New neckie introduction

[Katjonmadi]

Hi there! As you can see from my signature I'm not new to back issues, but I am new as a neckie

Cervical symptoms started in April with pain in neck and shoulders. By June my right arm was getting nerve pain, tingling and numbness so I decided it was time to call my N/S. Upon examination it was found I have hyper reflexes and arm weakness so he sent me for MRI. Results were as follows:

FINDINGS: there is loss of disk height and signal at C6-C7 and to a lesser degree at C5-C6 and C4-C5. Signal intensity of the cord are normal although there is a slight posterior displacement and indentation of the cord at C6-C7. Normal relationships are noted at the craniocervical junction.

C2-C3: No significant spinal stenosis or foraminal narrowing.
C3-C4: There is a right para central disk protrusion and disk osteophyte complex resulting in moderate eccentric right spinal stenosis. Facet and uncovertebral joint hypertrophy results in mild right foraminal stenosis.
C4-C5: There is a broad disk bulge resulting in moderate spinal stenosis. Facet and uncovertebral joint hypertrophy results in mild right foraminal stenosis.
C5-C6: There is a broad disk bulge with midline annular tear resulting in mild spinal stenosis. Facet and uncovertebral joint hypertrophy results in mild to moderate right greater than left foraminal stenosis.
C6-C7: There is a central disk extrusion with superior and inferior subligamentous extension resulting in severe spinal stenosis with posterior displacement and slight flattening of the cord. Facet and uncovertebral joint hypertrophy results in mild right greater than left foraminal stenosis.
C7-T1: No significant spinal stenosis. Uncovertebral joint hypertrophy results in mild right foraminal stenosis.

IMPRESSION: Multilevel cervical spondylosis with spinal and foraminal stenosis as described above. Findings are most pronounced at C6-C7 where there is a central disk extrusion posteriorly displacing the cord.

I've done a round of steroids which helped with the tingling and numbness but the nerve pain is still in my right arm and now I get intermittent nerve pain down my left arm as well. N/S said only non surgical option was traction. I tried it once, made my pain level worse, so he told me not to go back. He wants to do an ADR Prodisc on C6-C7 and is confident my insurance (Cigna) will approve and says I am the perfect candidate because I'm young.
I'm nervous as he has said he can't guarantee all of my pain will be resolved as I have multiple levels involved and he only wants to treat the 1 level. He hasn't offered any additional testing to determine the pain generators and scheduled a surgery for Aug 6th so he could start the per-authorization process with the ins. I'm feeling rushed and not confident that I will wake up pain free. After finding your website, I researched his experience with ADR and he said he does about 1 a month and has been doing them for 4 years. Not staggering numbers by any means.
I have a 2nd opinion this Wed with another N/S. I found a local O/S that was part of the initial US trials for the Prestige and am sched to see him next Wed for a 3rd opinion.

After all my rambling I guess I'm just looking for advice or opinions. I'm new to the neckie side of things and my current N/S made it sound like we need to act fast due to the cord compression and signs of myelopathy. Has anyone had experience like this? Is it really a rush type situation? Also, he hasn't offered any other non surgical options stating I'm limited due to the cord compression. Does that seem accurate? Also, does it appear I'm a candidate for ADR? I thought I've read that facet issues or spondylosis made you ineligible but my Dr insists the myelopathy is my primary diagnosis. I'm worried he might be trying to fit a square peg into a round hole.

I apologize for the novel and thank you in advance for any insight you might be able to offer!

[NJ Gene]

Dear Katjonmadi, For starters, I recommend you get multiple opinions from spine surgeons as well as neurosurgeons. I would say get at least 3 opinions from surgeons in the U.S. and if you think you can afford $40K or so to go abroad, get 3 opinions from surgeons in Europe. You should spend several hours on these boards reviewing the experiences people have had with the various surgeons. There's a thread called "Surgical Outcomes" with this information. Out of curiosity, did you have an EMG test? That will generally help isolate which level is causing your symptoms.

Based on the findings it sounds like C6/C7 needs the most attention. Coming from someone with no medical education, it's sounds reasonable to have ADR at that level. I don't know if pro-disc is the best option. That's why it's best to get multiple opinions. Furthermore, if the other levels can be addressed in a minimally invasive way (i.e. endoscopic spine surgery), that would be your best bet in my opinion. I believe ADR and/or fusion should only be considered as a last resort. Nothing does better than your own natural disc if it can be preserved. That's why I think that if something minimally invasive could be done at the less severe levels you'll be better off.

Good luck!!

Gene

[Katjonmadi]

Thank you for taking the time to read and respond! I'm hoping I get more confidence after meeting with the next 2 Drs.

[NJ Gene]

Dear Katjonmadi, I hope you get more information from these other 2 doctors. You didn't answer the question about the EMG test. IMO, that is very important to do in order to confirm the MRI findings. If you have any further questions, feel free to send me a PM.

Gene

[Katjonmadi]

No I have not had an EMG and will definitely ask about it. I met with the 2nd opinion today and he seems to think we can prolong surgery by doing cortisone shots. He feels that due to my age, the longer we can wait, the better. Have you ever done those shots in your neck? If so, did they work? For how long?
I did a couple back in 2002 when my lumbar issues first started but they never helped.

[2Confused]

Awwww! Those shots in the neck! I had a series of three and, no, they did not help and I actually felt ill after each one. However, many others say the shots are very effective. Hope you find relief!

Originally Posted by Katjonmadi

No I have not had an EMG and will definitely ask about it. I met with the 2nd opinion today and he seems to think we can prolong surgery by doing cortisone shots. He feels that due to my age, the longer we can wait, the better. Have you ever done those shots in your neck? If so, did they work? For how long?
I did a couple back in 2002 when my lumbar issues first started but they never helped.

[NJ Gene]

Katjonmadi, look at my signature, 40 epidural steroid injections from 2005 to 2007. I generally got about one week's relief from any given injection. I went to a pain management specialist who I now consider illegitimate. He ran a surgi-center which was like an assembly-line. Wednesdays were his "procedure" day. Hundreds of people were lined up in the surgi-center for injections. He only accepted insurance that had out-of-network benefits. Anesthesiologists were there to put you under for 5 minutes while the injection was administered. You then had nurses who attended to you in "recovery" while you woke up. He billed $5,000.00 to $10,000.00 to my insurance for each injection and got most of it!! I had so many injections that I developed osteopenia. That is unheard of in a 41 year old male. BTW, once my insurance changed to one that didn't provide out-of-network benefits, he dropped me like a hot potato.

IMO, epidural steroid injections will only delay the inevitable. If you want to try it once or twice to buy time, that's ok. Don't worry, most pain management specialists aren't like the one I had. Just know that the maximum number you should receive in a 12-month period is 3.

Good luck!!

Gene

[Dema]

Hi Katjonmadi, I tried epidurals for my neck pain, and did not work. But I know some people who did get few months of relief with epidural injections. If they work for you, it would be good to provide relief while you look for the best treatment option.
Best wishes,
Dema

[Katjonmadi]

Thank you all for sharing!

What was your pain level prior to your 1st cervical surgery? Part of the reason I'm hesitant is that my pain level averages about a 5. Uncomfortable but still manageable. Prior to both of my lumbar surgeries I was at a 10 so there was no question. Is cervical just different than lumbar in that way?

[2Confused]

Kat
Some days I was in tears the pain was so bad, most days I was a 6 or 7. There were days I could barely move & the radiculopathy was intolerable.