neurosurgeon. At that level, they're talking serious quad results with a screwup. But other people are telling me that anterior fusions are frequently done by orthopedic surgeons.

Any studies? Opinions? Anecdotes?

Thanks.

Sandi

Sandi,

The way it was explained to me, in determining which type of specialist to seek is: when it is primarily bone, it's better to have an ortho. surgeon; when it entails bones and nerves, then a neurosurgeon is the pref.

I would go with a neurosurgeon. You don't want to fool around with nerves.

My first fusion at age 16 was done by an orthopedic and I had no problems for 33 years until the DDD showed up under that one.

Next I had foraminotomies done by a neurosurgeon.

However I am still left with nerve pain.

Please research really well before making your decision.

Sandi,

Since you asked...I would definitely go with a Neurosurgeon. I had a fusion done at the C3/C4 (considered a very serious level due to the phrenic nerve that controls your breathing). I had the same NS do a fusion of the C5/C6 two years later. Actually, what SpineUniverse says is that either an NS or OSS can do the cervical fusions. But then it goes on to say that it is the Neurosurgeons that have more advanced training. But I can tell you also that the spine group I go to was the first in the United States to do the artifical disc for the cervical spine and actually it was the OSS that headed that up. However, my thoughts are...since those levels are high up there or any level in the neck for that matter...I would go with an NS before I would go with an OS...just my own preference though.

Neuro or Ortho
 

Hi, thought I would throw in my two cents. I had ACDF on C3-C7 in 2004. My doc was the same ortho surgeon who did my lumbar fusion. He has a great reputation and I trusted him completely. My recovery was excellent and the objectives of surgery were met. The only other 2 people that I know personally who have had cervical fusion were my brother and my stepmother. Both of them had single level fusion and they used neurosurgeons. Both had a multitude of problems and my brother is still going through the mill trying to get reasonable relief from pain. I guess the main thing is to choose a doc who you have heard other people have been happy with, who has a good reputation, and who you feel you can trust. I'm not saying one is better than the other, this is just my experience. Best of luck!
Kat

I too had ACDF on 12/13/07, C6-7. I had an orthopedic surgeon handle everything. He had to do a little nerve work but the majority of my surgery was bone. I have a titanium plate, screws, and donor bone in place of my disc.

It's been almost five weeks - I'm doing great. Very little pain, and very little that involves having to take meds. I've followed my very conservative doctor's orders - no physical activity aside from walking (ie no weightlifting), no lifting over 2 lbs, no driving, etc. It does suck but I have to attribute it to my great recovery thus far.

I'm no expert, but I am more than happy with my orthopedic surgeon. He specializes in spines and I trust him completely. My experience was a good one.

:)
Kelly

Dr Jho
 

Have you heard about this neurosurgeon in Pittsburgh? I guess he's really good. I'm going to see him on the 28th of this month for my c-spine. Before you have fusion, he might be looking into.

Marshall

I must be frustrating for you
 

how do you choose? I have always had success when I get a second opinion. after looking at your fims, a good surgeon should be able to tell you that, for example, that your surgery isn't brain surgery, or if there is anything they see in the films that might make it tricky. Another thing you might want to do is to ask the surgeon who he will be sending you to for pysical therapy. Sometims, you can get an appt before the surgery to learn some exercises to do before the surgery to strengthen the muscles tha will atrophy the most.
Good luck

Hi Sandi, I had a 2 level fusion in 2004 done by a neurosurgeon. I had a 2 level lumbar fusion done by an orthopedic surgeon who is a spinal specialist. If you do decide to go with an ortho make sure he has a fellowship in spinal surgery. If not then I'd go with a neurosurgeon. Like you I wouldn't just let anyone operate on my neck. Hope everything works out for you. Dee

I've had a cervical fusion
 

I had a fusion at C-4 through C-6 because of DDD performed by a neurosurgeon. My ortho sent me to him, so I would say find a good neuro. Mine is wonderful. I also had a laminectomy of L3-L5. I still have sciatica because of nerve damage which we are investigating. He doesn't want to do a fusion there because he said it would basically mess up the rest of my back because the lumbar region is designed to be mobile. Make sure you find a neuro you can TALK to and who answers your question and is concerned about YOU as a total person. I went to one who looked at my MRI and said, flatly, "There's nothing I can do for you," and walked out. I chased him out of the room, in tears, asking if I had to endure the pain forever, and he said until I am 60 or 70 years old! I'm only 54--that's along time to be in agony! The fibro is bad enough, along with the sciatica, without all the numbness and pain from the DDD!!!

Good luck and God bless you! Let me know how it goes. Email me if you'd like.

Thanks, that's useful. I know the surgery will be tricky because of two things:

1) Coming in from the front and moving the trachea and esophagus aside will be a problem, because I had my esophagus created/stitched up at 2 days post-birth; it has loads o' scar tissue....

