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Spinal Cord Disorders Message Board


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I've read much of what is posted here. I'm scared to death. In a bad car accident in 1990 - did 3 yrs chiro that helped, could live with the occasional pain. Then 3 months ago woke up felt like I had knife in my back and no feeling at all in left arm. MRI shows bulging disks from C4-C7, compression of nerve root. I've done therapy, many drugs, 3 epidurals. Left arm better but tingles. Can barely move neck at all in any direction, constantly using icy hot (but it makes my skin peel). Neurosurgeon is recommending ACDF for C4 thru C7 and removing bone spurs. I've read of so many problems having this done. Considering the minimally invasive laser procedure instead. Does anyone have idea on which one is better for long term pain relief. Also with C4-C7 fused, how bad is it moving your neck? And I keep hearing swallowing after ACDF is terrible. I need to do something to help with the pain. My main objective is to not go thru this again, but I don't want to do a terrible procedure if I'll still hardly be able to move my neck. I'd really appreciate any responses! Sandy in Orlando:confused:
Hi Sandy. SpineAZ asked to come on and talk to you about necks. I've had a lot of neck problems and 2 major neck surgeries. I am fused from C3 to T1 from the back of my neck(not an ACDF).

I know you are scared but learning all the options and how they will affect you after is very important as the wrong procedure now almost guarantees you more surgery in the future.

If you have the results of your neck MRI, could you post them? I'm pretty good at interpreting them so you can understand the situation and it helps to make a better decision.

On the laser treatments, when they remove bone spurs from arthritis, they do grow back. It is not a permanent treatment. And oddly enough, sometimes removing them makes them grow back even faster and worse than before. And you won't know if you are one of the people who will have this reaction until after surgery. Trimming back disk bulges can be done by various methods, not just laser treatment and the laser can only get to what is exposed, not within the bone. So it is extremely minimal at best. In an ACDF, they can remove large chunks of the bulging disk. And the nerves of the facet joints can be burned off without surgery and they do grow back(ALWAYS) within 6-12 months. You would still need the nerves burned off at regular intervals.

The ACDF, has it's problems in that you have plates and rods in your neck right up against the esophagus. Some people have problems swallowing after and some don't. But in the hands of a really good spine surgeon, you should be okay. This is a surgery that has been around for a long time. Does it need to be expanded as more disks go? Yes. Any fusion has that risk. And the same goes for laser surgery or posterior fusions. Only something like a laminoplasty will avoid that as it's doesn't have a fusion.

You can also do a fusion from the back of the neck. It is a lot more painful as they have to cut muscles to expose the spine but you don't have any problems with swallowing and the rods they use allow for a stronger fusion than with the plates of an ACDF. So you trade off less post-op pain with the ACDF with no swallowing problems and a stronger fusion with the posterior fusion.

And there are even more options. If you have a problem with spinal cord compression as well as nerve compression, a laminoplasty would really help. If you have badly closed up foramens where the nerves exit, they can only be reached from the back as well so a foraminotomy would be the best bet.

I will caution you against chiropractic treatment for now. On top of everything else going on in your neck, you also have 2 major arteries that go to the back of your brain, going up to your head through the bones of C6 to C1. A bad adjustment can lead to a stroke. Here in CT where I live, chiropractors have to disclose to all neck patients that they can have a possibly fatal stroke from a neck adjustment. It has killed people. Be VERY careful.

Again, if you can post the results of your MRI here, I can give you a better idea of what you need done and which way to go with this. But I can tell you one thing.....a bad surgeon or the wrong surgery is the best predictor of whether or not you'll be in pain the rest of your life and need additional surgery. My own surgeon has built an entire practice of fixing what others docs have messed up. There are a lot of bad spine docs out there. You want one who does spines and only spines be it an orthopedic spine surgeon or spine neurosurgeon. The best ones are those who teach at medical schools.

The spinal cord is part of your brain so you choose the doc based on the seriousness with which you'd choose a brain surgeon.

And lastly, spine doc's don't operate for pain. When it comes to the cord and nerves, pain is a good sign. Pain means the nerve is alive and kicking even though it is hurting. Spine docs operate for numbness, tingling, loss of muscle function...........signs that the nerve is in danger of dying and leaving you with permanent paralysis.

