[lac27513]

Do I have a problem here?

Hi, I've been reading and learning here for a few weeks without ever posting. Sorry for asking the question before introducing myself. I am six weeks post op having had an anterior cervical diskectomy and _________placement. In case it doesn't show, the link is to an image of the first xrays that I have seen since before the procedure and I'm wondering if I haven't made a huge mistake. I'll explain more about that later.

I've been off work since the end of February. I merely woke up one morning with a stiff neck and fever, but went to work anyway because I had a meeting. I felt progressively worse and thought I may be getting the flu so I told my supervisor that I needed to leave. I went to the GP doc the next day. They felt that I had 2 unrelated problems...a virus and after doing an xray, possibly a herniated disc. I knew that I have had 2 herniated discs in the past, but they had not been causing me any problems. But comparing the new xray to those in the past was significantly worse. My doctor told me stay home a few days gave me a course of steroids by mouth and referred me to a local pain management group. My range of motion became progressively worse. The pain management group ordered an MRI and nerve conduction studies. It showed DDD with HNP at C5-6 and C6-7, radiculopathy, along with another course of steroids by mouth. When I had no significant relief, they ordered PT which I was unable to tolerate. Next came epidural and transforaminal steroid injections. (3 each, 2 weeks apart) The doctor felt that if I had 2 more transforaminal injections, I would be better and my left arm pain would be at least as good as my right. I felt that I could not tolerate any more steroids because of their side effects, so I asked for a referral to the neurosurgeon. The pain management doctor didn't feel that would be of benefit but finally relented. I was having increasing symptoms including problems walking, and urinary frequency/urgency/incontinence along with the headaches, arm pain, neck range of motion problems. It was difficult and tiring just holding my head up. The pain management doctor suggested that I see a psychiatrist in addition to the neurosurgeon and I was started on antidepressants in addition to steroids that were already in my system. The pain management doctor kept telling me that he could fix it...and I was trying to go the conservative route, but I finally felt that I just wasn't getting any better. When he said that only 10% of his patients require surgery, I figured that he didn't want me messing up his statistics. My blood pressure had never been high in my life, but was now 154/92 and I was an emotional mess. I think it's called Roid Rage.


The neurosurgeon ordered another MRI after having seen that I failed conservative care. I was amazed the pain management doctor still wanted to do more injections.

This is from the 2nd MRI-
Findings-
C2-3 and C3-4 –Small central disc protrusion minimal distortion to ventral theca sac

C4-5-Moderate disc degeneration with disiccation and height loss and 2mm anterolisthesis, Moderate endplate osteophytic ridging is present, eccentric to the left, flattening the left ventral thecal sac, possible minor cord distortion. Mild bony foraminal narrowing on left.

C5-6- Severe disc degeneration with desiccation and height loss. Moderate endplate osteophytic ridging is present, eccentric to the right and left of midline. Right ventral thecal sac is flattened, possible canal stenosis and cord distortion. Uncovertebral joint hypertrophy and to a lesser degree facet hypertrophy leads to bilateral foraminal narrowing, moderate-severe in degree.

C6-7-Moderate-Severe disc degeneration. Moderate endplate osteophytic ridging flattens the ventral thecal sac. There is bony foraminal narrowing bilaterally, roughly moderate on the right and moderate-severe on the left.

Impression-
-Multi-level cervical spondylosis with bony foraminal narrowing most advanced at C5-6 and C6-7
-Small dorsal, central disc protrusions noted at C2-3 and C3-4.

The neurosurgeon felt that a single level ACDF at C5-6 would be sufficient. I explained that the reason that I had gone through all the conservative care was to avoid fusion. I was very active, with an active family. My insurance only covered fusion so he mentioned the possibility of participation in a clinical study for a new artificial disc. I read the protocol and after a few days thought, agreed to participate. It was a 50/50 chance of having the fusion anyway, so I figured that I couldn't lose by at least allowing myself to be randomized. In mid-June I received an Anterior cervical diskectomy and neo disc placement. I was discharged the next morning with pain meds and no collar after my post op xray. I never saw that xray or report. I read the operative report and I'm not sure that an xray was taken prior to closing...I don't even know if that is standard procedure or not.

My post op course has been rather disappointing. While the pain down my arm is mostly gone and the some of the worst of my neurological problems are improved, my neck pain, tolerance/fatigue and range of motion problems have not improved at all. I am still very limited in my range of motion, and cannot drive on the highway. (I'll admit to driving short distances when I have someone else in the car to help since only one of my kids is old enough to drive). I hate that shampoo and water runs down my face and into my eyes and mouth because I can’t extend my neck back. My hands go numb when I'm doing anything with my arms extended (using a hairdryer, driving, working on a computer). I still have bad headaches, and depression (now on 2 antidepressants!), difficulty swallowing and my voice is very weak. It is difficult to talk for any length of time. I still need head support when sitting for a long length of time and still need pain meds to be able to get some sleep at night. I was totally unprepared to be dead numb from the top of my scar to my jaw line. I don’t feel that I have had any change since the initial improvement after the surgery itself. I hate to listen myself complain because much of these problems are so minor compared to others, but to me they are just nagging reminders of my continuing frustration. I want MY life back.

After I saw my 6 week post op xray, I’m now wondering if I can even hope to have my life back. I am not totally comfortable with the neurosurgeon’s explanation when he said that this is not a problem. It appears to me, at least in the xray, that one of the 4 screws is angled down past the end of the vertebrae and extends into the disc space and into the replacement disc material. The other 3 screws are straight and perpendicular to the vertebral body, so why is one angled down past extends past the end of the vertebrae. Is it trivial to think that I’ll ever have any more range of motion in my neck? Can I be positive that the material in the artificial disc would never cause a problem since I’m not positive that it hasn’t been compromised? I’m having to trust something that I didn’t even consider when I read the protocol.

At first, I was able to do some work from home, but my supervisor required me to take short term disability because I was unable to supervise my one direct report from home. Once on short term disability, I was no longer allowed to work from home at all, but was called frequently at home for help anyway.

One thing that I do know is that short term disability will not last forever. I am now really being pressured to come back to work. My being a short woman with progressive lenses (*OK...they are bifocals) doing computer work is a problem. I don’t have a lot of options when it comes to accommodations. I have had ergonomic assessments at work, but when it comes to being able to see at different ranges…that’s a problem. I can’t have a pair of glasses for every job activity. My eyes are too dry for contacts (I tried) and because of the dry eyes, I'm not a LASIK candidate. It is hard to be constantly looking up to talk to someone, searching for an item on an upper shelf or even sitting on either side of a long conference table. I get so tired just trying to hold my head up. Outside activities like even trying to read music while making eye contact with another player or singer is difficult.

I never thought that these minor things would be such difficult problems to fix. I used to be such an active person. I did years of martial arts with my kids, I ran, I played in orchestras, I taught community first aid and CPR classes, I drove to all the kids activities and school events…all these things that made my life are affected by this. My family deserves much more than I am able to give right now. I’m afraid that I’ll never be normal again. Wow….I really am frustrated….and I apologize for complaining but would really appreciate some suggestions if you have any….(just don’t tell me to chop my head off!) Thanks for listening.