Need help with surgical decision
 

My most recent visit to an Orthopedic Surgeon ended with him leaving the decision for an ACDF up to me. He basically said that when I could no longer tolerate the pain, come back and we'd schedule surgery. I just got copies of the most recent Cervical MRI report and Nerve Conduction study that led to that visit. Here are the significant findings:
MRI:
General: Normal Cervical Lordosis. No fractures. Diffuse DDD and facet arthropathy, most prominent and moderate to severe in nature at C5-C6. Small Schmorl's node superior endplate of T2 is unchanged. Minimal anterior wedging of T2 vertebral body is unchanged.
Specific:
C2-3: Mild DDD. No canal stenosis Mild facet arthropathy. No Foraminal narrowing
C3-4: Mild DDD w/mild posterior disc bulging and 2mm central disc protrusion which exhibits slight mass effect on the thecal sac but does not touch the cord. Mild posterior ligamentous hypertrophy resulting in mild canal narrowing measuring 10mm in AP diameter. Mild to moderate bilateral facet arthropathy and mild to moderate bilateral foraminal narrowing.
C4-5: Mild DDD. mild diffuse disc bulging and endplate spurring with a 2-3mm central broad-based disc protrusion. Mild posterior ligamentous hypertrophy and facet arthropathy results in moderate canal stenosis measuring 7-8 mm in AP diameter. Moderate bilateral foraminal stenosis.
C5-6: Severe DDD. Diffuse posterior osteophyte complex, moderate to severe facet arthropathy and moderate posterior ligamentous hypertrophy. Severe canal stenosis with obliteration of surrounding CSF signal and resultant mass effect upon the cervical cord. The canal measures 5-6 mm in AP diameter. There is no underlying cord edema or myelomalacia.
C6-7: Moderate DDD. diffuse posterior disc osteophyte complex an posterior ligamentous hypertrophy. There is severe resultant canal stenosis measuring 6-7 mm in AP diameter. There is obliteration of the CSF signal surrounding the the cord and there is mass effect upon the cord without underlying cord edema or myelomalacia. Moderate to severe bilateral foraminal narrowing.
C7-T1: Canal is of fairly normal caliber. There is minimal posterior disc bulging and mild posterior ligamentous hypertrophy. Moderate facet arthropathy and foraminal narrowing.
T1-2: Normal
T2-3: Interval increase in central-left paracentral disc protrusion measuring 3-4 mm in AP diameter which exhibits slight mass effect upon the left ventral aspect of the thoracic cord. Mild to moderate left-sided foraminal stenosis and mild right-sided foraminal narrowing. Small right foraminal disc protrusion.
T3-4: 3mm central-right paracentral disc protrusion which touches the cord without displacement. Increased since prior study.

The nerve test showed moderate to severe chronic bilateral C6 and C7 radiculopathies, and could not rule out C8 nerve root involvement. There was no evidence of generalized peripheral neuropathy.

I have about a thousand questions, but will limit myself to the most pressing for now.
I'm as much concerned abot the resulting nerve damage as I am about pain. What should be my determining factor in deciding when to have surgery? Notice I said "when" not "if".
Will an ACDF actually reduce the pain? I presume the Doc meant C5-6 and C6-7.
As you can probably tell, I'm a mess all the way up and down my spine. How will the "ladder effect" come into play:?

Thanks in advance for your opinions.

Have you had more than one opinion on your films? If not, please do get a couple of opinions, okay? Never take just ONE doctors opinion. ;)

Yes, you DO have some serious problems here and will probably end up HAVING to have surgery. :( But I have to tell you that PAIN is NOT a reason to have surgery. Surgery is only for MECHANICAL problems. It does NOT relieve pain. Most of the time, you're left with the same pain or worse. :( You MAY get lucky have have some pain reduced, especially at first. But after awhile, much of the pain comes back. Plus there is the problem with the "Domino Effect" -- this is where the levels above/below the surgical site fail. That's because they have to take on more of the load, and this happens all the time. Then you need MORE surgery, and after THAT surgery, THOSE levels above/below will fail, etc. It's a vicious circle. :( It's happened after each of my surgeries.

You would be smart to have a long talk with your doctor about pain meds for AFTER SURGERY. You want to make sure that your pain is WELL CONTROLLED after surgery because you ARE going to be in pain.

Also, we can give you some hints of what to do before surgery to get ready for it. Let us know when you're surgery is going to be, well in advance so we can give you those hints. ;)

I'm sorry to be the bearer of "bad news" but I don't sugar coat anything. I tell people the truth -- I wish you the very best. I sure wish you didn't need surgery, my friend. God bless and please take care. Hugs, Lee

Hi bipe flyer
 

C5-7 you do have damage. Repair is a good idea, when the situtaion says severe, and cord impingment. One of my concerns is that with doing just those few, you will be setting yourself up for more surgery in the future. The verterbre above the surgery site and below the surgery site need to be strong enough and healthy enough to support the hardware. You need to ask your doctor about this. It is also called the domino effect. I also hope you got more than one opinion, from a neuro surgeon. I am sorry you are facing this. I also offer some hope. This can turn out OK, I had origional surgery at C6-7, had the domino effect, and am now fused C3-7. I have NO regrets doing this last surgery. I am in pretty good shape with just moderate pain. Very tolerable. I also did alot of PT in the last several years. I wish you the very best outcome. We will all be here for you. ginnie:hug::grouphug:

First of all, Thank you for the quick replies. It's good to know that people care.
I still don't know when to say OK to the surgery. I'm very pain tolerant, but not very tolerant of the other symptoms I have. The muscle twitching in my arms, hands cramping and reduced sensory input from fingers, along with clumsiness in my hands (dropping things, can't move small objects between fingers) is driving me crazy. The electric shock down my arms no longer needs a forceful cough, it sometimes happens with clearing my throat. Sneezes are unbearable. I have also recently developed occasional weakness in my hips and right leg while walking, but my Primary Doc wants to rule out circulation problems for that. He hasn't seen the most recent MRI report, yet. I'm not sure why, but I think it got lost in his office as it was sent to him. I'll take copies with me on my next visit.
I understand the domino effect as I've dealt with back problems for over 20 years. I had laminectomies on L4 and L5 along with discectomys at L4-5 and L5-S1 back in 1991(no fusion). I now deal with those discs being re-herniated and L3-4 joining in. I also have a large herniation at T11-12 which may be related to that. My T7-8 disc is totally gone (ruptured), with major osteophytes formed on the endplates and facets and bone marrow edema totally encompassing T7, the caudal 2/3 of T8 and up into the pedicle of T6. As I said, my spine is a trainwreck.
That's the main reason I'm hesitant to get the ACDF. I don't think the rest of my spine can handle the added load. Otherwise, I'd get it done immediately to try to prevent as much permanent nerve damage as possible. I already deal with permanent muscle atrophy in my left hand due to not getting a pinched ulnar nerve treated soon enough. I'm really confused on which way to go.

Had L4-5 fusion, laminectomy a few years ago. As Leesa mentioned, still pain, but if I didn't have surgery, major nerve was being crushed and might be much worse off today if not done. Surgeon said he had never seen such a "angry red nerve before". It was not a choice; surgery had to be done.

Making the decision is the most difficult part of all of this. Wish you a speedy recovery with sufficient pain control.


Gerry

Bipe Flyer,

How old are you and how is your general health?