Here are a couple of warning signs that you have a doc who is not telling you the truth.

1) no doc can guarantee you won't have continuing pain after surgery. Surgery to stop pain is successful only 30% of the time.

2) no doc can guarantee that you won't still have numbness or tinging or muscle problems after surgery. Surgery for that is successful only 70% of the time.

Anyone tells you that they guarantee you will be pain free or numbness free is lying to you. Run the other way.

You have a degenerative disease in your neck....arthritis. It doesn't stop or get better. It will continue to get worse.......period. It requires management for a lifetime. Once you have a bad neck, you will always have a bad neck but the right surgery with a really good surgeon can help to make it much easier to live with.

hugs.........Jenny
Jenny - you are WONDERFUL. I am so thankful I found this board and that spineAZ referred you to me. First I need to ask - you had 2 major surgeries and fused from C3 to T1 but not ACDF - can you move any part of your neck? (they recommending me C4 to C7). and you said not ACDF - I'm very new to all this - so what did you have done and what caused you to have all this?

Quick history on me - major car accident in 1990. Chiro for 3 yrs after it, and then just learned to live with the pain. Until April of 2011 when I woke up from sound sleep feeling like I had a knife behind my left shoulder blade and complete numbness in my left arm. Dr's, xray, MRI, meds and more meds, Phys therapy, TENS (that I now own and love), and 3 epidurals later - I'm better. Left arm just a slight tingle occasionally, still some pain behind left shoulder blade. Biggest concern is very restricted neck movement left, right and up (down is fine), and continual pain in neck area. I put on flex-all 6-8 times a day (tried icy hot and it made skin peel over and over and gave up). I can't wear even a thin necklace around my neck. Working on a PC with monitor at any level painful for more than 20 min or so, looking up very painful at all, looking down to write for more than 5 min very painful. Scared to drive as I can't turn head but need to drive to get to work and back. I just found out that all I had done was temporary, even epidurals. I'm absolutely scared to death to go back to the knife in the back feeling. And I would love to be able to move my neck again.

Went to neurosurgeon, wants to fuse C4-C7, moving disks, adding bone grafts and plate installed, going from the front, and he would remove the spurs. Completely floored had no idea I needed something like that! So now I'm looking for opinions of others. I talked to LSI re laser, much less invasive of course, but opinions is it too is temporary. I have aptm to talk to orthopedic surgeon next week for 2nd opinion. I know I'll need some surgery and I'm the biggest baby you ever saw for anything medical. They had to completely knock me out for each epidural. All this talk of not being able to swallow, having a scar on my neck, not being able to move my neck afterwards, and the fact that it might make things worse is making me think there is no real fix for my problem.. And ironically, I just came back from a chiro aptm. He tried to do an adjustment and said my muscle were very tight. And then I tried the decompression machine. I'm in a huge amount of pain and on ice right now! I'm not sure the aptm was successful at all.

Here are my summary MRI results (this was taken early May 2011 before I had any of my treatments - so I have to believe it is at least a bit better now)

C3-4 - minimal bulging and ridge without significant stenosis
C4-5 - central protrusion with ridge contracts and mildly impressed cord
C5-6 - broad based protrusion with left paracentral with uncinate spur with cord compression and compromise of C6 nerve roots - left greater than right
C6-7 - left lateral recess protrusion with uncinate spur with cord compression and compromise of C7 nerve roots- left greater than right

you mentioned with ACDF the plates hits the esophagus and causes hard time swallowing - isn't that scary, and then how do you eat? That would really scare me! Is this a life long thing, or how long does it last?

You also mentioned spine doc operate for nerve issues or loss of muscles. For now, I'm guessing the nerves are not compressed as much as my left arm is so much better. for now the only real bother is loss of movement in my neck and neck pain - not muscles or nerve isues - so does it mean I shouldn't have the surgery? Or is it that after the 3 epidurals - which are temporary - I felt better and din't have the nerve or muscle issues and I should have surgery now before they wear off?

The loss of movement in my neck could be from tight muscles (how they react since they sense full movement would be painful) or is it arthritus? Am I right that there is no cure for arthritus, so no matter what I do I may have this the rest of my life?

