Evaluating Surgical Options For C5-C6

[DrewDotNet]

Greetings, my name is Drew.

About me:
*Currently living in Texas. Long-tme Virginia resident, have also lived in Florida, North Dakota, Mississippi, UK, Japan, Germany.
*My folks were both in military Health Care. My mother was an RN, father was a Hospital Commander (aka: Med Group).
*I've worked for some great organizations over the last 8 years as a Network Engineer/Architect. Recently finished my CCNP, working on my CCIE.

I've spent the better part of the last 6 months undergoing treatment for my neck.

I've done traction, physical therapy, TENS, EMS, Robin McKenzie's treatment routines (I highly recommend "Treat Your Own Neck" and "Treat Your Own Back").

I was not a candidate for TCMD - www.youtube.com/watch?v=PekisR5K6X0
For anyone not familiar with it, it's a newer minimally-invasive cervical procedure, using an anterior drill channel to gain access.
The hole is filled afterwards, leaving the natural disc intact.
It can sometimes save an ACDF/ADR for a patient with bone spurs or herniation.

A Neurosurgeon advised me to consider ACDF on my C5-C6, but I am much more in favor of any Artificial Disc option. I'm currently seeking second opinions.

I applied to the U.S. Restore Clinical Trials for the M6 disc, based on my MRI's and review of their requirements, I may actually be a good candidate for this.

If I'm eligible, Texas Back Institute is the closest provider, but I understand there are a range of participating providers. I've heard good things about Dr. Carl Lauryssen, and GBNA. Anyone else have any experiences, good or bad with the providers on the clinical trial list? (scroll to the bottom for the full list) https://clinicaltrials.gov/ct2/show/...1609374&rank=1

[Old Codger]

Drew,

I am a newbie to this forum, also... just ahead of you by a few weeks. However, I had a cervical fusion in 1999 of my C4, 5 & 6, with a titanium plate, screws of unknown material -- there is a problem with sheer forces with Ti, I understand, and mesh of unknown material -- maybe metal or a polymer -- both can be allergic.

At the two and a half year mark after that fusion, I was seeing a rehab doc for neuropathy in my toes, feet and lower leg, which after seeing about eight docs, and being convinced to have two additional surgeries on my lumbar spine for stenois, did nothing to improve my situation. Also, I had some other symptoms of now-questionable origin. Now, at approaching the sixteen year mark, I have terrible neuropathy, and other symptoms, which cause me to have strong suspicions they are related to the metal, and maybe something else, in me.... proven or not, by the capabilities of our "modern" testing.

Only did I remember about five weeks ago, and connect, my past experience with metal implants with neuropathy.

In 1981, I fell and broke myself up badly. The ortho surgeon used some metal plates and screws, etc, to do fixation of the fractures. At some un-remembered time, I developed the same neuropathy, as I have today, in my toes, feet and lower legs. Then, after I had that metal removed from my body, the neuropathy dissipated over an un-remembered length of time... and stayed away until I had the newer crop of metal put into me in 1999 for my cervical spine problem of a pinched nerve that caused pain in my right forearm. But I had forgotten this scenario of the neuropathy with the metal until the recent recall.

In 1999, by not being sufficiently informed, I chose to go to an orthopedic surgeon instead of a neuro-surgeon, which woundup causing me to have a cervical fusion. I have no questions about the abilities of my orthopedic surgeon as a surgeon. But, I gather that the neuro's like to do an "open-door" or, "raise-the-roof" type of procedure, if possible, as opposed to the ADR or fusion that ortho docs like to do. The neuro's seem to like to relieve the pressure on the nerve rather than do the fusion or ADR, to do the same relief of pain.

No, I have not done an extensive survery of docs to arrive at this conclusion. I have come to that conclusion from my discussions with affected people, and my reading.

Due to the fused partial-cervical, with metal, I have a more restricted head movement capability that is really bothersome... and may cause more future trouble with putting more stress on the remaining joints. I also now realize that my neuropathy is probably caused by reactivity (allergy) to certain metals. Upon presenting with a rash/exzema/itching, I was shown to have a positive reaction by patch test to chromium, nickel and cobalt, which are used in alloys. There are also some other metals that are used in alloys, as well. I was also shown to be "Higly Reactive" to nickel by a metal-LTT a few weeks later.

I may be in the 4%, or some such percentage, crowd that is allergic to foreign bodies in my system. I am miserable!!! And sure wish that I had at least consulted a neuro-surgeon as well as the ortho-surgeon!!! However, pain of then in my arm drove me to get relief as fast as I could. I realize now that my learning curve was insufficient. But to tell the full truth, I am not sure that without the Internet, I would have learned sufficient then.

And yes! I can see a rational for doing a fusion and ADR in various cases. I think that even a neuro-surgeon will see that also. Our various problems are caused by different causes.

IMHO, surgery may only add to your problems. Go cautiously!!! And do the least surgery that you can.

Wishing all wellness!

Old Codger

[DrewDotNet]

Believe me, I don't want surgery, and I understand the gravity of this decision. Pain isn't my primary consideration.

