Fusion or Nothing?

[cgmagoo]

I went to Dr. Yeung today with DISC in Phoenix, AZ. He told me that he would not recommend ADR because of my symptoms. He also told me that my neck pain and tension headaches may not go away after fusion surgery. He gave me a 50/50 chance that those symptoms will not go away.

Has anyone ever heard of or had experience with muscle spasms in their neck and tension headaches not being related to a herniated disc?

He also said that my symptoms are not correlating to what he sees on the MRI. He said that my C5/C6 is compressing the spinal cord and that it is not severe but moderate. Also that there is some foraminal stenosis.

My MRI is worse than last year but Dr. Yeung told me there is a possibility it could get better.

Now I don't know what to do. I don't want to have surgery if it won't take away all my symptoms. But what if it could take away the symptoms.

So confused now!

Any suggestions on where to turn for advice.

Thanks in advance!

[jss]

cg,

Condolences on the lack of a clear path. It is difficult enough to move forward with surgery when the pathology and best course forward are clear. As I'm sure you're aware, there is no guarantee that surgery will help; that is, with each of my three spine surgeries, the surgeon told me with a straight face that I would come out of the surgery either better, worse or the same. All three times the current and pending damage warranted the risk of surgery, and all three times I came out better.

To me your case seems to be calling for multiple opinions. If you consult multiple doctors, a best clear path forward might begin to emerge; and it may be surgery and may be something else.

Good luck, Jeff

[LauraB]

CG,

Strangely enough - I was told the same thing from my neurologist as well. I had experienced muscle spasms and moderate to severe migraines that WAS related to my neck problems. When I experienced these "headaches," I could feel physical pain at the base of my neck which radiated over the top of my head with skull-crushing intensity. My muscle and nerve pain was ALWAYS tied to any type of upper body movement. After my surgery, I've only experienced one extreme headache (just this past weekend); I'm not sure if it was at all related to my neck - as it felt somewhat different.

I can certainly empathize with your pain as it can be so debilitating. I agree with JSS; you need to obtain other opinions - not necessarily to get the "magic" answer you seek, but to get continuity with diagnosis and treatment plans. Whether my migraines are completely cured, or not....my degenerative disc disease (I believe) has been stopped in its path. I am hoping that my ADR protects (absorbing the mobile energy displaced by my prior fusion) the adjacent levels.

How long have you experienced these symptoms? Also do you have past diagnostics that indicate changes in these levels? I waited five years (due to my obstinate stand on fusion) with alternating symptoms - never quite sure what to do....it came a time when the quality of life dictates intervention.

[cgmagoo]

Dr. Yeung is my 2nd opinion. I went to an Orthopedic surgeon last year and he looked at my last MRI and told me the same exact thing.

And now that my recent MRI is showing that the C5/C6 is compressing the spinal cord, I am wondering if I should wait another year and maybe I will get a more definitive answer.

Also, Dr. Yeung is suggesting a one-level fusion and not ADR. So this leads me to believe that it is not as bad as I think it is and maybe I should wait until I get worse.

Who knows, maybe it might get better?

[cgmagoo]

Originally Posted by LauraB

CG,

Strangely enough - I was told the same thing from my neurologist as well. I had experienced muscle spasms and moderate to severe migraines that WAS related to my neck problems. When I experienced these "headaches," I could feel physical pain at the base of my neck which radiated over the top of my head with skull-crushing intensity. My muscle and nerve pain was ALWAYS tied to any type of upper body movement. After my surgery, I've only experienced one extreme headache (just this past weekend); I'm not sure if it was at all related to my neck - as it felt somewhat different.

I can certainly empathize with your pain as it can be so debilitating. I agree with JSS; you need to obtain other opinions - not necessarily to get the "magic" answer you seek, but to get continuity with diagnosis and treatment plans. Whether my migraines are completely cured, or not....my degenerative disc disease (I believe) has been stopped in its path. I am hoping that my ADR protects (absorbing the mobile energy displaced by my prior fusion) the adjacent levels.

How long have you experienced these symptoms? Also do you have past diagnostics that indicate changes in these levels? I waited five years (due to my obstinate stand on fusion) with alternating symptoms - never quite sure what to do....it came a time when the quality of life dictates intervention.

LauraB,

I have been experiencing neck pain and muscle spasms for about 6 years and the headaches I have had since I was 21 years old. In the last year it has been constant and the pain never goes away. It is just varying degrees of pain. I do believe the headaches are coming from my neck even though it may not be coming from the C5/C6 area and in fact you described the pain that I feel.

The MRI that I had in May 2012 did not show spinal compression anywhere. Whereas, the most recent MRI show moderate spinal compression and foraminal stenosis at C5/C6.

Dr.Yeung said that ADR would not correct the symptoms that I have and in fact may make the headaches worse because it would make my neck unstable. He recommended fusion instead. I am still leary about having fusion done. That is the reason why I went to him because he did both fusion and ADR. But I understand his reasoning.

Did you get "headaches" before you had fusion done? Stupid question, but do you have arthritis in your neck?

Do you think that the fusion surgery affect above and below levels?

Thanks for responding to me.

[LauraB]

CG,
Before my 2006 fusion, most of my symptoms were focused on muscle pain in my shoulder and occasional numbness radiating down my arms; whenever I turned my head. I did have migraines - which I didn't think were related, until I had THE ONE that landed me in the hospital. This migraine was the turning point in my cervical health and from that point on my other symptoms became chronic. My "migraines" were basically gone after the surgery - along with all other symptoms. Within a few months after surgery, I was working out again, rollerblading, and even downhill skied six months later.