2) There are bony protrusions on both the front and the back of the neck, and they're impinging on the spinal cord. They need to be removed, in addition to the fusion. Working that close to the spinal cord, I really do want a neurosurgeon.

Thanks for the comments, all. I'm really glad I have a lawyer working to make sure I get to choose my surgeon. :)

Sandi

Hi Sandi and others who have responded to this thread.
I wonder if any of you with C1 to C7 problems could give me a brief history of what has happened to get them to the surgery stage?
I'm presently having steroid facet injections to C5-6-7, with great success for 2 months after. So I'm just wondering if you started out this way too. Trying to see what's ahead for me.
Thanks

Hi Peter,
I too had problems with C5-6-7.. Started with steroid injections which worked for about 2 weeks for me. Shortly thereafter, I progressed to massive pain meds as the injections no longer worked. Mind you I found out that both discs were completely "blown out" as my Neuro-Surgeon put it. I had surgery on Feb. 14th of 2007 and am doing fine. I was back to work lifting normally 3 weeks after surgery.. (yes, it was the ACDF..yet my Surgeon used cages and plates ...no bone at all) I still had swallowing issues, and some muscle spasms, but all in all...very good results. I am normal now, and living fine. Prior to surgery, I could not sleep...was working a max of 3 hours per day, and had given up everything I lived for. I strongly suggest if you reach surgical stage to ask your Doctor about the cages and plates. I would be happy to e-mail you a post-op xray of them to show your Doctor, as it worked well for me.

Cheers Mate!
Dave

Hi...Me again,
Figured out how to post the xray here... just click on it for the full size image. If you want to chat, I am available by e-mail and msn messenger at hansmathias8@hotmail.com

Hi Dave, that's just the sort of thing I'm interested in, and so good to hear that it has had such a good result for you. I can well imagine the relief.
My last injections have given very good relief for 2 months each time-like night and day. I forget how bad it is between times while the injection lasts-but I have had a good reminder this week!
The X-ray pic was excellent. Did you scan it?

Yes I scanned it ...turned out pretty good! If you ever need to chat about anything more specific, you can e-mail me or add me to your messenger and we can talk. I have friends in England I speak to almost daily and would be happy to hear from you.
Dave
hansmathias8@hotmail.com

I have to decide whether to get the other two levels fused or do the Minimally Invasive Procedure by Dr. Jho. If I decide to use my traditional surgeon who is renowned how well could I move my neck if c3 to c7 were fused. I know what the doctor said, but I want to hear from someone who had it done. Please feel free to write me directly if you want. Thanks, david

My understanding of a fusion is that you might have fine range of motion after a fusion that went well and healed well (bone grew throughout). However, you have to know how to take care of it afterwards, which wasn't explained to me. No jackhammering or splitting logs because force is now multiplied to the disc above or below the fusion. None of the kind of straining work that would blow a disc, because you will blow a disc above or below the fusion more easily than if have no fusion. Sometimes you are supposed to practice using only Eg 70% of your available range of motion to avoid putting strain above or below the fusion. You should get second opinions on these questions and on what you can expect after the fusion from both doctors and physical therapists who have experience with cervical fusion.
Good luck

Hi, just a note to say I am seeing Dr, Jho on April 2nd and I see Dr. Spiros at UPMC tomorrow on feb 20, 2008 who also does endoscopic surgery. I have one oppinion from Dr. Kang at UPMC (orthopedic surgeon of renown) and I am going to also get two more from the neurosurgeons listed above as I am getting mixed remarks from the medical community. All I can say is try and get a few oppinions to be make a good decision about who you want to do your surgery. Dr. Lee at UPMC (orthopedic) also does endoscopic surgery, but I think I will have enough oppinions to satisfy me when I am done with the last visit with Dr. Jho.

I so wish I had gotten a 2nd or 3rd oppinion before my fusion done in 2005. I was trusting the surgeon to be honest with me and tell me of other options and he told me I had no other options which was not true. A specialist is not going to refer you to another doctor so YOU have to do the leg work yourself. It is sad, especially when you are counting on straight answers, but they make their money doing surgeries and are wanting to do what they do and not what is best for you in the long run. I never even heard of cervical or lumbar endoscopic surgery until I found it by accident on the web. Why wasn't I given that choice before when I was asking very explicit questions of my surgeon?

If I could do it again I would have had endoscopic surgery and not a fusion, but it is done and now I am at the crossroads again. I have heard great things about Dr. Jho and I know many surgeons say unkind things about him, but I am not basing my decision so much on others as I have been misled so much before. There are sites on can check on Dr.s to see how they are rated or what others say. I feel real comfortable with considering Dr. Jho. I am taking my time as I am managing my pain somewhat tolerable, but don't rely on your specialist to give you much help is what I have found unless they are not in competition. You will always find someone unhappy also so be very careful about how much weight you give them also.

I am going by my heart, the facts I find, and a good dose of prayer to make my final decision. The endoscopic route just seems to make more sense to me if I am a candidate.

good luck