Lastly, if I do have the C4-C7 fusion, is there anything I can do to slow down problems with the disk above and below it. At this rate I feel that eventually I'll be fused from head to toe (ok not quite that) before I die and be one solid spine!:dizzy:

Again - I definitely appreciate your thoughts and comments. I found out I have an max out of pocket of $1,400 no matter who I see and what surgery I have. So financially it won't matter either way..

Sandy
Let's start with some good news. Since you have less pain and tingling in your arm, you have time to find the right surgeon and the right surgery. If your arm had stayed numb, you'd be looking at urgent surgery.

You have 2 major problems that can happen in the neck...one is compression of the spinal cord and the other is compression of the nerves to the arms, neck, head etc(there are others but not noted in your MRI report so I won't go into them). The "uncinate spurs" are bone spurs on tiny joints on the outsides of the vertebrae themselves. Strange but your laser guys wanted to burn the nerves off the facet joints(more tiny joints on the outside) but you don't list bone spurs there. Hmmmm. But the uncinate joints don't seem to be the cause of your problems. Herniated disks and arthritis is your major problem.

You are correct when you say arthritis doesn't go away....it will be with you for life, slowly getting worse. In theory, the bone spurs that develop from the arthritis only develop where there is movement and that is why they fuse the vertebrae....to stop bone spurs from forming. But that is not necessarily true...I have bone spurs growing inside of my fusion where is no movement at all. So even a fusion is no guarantee of the arthritis slowing down or stopping. And removing bone spurs can make them grow back faster.....ask anyone with major knee arthritis....docs almost never remove bone spurs in the knees as they grow back bigger and faster.

As for the disks, as we age, they tend to dry out and get fragile so they tear and the inside contents bulge out. The backside of the disk is right up against the spinal cord so pressing on that can do a lot of damage. And if they bulge to the back sides, then they block where the nerves go out to the body. Even in an ACDF, they don't actually remove the entire disk but the part of it they can reach but it's enough to relieve the pressure. Then they but a piece of bone into the space where they took out a section of disk and that acts to fuse the bones together, stopping movement and hopefully slowing the arthritis. So bad disks is a pretty common problem as you age.

But I'm concerned that they don't say more on the MRI report as to how much the holes for the nerves are blocked(they use words like minimal, mild, moderate or severe) or how much the cord is indented. Was there anything like "thecal sac indented" or "mild cord compression" mentioned? We think of them as descriptive words but they are actually medical terms when it comes to the neck. The reason I ask is that if your spinal cord is compressed to a certain level, you need to have that addressed as well. Spinal cord compression shows up in the legs or feet, not the arms. Any problems with your legs?

Some people like to go with the least possible option for a problem even if it means more surgery down the road. That is when laser surgery is helpful. If you are scared of surgery, then have as much done as possible in one big surgery in hopes you'll never have more done. Laser surgery almost assures you of more surgery.

In an ACDF, the scar goes up and down on the side of your neck with maybe a short sideways scar. They have to push your windpipe and esophagus to the side to get to the neck and that is why lots of people have trouble.....it can bruise them and make them hurt for a while. The plates they use will be in between the spine and the esophagus but most don't feel it unless they swallow something big. And with time, all the swelling from surgery goes down and it slowly goes away as the body adjusts.

Then you get someone like me who had major problems with compression of my spinal cord, not just the disks and nerve problems. My surgery was done from the back of my neck as that is the only way to resolve cord issues. The first surgery re-built the bone over my spine, making room for the cord. The second was a full neck fusion as I had some complications after surgery(broke some of the tiny bones in my neck). It is an option for someone who needs a lot of vertebrae fused or needs to make sure the voice and esophagus are not damaged(like a pro singer).

Just so you know, I can move my neck pretty well and I'm C3 to T1.....1 vertebrae longer on each side from what is being proposed for you. Initially I lost about 50% of the movement of my neck in all directions but now that I am 4 1/2 years out from surgery, I have gotten more movement back. I can drive with few problems. Yes, I can't look up a the sky without leaning backwards and I can't put my chin on my chest but I get along quite well. Side to side I can almost get to my shoulders. A C4-C7 should leave you with at least 75% movement....or more than you have right now.

The biggest problem with necks is the muscles. They try to protect your neck and in doing so, spasm, painfully. Fixing the neck may or may not help. My muscles still spasm and I am still doing PT to help relax them.

