I haven't frequented the forum regularly in a long while, but I just found it moved and the old archives are not accessible. The archives are incredibly valuable for future patients, so I'm reposting the report of my surgical experience from 3 years ago with Dr. Jho:

On Monday 4/7/03 I flew to Pittsburgh for a pre-surgical consultation with Dr. Jho. I developed symptoms one year earlier and MRI revealed broad central herniations at C5-6 and C6-7 and significant stenosis (6mm) of the spinal canal at both levels. The intense left-sided pain subsided within a few weeks but I was left with constant numbness in 3 fingers of the left hand, and some left triceps weakness. Of major concern was the significant spinal stenosis at both levels. My neurologist and 4 neurosurgeons I've consulted all agreed that surgical intervention was advisable due to vulnerability to significant future spinal issues due to the marked stenosis. Also, I am an avid cyclist and surgical intervention held out hope to resume spirited cycling, although this was a secondary concern.

Aided by information gleaned from the great folks on this forum and my own research (including in-person consultations with 3 other neurosurgeons), I felt that Dr. Jho's procedure held out hope of potentially correcting the problem completely, with minimal recovery, low risk, and leaving options open for any other future procedure. Although Dr. Jho was quite responsive from a distance (amazingly so compared to other doctors), he couldn't answer a few questions about his surgical intentions for me until examining me personally. A surgical appointment with him includes a personal consultation on the previous day, so I went off to Pittsburgh to meet with Dr. Jho and possibly undergo surgery. By the way, I was fortunate to find an excellent neurologist soon after my symptoms first developed who served as the focal person , and he endorsed my eventual decision.

I was overwhelmingly impressed by Dr. Jho and his staff. Dr. Jho seemed to have all the time in the world for me when I met with him and his P.A. Frank. I had done a bit of research and have some medical background, so I asked a lot of questions and received thoughtful, respectful responses. In addition to discussing my personal case, Dr. Jho shared many anecdotes and discussed the whole gamut of disc procedures. He carefully explained what he wanted to do and why: a two-level anterior microforaminotomy ('Jho Procedure'), principally for general decompression of the spinal cord but also to free up the two nerve roots. My understanding was that based on MRI films showing cord compression posteriorly as well as anteriorly (disc side), Dr. Jho felt that there were bone spurs involved which he readily deals with in his procedure. A big unresolved question before I went to Pittsburgh was whether Dr. Jho could and would perform general decompression caused by central hernation from such a lateral approach. Dr. Jho assured me that this was exactly his intention.

The procedure was performed on Tuesday and took 2-3 hours under general anesthetic (with intubation). I awoke groggy and with some soreness and stiffness, but no real pain. When I asked about when the pain medication would be wearing off, I was told that I hadn't been given any, and haven't needed any since. Dr. Jho said the procedure went very well and he had to remove a lot of bone spicules (spurs). Dr. Jho made a single 1-1/2 inch horizontal incision along a natural fold of my neck, so the scar shouldn't be too bad after the incision heals, and it's already looking much less noticeable. My throat was very sore from the intubation, and it is still pretty sore as I write but slowly getting better (cold pumpkin pie and fruit smoothies help ;-). I am fairly sensitive to medication, and effects of the general anesthetic still seem to be lingering and slowly going away. I had no problem driving two days after the surgery, although I was pretty gentle with the head turning (BTW, no collar is worn after the Jho procedure). My neck can stiffen up a bit depending on how I am sitting, but I'm noticing that this is also improved from yesterday. I've been told that many of the acute issues will resolve over the next week and I'll be pretty much healed up from the surgery in 4 weeks. In the big picture, these post-surgical symptoms are shockingly trivial considering the work that was performed. My experience of Allegheny General Hospital was also overwhelmingly positive (except the food).

The numbness in my fingers seemed to have improved slightly right after surgery, but another noticeable chunk came off the numbness on the third day perhaps it's 25% resolved already. I believe Dr. Jho will be proven correct the numbness will resolve eventually. [postscript added 11/9/2003 - I'm sorry to report that the numbness did NOT resolve any further than this]

Another comment - due to the very sore throat and effects from the general anesthetic, I didn't sleep more than a few minutes at a time until the 3rd day. I'm not entirely clear on what was going on, but perhaps some combination of 3 possible issues kept waking me up every few minutes: a constant need to swallow to clear the small amount of phlegm that constantly invaded my throat, side effects of the anesthetic on my diaphragm or inflammation from the intubation causing my windpipe to slightly close in relaxed sleep [9/27/06 postscript - I believe this last possible explanation, a temporary form of sleep apnea due to the surgery, was correct]. On the 3rd night I discovered somehow that I could sleep well on my side (I've only slept on my back for years) and this was a huge relief. By the way, I noticed a dampening effect on other smooth muscles besides the diaphragm, affecting my ability to swallow, belch, urinate, etc which improved by the 3rd day.

I am very grateful to Dr. Jho for his pioneering work developing his procedures and being so accessible to new patients. I'll have a follow-up MRI in 6 weeks and hope to see amazing improvement on the films. I plan on taking one more week off from work, just to pamper myself a bit.

Cheers,
Barry

9/27/06 postscript: I have had no further issues with my neck in the 3+ years since the surgery. I had a followup MRI one year after the surgery and my neurologist was happy with what he saw. I still have numbness in 3 fingers, but no pain at all and fairly good range of motion in my neck. I was able to resume normal activity soon after the surgery and eventually built up to 100-150 miles of weekly bicycling. I still avoid extending my neck for long periods of time – that's probably the only thing that might bother me – eg., when I get my haircut and they shampoo me, I won't lean my head back over the sink – I turn the seat around and lean forward over the sink. In retrospect, I'm very happy with the surgery.