My biggest concerns are: decompressing the spinal cord, and restoring proper lordosis (I'm actually better on the latter since physical therapy). I don't have any outward signs of myelopathy, but I have moderate cord compression that may progress.

My understanding is that when myelopathy symptoms show up, the "should I, or shouldn't I?" debate is basically over, unless you really like to gamble with your life.

If that happens, I want to be prepared to execute a well-researched set of options.

Thank you for sharing your story. I don't have any known allergies, but I definitely want to check for reactions to implant metals prior to making any decision.

Isn't there some kind of standard testing for this now? I thought I read about that somewhere.

[NJ Gene]

[QUOTE=Old Codger;109541]Drew,

In 1999, by not being sufficiently informed, I chose to go to an orthopedic surgeon instead of a neuro-surgeon, which woundup causing me to have a cervical fusion. I have no questions about the abilities of my orthopedic surgeon as a surgeon. But, I gather that the neuro's like to do an "open-door" or, "raise-the-roof" type of procedure, if possible, as opposed to the ADR or fusion that ortho docs like to do. The neuro's seem to like to relieve the pressure on the nerve rather than do the fusion or ADR, to do the same relief of pain.

No, I have not done an extensive survery of docs to arrive at this conclusion. I have come to that conclusion from my discussions with affected people, and my reading.

Old Codger,

Things were different in 1999. There were not nearly as minimally invasive techniques as there are today. I had a fusion with an ortho spine surgeon in 1998 but it was with a neurosurgeon present.

Oldie, I would not beat yourself up over what happened in 1999. There weren't as many choices then as there are today. I'm only sorry to hear that you're suffering. Now both ortho spine surgeons and neuro surgeons do both minimally-invasive procedures in addition to fusion and ADR. One of the most well known European surgeons for ADR is Pablo Clavel. He is a neurosurgeon. You'll see his name come up a lot on these boards.

Gene

[DrewDotNet]

[QUOTE=NJ Gene;109544]

Originally Posted by Old Codger

Drew,

Old Codger,

Things were different in 1999. There were not nearly as minimally invasive techniques as there are today. I had a fusion with an ortho spine surgeon in 1998 but it was with a neurosurgeon present.

Oldie, I would not beat yourself up over what happened in 1999. There weren't as many choices then as there are today. I'm only sorry to hear that you're suffering. Now both ortho spine surgeons and neuro surgeons do both minimally-invasive procedures in addition to fusion and ADR. One of the most well known European surgeons for ADR is Pablo Clavel. He is a neurosurgeon. You'll see his name come up a lot on these boards.

Gene

There is a lot of truth here. The differences between ortho and neuro are less pronounced than they used to be.

One thing you can say about a Neuro is they usually have to graduate in the top 5% of their class to even be selected for a residency. There are also many great Ortho fellowships which are just as, if not more selective.

Ultimately, you have to consider the surgeon as a whole person, not just as a broad category.

[Dema]

Hi Drew, my wife & I have worked with Dr. Lauryssen for months, but given her multi-level issues, she did not qualify for the M6 study, so we are looking to Europe. We liked Dr. Lauryssen, but had not surgical experience with him, and found him to be informative and caring. TBI has a good name, and I see Dr. Blumenthal name in many studies and papers while trying to read up on spine issues & treatments.
I would appreciate if you can describe your symptoms to compare, I have problems in C3-C6, and have pain in neck, shoulders (trapezius), upper back (pain & burning around shoulder blades) and tingling & numbness down arms to fingers (mostly middle finger).
Hope you find pain relief soon,
Dema & Raouf

[Disky]

Drew - I just had C5C6 ADR last week. I started a post-op thread and will update my progress there the next few weeks/months. Feel free to check it out and/or PM me if you have any specific questions. I did a lot of research and met with 6 different surgeons before committing. I'd be happy to share all of what I've learned.

[DrewDotNet]

Originally Posted by Disky

Drew - I just had C5C6 ADR last week. I started a post-op thread and will update my progress there the next few weeks/months. Feel free to check it out and/or PM me if you have any specific questions. I did a lot of research and met with 6 different surgeons before committing. I'd be happy to share all of what I've learned.

Multiple opinions are key. You have to know you're on the right track.

[drewrad]

[QUOTE=DrewDotNet;109547]

Originally Posted by NJ Gene

There is a lot of truth here. The differences between ortho and neuro are less pronounced than they used to be.

One thing you can say about a Neuro is they usually have to graduate in the top 5% of their class to even be selected for a residency. There are also many great Ortho fellowships which are just as, if not more selective.

Ultimately, you have to consider the surgeon as a whole person, not just as a broad category.

Clavel is uniquely rarified air. Not only was his father a neurosurgeon, today he is a teacher to other neuros looking to be trained in the craft. I find these doctors to other doctors to be in the 1%. Since he was in 'the family business' from such a young age, he has the ability to see the progression of medical technology and approach in real time. There is a reason he prefers the M6, even if he is not married to it.