Your spine is designed for movement, fusion halts that movement and displaces the energy to the adjacent levels; thus causing additional stress. In some cases, it will be a godsend and you will never experience any additional spinal problems again. However, in my case, my adjacent levels developed DDD; the discs herniated and deteriorated. Not only did I start getting muscle and nerve pain (stabbing pain in my shoulder blades), but the headaches came back with a vengeance.

I began keeping records of the frequency of my symptoms in relation to my activity. I found that as long as I was sedentary and experienced no stress - I could remain symptom free. BTW, I'm not a sedentary person. I found that whenever I worked the muscles in my upper body (anything from routine household chores to sports activities), I began to experience a low-grade to moderate pain; including a dull-headache. Eventually within hours it would upgrade (at times) to the debilitating migraines that I could no longer live with (and I truly mean that I couldn't live with it anymore). Also, we accumulate stress in those surrounding muscle tissues. Anytime I began to feel pain, my muscles naturally tightened and it slowly moved up through my C-spine into my head. This was nothing more than a vicious circle.

When I saw my ortho and changed to my neuro surgeon - I explained this tendency and really felt that I wasn't getting a serious response. They just told me fusion (ultimate answer for everything in the US) would be the best correction. I held off (5 years until something miraculous appeared - ADR).

I will not compromise the integrity of your physician - as I am not qualified to contradict his evaluation, but I do feel that you need another opinion. It is in your best health interest - remember you are the one who lives with the consequences regardless of your decision. US surgeons are still limited to the type of ADR surgery that they can perform. I agree that some of these devices do not appear to be designed for cervical/lumbar implantation; they are similar to the design of socket implantation. This is where I might agree, but this is where you should not leave it alone.....look into other devices. My life changed when I discovered the M6 and began research.

All I can say.....I experienced severe migraines (not just headaches) on a regular weekly basis - ultimately lasting 2-4 days before the onset of another. As my DDD progressed-it became consistent. I do believe that it had much to do with the muscle tightening and hardened "knots" throughout my neck. Since my surgery 6+ weeks ago, I have only experienced 1 and was remedied with a muscle relaxer and ibuprofen (something that never worked before). I'm not exactly sure if it was connected since the pain "seemed" different. I will be following up with a neurologist here (Chicago area) who also does ADR surgeries. I will bring up this question and certainly will share with you.

If I can leave you with anything.....please get other opinions. You wouldn't be inquiring on this site if you weren't satisfied with what you heard. This is the only body you get (and live with), treat it well and give yourself relief that you will make the best "informed" decision.

Wishing you health, Laura

[cgmagoo]

Laura,

Thank you so much for your honest words and advice.

All I am trying to do is rid myself of these darn tension headaches (migraines) and the constant muscle spams and knots in my neck and shoulders. They get so bad that I can't function. I have been having them since I was 21 years old but they have gotten worse and more frequent. In the last month, I have been getting 2 or 3 episodes where I would be going to the emergency room if I didn't use a a shot that my pain clinic gave me. I have 2 left and don't know what I will do when I run out.

I have been keeping a daily diary also and the tension headaches are not as bad if I do nothing, which I have been doing.

But you are right! It doesn't sit well with me that the Neurosurgeon saying that ADR will not work and fusion is the best way to go. And I am afraid if I go to another Neurosurgeon that they will say the same thing.

But I do think that I should get another opinion and if then take it from there. I am not showing signs of paralysis so I guess I don't have to be in a hurry to get surgery.

Again thank you for taking the time to respond to me.

Christina

[LauraB]

CG (Christina)

It is the best way to go. I would send my diagnostics to the European surgical sites along with a few US surgeons as well. Maybe someone else could possibly explain it better, but I don't see how fusion would solve your problem, and ADR would not. We sound so much alike, but I will tell you....My C5/6 was my first fusion. I sincerely believe that it played a significant factor in my DDD and ultimately my recent surgery. I lost 5 years of life waiting for something better than fusion. This is why I feel it is important to let everyone know that there are other options.

I hope you receive a more thoughtful acknowledgment of your symptoms and a more thorough evaluation.

[CDW321]

My neck MRI "looks" much worse than my Lumbar MRI, even though that is the one that's the big problem.
I believe I get neck stiffness and some muscle spasms in my neck and shoulders due to my cervical herniations though I have spasms that run from my low back all the way up to my shoulder from my low back, so it's tough to tell where one ends and the other begins.
I have spent 2 & 1/2 years not getting answers on the incredibly painful spasms until a consult with one surgeon finally confirmed that they are due partly to my L5S1.
I wouldn't trust any surgeon who pays more attention to your MRI and discounts your disc issues. We are all different and I think some of us have pretty violent muscle "guarding" responses to disc problems.
Are any of the surgeons you have seen Neurosurgeons? That might make a difference. If you haven't already, I'd see a Neurologist too.
Regarding just getting relief from the spasms, I found the only thing that helped me at all were Trigger Point injections that contained some steroid. (The steroid part is important, unfortunately.) I needed three rounds every 2 weeks before it really began helping. This is a limited help because of the hazards of steroids. However, my PM doc told me he used 1/8th the amount of steroid for these injections as used in an epidural which equaled a lot more bang for buck than an epidural that didn't help me. Botox is also a really good palliative, safe measure for both headaches and muscle spasms. I tried a round of Botox recently that failed but my PM doc thinks he simply didn't use enough and I have to wait a few months before we try again.
If you have a good Pain Management doc, I'd speak to him/her about these measures or find a really good PM doc. This might buy you some time while you figure things out.
BTW - I don't get how a fusion will help this and why an ADR wouldn't as well.
Best of luck.