Since your arm is doing better, I'd keep working with whoever is doing the epidurals and learn how to relax those neck muscles. Don't do surgery until you are really ready and then do as much as you can to fix it in one surgery. I'd avoid the laser stuff....you'll have to keep doing it over and over. They love people who are afraid of doing the real fix. Then search for the doc you feel comfortable with who will do a full fix. Yes, you always end up putting stress on the disks above and below the fusion but that can't be avoided. But it also doesn't mean anything will happen. I've got a bigger fusion and so far, so good. Being careful after surgery can keep you out of the OR.

ACDF surgery is not very painful. Most go home within a day and are in a hard collar for about 6-8 weeks. The surgery from the back of the neck is very painful and you are still in a hard collar for about 6-8 weeks.

Either way, the quality of your surgeon is the biggest factor in how well you'll do. I've had a lot of major surgery and this is one case where the doc doing the surgery means everything. A sloppy doc will end you up with more surgery and lots of pain. A really good doc and you'll have a much better outcome. Experience and ability are #1. I can not stress that enough.

Ask me whatever you want to. I have been through a lot. I try to be fair when I answer although I do have my own opinions.

hugs........Jen
Sandy, as far as I know, MCU not suppose to cause you any pain. This has to be done with the physical therapist only, perhaps you went to the chiropractor?

I am trying to hear about people's experiences with this new machine but I guess cause it is new so, but that surprising me.

I had a severe whiplash just like yours. But my pain is horrible, impossible to live with.

Did you have those bulging disks after the accident or they found out later?(have you done an mri 20 years ago?).
I do not think I had an MRI all those years ago. I went to a doctor first for pain and the did x-rays and recommend a chiropractor. I went to him for 3 years. I am positive I never had this severe pain that I experienced 3 months ago back then. I understand the severe knife in the back pain was caused by the pinched nerve which left me completely numb on my left side. This is all new. This is why I'm considering surgery now. After 3 epidurals I am much better. Left pain in arm is minimal. but neck is still tight and painful. I'll post what the orthopedic surgeon says when I go tomorrow. Is your whiplash new? As much as I hated the epidurals, in my case they worked very well.. Does your MRI state the thing mine does - I have it listed in a post above.

Sandy
Hi, I definitely have several compressed -pinched nerves. It showed clearly on the MRI. So far the neurologist showed me the MRI on his computer and actually showed me on my MRI what a pinched nerve looks like and showed me the bulging disks very clearly. I had complete numbness in my left arm, then terrible pins and needles and very deep arm pain for months. Thankfully with the three epidurals that part is mostly gone. My biggest problem now is very limited neck movement and neck pain. And I fear the epidurals are only temporary and the pinched nerve feeling may come back. I didn't feel the extreme pain where the actual pinching was just off the vertibre. For me it was behind my left shoulder blade. I was on straight ice for 2 days - (resulting in all my skin peeling off) until I could see the doctor. That horrible pain behind should pain lessened a bit, but was there and slowly went away after each epidural. I'm more than 2 weeks past my last one, and unfortunately it hasn't done anything about neck movement. The epidural is done to reduce inflamation and pain and it did work for the pinched nerve.

In your case since it is very new whiplash, I'd definitely see a regular doctor. Unfortunately it took 3 years of chiro treatments for me to make my pain bearable. I used to live with 'flexall' liberally spread on my neck back all those years ago. And oddly, I'm back at it now, putting it on about 10-15 times a day. I tried icy hot and it literally peeled my skin - I've had horrible neck skin peeling at least 10 times in the last 3 months and finally gave up on icy hot - it has 16% menthol and I apparently cannot handle it. Flexall has 6% and I'm fine with it. Mineral ice has only 2% and barely does anything for my pain.

I remember the chiro showed me stretching exercises to do, and they definitely helped. Of course this goes back 20 years. I think my biggest suggestion to you is be aware that what happened to me may happen to you. Neck is mostly good, and then bam, you wake up like I did in so much pain due to bone spurs hitting the nerve root - that is what it shows on my MRI. That is why I'm considering laser surgery. I go see the orthpedic surgeon today and hopefull he will steer me in best direction. I am fairly sure I will go thru one surgery or another if and only if they say it will help prevent going thru pinched nerve again and it will give me my neck movement back and less neck pain. I'll post later. I hope you feel better!





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