Do it again... or not?

PDiddy · #1 05-08-2007, 03:33 PM

I'm a C5/C6 about to get either fusion or ADR. And I can't decide! Here's how I see the issues:

1) Go with fusion. It's a known technique, gets rid of the pain/numbness. Downsides are less mobility and increased stress on adjacent disks (perhaps less so with cervical fusion due to the lesser weight involved). Upsides are it's a known technique and doesn't require all the followups and nukings (X-rays) post-op.

2) Go with chance at an ADR. Downsides are it's not as well-known (how long HAVE the Europeans been at this??) and may carry additional risks (displacement, particulate matter, etc). Another downside is the followups post-op for 2 years.

So... go with fusion and get it over with and hope none of the other disks deteriorate (but if they do, by then perhaps disk replacements will be the norm and not in trials), OR try for the ADR and have a speedier recovery and chance for better long-term outcome (assuming the above-mentioned items don't come to pass)?

My question to all of you (besides help me make my decision ;-) is this:

If you had it to do over again, what procedure would you choose (and, of course, which did you have done)?

rob_zzz · #2 05-08-2007, 07:05 PM

If I had to do it again I would make sure that the surgeon I chose knew me well, I had seen him several times, they had examined and reviewed my clinical state and radiology in detail and I completely trusted them, and I would go with their advice (fusion, ADR or no surgery).

It can be a very individual thing depending on the complexities of your spine. Are you mainly looking for surgery for arm pain or is it for cord compression?

PDiddy · #3 05-09-2007, 09:10 PM

Well in looking at the MRI it seems that the disk is impinging on the spinal cord (C5/C6); isn't that what is creating the wrist pain? I get carpal-tunnel-like symptoms when using the computer, even though I tested negative for carpal tunnel.

Jessica · #4 05-16-2007, 09:59 PM

Hello PDiddy,
As I understand it, the wrist pain could come from nerve compression or cord compression. I was told that if the symptoms match the compromised level, it is more likely nerve compression. If the symptoms don't match the level, especially if they are multi-level, it would more likely be cord compression.

I am almost 10 months post op. I had significant cord compression, neurological symptoms in both legs and right arm, unbearable pain and severe numbness in entire right side of my body. I was unable to work more than 20 hrs per week and had no personal or social life to speak of. I am not meaning to compare symptoms - just make the point that my case was clear cut. I had none of these problems prior to my injury.

I did not feel that I had a choice to continue without surgery. I felt that the disc replacement was the right choice for me and I would do it again in a minute.

The possibility exists that I may have to have revision or fusion at some point. In my opinion, better a fusion at 55 or 60 yrs old than 40 yrs old. My physical therapist thinks that my neck is much more functional than those people he has worked with that have fusions.

I agree with Rob - you need thorough evaluation and a doctor that will weigh all options for you. ADR is not the best solution for everyone.

PDiddy · #5 05-19-2007, 02:22 PM

Thanks for the info!

I was wondering if you (or anyone else) has an opinion about the durability of the artificial disks and the chances of them becoming dislodged? Specifically I'd like to know opinions or experiences with the Mobi-C cervical disk.

This site has a lot of info on it, including an animation that shows the entire surgery in animation form. Very informative! As I understand it this disk is the first second-gen disk to come out and looks very nice IMO. The only concern I have is anchorage. I'd hate to have it slip loose due to activity and have to undergo surgery again.

http://www.ldrmedical.com/mobi-c.php?Langue=en

PDiddy · #6 05-29-2007, 04:45 PM

Quote:

Originally posted by Jessica:
Hello PDiddy,
As I understand it, the wrist pain could come from nerve compression or cord compression. I was told that if the symptoms match the compromised level, it is more likely nerve compression. If the symptoms don't match the level, especially if they are multi-level, it would more likely be cord compression.

What's the effective difference between the two? Does one have a better prognosis after treatment/surgery than the other?

Jessica · #7 05-29-2007, 09:14 PM

As I understand it, removal of the bulged disc, and possibly some spurs, should relieve the cord compression. The nerve compression can be more complex to relieve. It could be from the strain on the cord, spurs, or foraminal narrowing.

My cord compression was relieved and my neurological symptoms were improved immediately. I still suffer from nerve pain, this could be still healing or permanent damage, but it is considerably less than prior to surgery. Less meds and less pain.

PDiddy · #8 06-03-2007, 08:51 PM

I can see the disk impinging on the spinal cord, so would this be the type of situation I can expect the symptoms to subside after the removal of the offending disk?

ZorroSF · #9 06-03-2007, 09:34 PM

Seems cervical disc replacement is the best so far. Lumbar disc replacement encompasses too many factors and has less success than cervical replacements, or so the studies show.

Nerve impingement can come from a variety of different places and isn't always originating from where you would most expect it to. You can get a slight idea of the pain relief you will get if you perform some sort of traction technique. This can range from being in a pool up to your head, or an inversion table. those techniques must be repeated for at least two weeks to get a good idea.

Seems the moajority of people writing on this forum after their surgery still experience pain and need to take meds or perform high upkeep on their spine. be prepared for that. I know I wasn't.

To make this short; you will receive relief no matter what op you have, but it might not be everything you want it to be. Instead you need to think in terms of what you would be willing to deal with. Do you NEED an operation now, or can you wait a couple of years? are you expecting the same range of motion, or can you tolerate a limited movement. The disc obviously shows in your MRI that it is pushing itself into your chord, but do you have any facet joint degeneration? If you do then there's still a good chance you will likely endure some pain long after the op.