Barry:
It was partly yours and Dave Edwards positive experiences with Dr. Jho that helped me make a decision to have surgery with him. I recently posted here on a Jho thread with a link to a cached version of my post-surgical thread from the old board. I too am doing very well going on 2 yrs. I haven't had an MRI since six weeks after surgery but I have no detectable problems. I sometimes wish I could jump into an MRI and see what is going on in there to satisfy my curiosity since long terms studies of the effects of Jho's procedures had not been published when I had the surgery. Does anyone know if Jho has recently published long term results? Eric, his (former?) PA told me when I was there they they were working on the study.

Kerry

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.

on a whim, I rediscovered this site today since I have not been on braintalk for probably 2 years. The only reason I am registering is because as coincidence would have it, I saw a thread about BarryG and Dr. Jho. I also had surgery about 2 months after BarryG (June 2003) and his advice (including asking for pumpkin pie post surgery!) was very helpful! My surgery has been a success. I had his procedure performed on C3-4, C4-C5. I have cervical stenosis at lower C levels as well and Dr. Jho was going to do those levels in a second surgery. Over the past 3 years, I have, at times, contemplated an additional procedure on the 2 lower c spine levels but then the symptoms diminish. In writing Dr. Jho, he has pretty much told me to consider an additional procedure when symptoms are truly persistent and aggravating. He is definitely one that respects the risks of surgery and does not operate just upon the 'anatomic or MRI findings'. For that, I greatly respect him.

Again, my reason for registration and posting here is to provide yet another positive and successful experience with Dr. Jho. His specialized procedures are not always helpful and appropriate for certain patients but for those who are good candidates, I would highly recommend him.

Hi,

I am glad you all had a positive experience with Dr. Jho but I did not. I had surgery on a T7 herniation about 2 1/2 years ago and my pain increased 5 fold. At the time of my surgery, a woman was suing him for a bad t-spine surgery and he warned me that I'd better not follow her example!!!

If I had to do it all again, I would not. I am much worse off now than I was before I started!!

Lisa

I think it is important to note too that he chooses his patients carefully. I would not be a candidate for his procedure. The surgeon that did my cervical fusion told me Jho would never consider me because he is very statistic conscious as most of them are, but Jho more so. I was warned by other medical professionals that know him not to use him and steered clear. I was also told by one surgeon that there are people that studied with him and for some reason cannot duplicate the success he claims with his procedures. I think if you had a great outcome with him and are happy that is wonderful, but I went with a traditional fusion and had a good outcome too and happy that I went that route as well. I hope you both continue to do well. I have heard too that if you have problems it is difficult to have any follow-up care with him. True? I do not know...I just know I experienced poor post-op care with my first lumbar surgery and did not want to go through that again with the cervical spine.

I am headed for Dr. Jho on April 2 for my consultation. I already saw Dr. Kang at UPMC who was HIGHLY recommended and researched, but I really don't want the "bone from the hip" for the cervical fusion thing and hope Dr. Jho is my man. From what I have read in most cases it seems some people go in to surgery forgetting the warnings they were given about what "could happen", but most likely won't. Sometimes the surgeries are not a success or things can get worse.

Dr. Kang already warned me as I am sure Dr. Jho's office will. Then some people tear Dr. Jho down with out all the facts so I am weighing things myself. I have read a few unfortunate situations with Dr. Jho that I have no explanation for, but I guess I will follow my heart and common sense and pray for the best what ever I decide. Any more Dr. Jho stories of success I would like to hear them. thanks, david

If the "bone from the hip" is scaring you, then why don't you ask about a cadaver bone? My own NS prefers NOT to take bone from the hip. I have had a cadaver bone instead for both fusions and I did well. My concern and I could be wrong, that with all the levels that are involved and having the minimally invasive surgery would set you up for more instability. It SOUNDS like, from what you have said in other posts, that it is a foraminotomy. And to have that many levels done would frighten me. I would lean more towards what your Dr. Kang has said. Just my own opinion though. I guess what I am trying to say is that no matter what; I would go more for STABILITY rather than worrying too much about what TYPE of surgery. If your neck is as arthritic as you and your doctor have said; then roto rootering out the bone spurs, etc., might NOT be the appropriate course of action. Anyway, get the second opinion but I would proceed very cautiously. You wouldn't want to have all that work done only to find out later that you need fusions.

that is very wise advice that I will consider. It was the same concern of Dr. Kang, but another doctor of the Minimally Invasive type did not have that concern. I will truly weigh all thoughts and pray I make a good decision. thank you for the advice to think about.

Please note I have two other posts that go into details regarding my surgery above. This is update #2

I had the surgery on Dec 20 and it's about 10 weeks after the surgery. The surgery relieved 95% of my problems. The only issue I now have is tingling in my left foot, the tingling is very mild. I have resumed playing basketball a few times a week, with no ill effects. I can stand for long periods of time, and walk for extented time. All of these activities I could not do before the surgery.

I am considering get the next level done, which would be L3-4. hopefully this would relieve the tingling in my left foot. The tingling is nothing I could not live with at this point. But I think it would be better to have it done when I am active and relatively young.

From my experience I would highly recommend Dr. Jho for Stenosis Surgery. I traveled halfway across the country to have it done by him, and would have it done by him again.