How does discectomy (ADR or fusion) help severe foraminal stenosis?

[mmarsh]

Scott

Though you will have range of motion issues after fusion (if you go that way), they are minimized by stretching. I have 2 cervical fusions (C5-6 and 6-7). I can't hold a phone between my ear and shoulder, but other than that it's not a huge issue. So, if your facets are not in condition to take an ADR, don't fret too much. Fusion is a very good option. If you continue to take care of yourself by stretching and strengthening, you can put off further problems until (hopefully) some ADR questions can be answered. Just wanted to give you some hope for the future! Best of luck.

[scotto74]

Hey everyone,

It's been awhile since I last posted, so I just wanted to provide a quick update as I'm still agonizing over my final surgical decision (my hair is literally falling out as a result of all this stress LOL)... sometimes, just posting on here helps get some of the weight off of my shoulders and I always genuinely appreciate everyone's feedback and thoughts.

So I met with Dr. Yue up at Yale a number of weeks ago. Really nice guy, and I thoroughly enjoyed talking to him. Biggest take-aways were that he urged me to get a CT Myelogram before surgery (which I did right before the holidays), and he also is a pretty big fan of the Spinal Kinetics M-6 disc. He said something to the extent that if he could implant one device in all of his patients today, that would be it. He also confirmed that I've lost all reflexes in my left arm at this point. I followed up with him after I got the CT, and he recommended facet blocks at 2/3 (left) and C7 / T1 (right) before I got a two-level fusion or ADR. At this point, I think I need to move forward with surgery to alleviate the cord compression although I appreciate his conservative approach.

I also followed up with Dr. Bitan and Nick Boeree after the CT scan. Both are sticking to their original recommendations... a hybrid with Bitan (which he thinks is slightly preferable to a two level fusion), or a two-level ADR (M6) with Nick Boeree. Dr. Bitan said my facets appear to be in pretty good shape, and Nick Boeree said he didn't see anything in my CT that would be a contraindication for the two-level ADR. Nick also feels strongly that a two-level ADR is the best course of action for me.

My biggest concern, however, is that I was finally able to get TBI to review my CT Myelogram (which they suggested a while ago) and give me some feedback. I believe it was Dr. Zigler and Dr. Blumenthal who reviewed them. While I did not speak to the doctors directly, the feedback was that they did not think that I was a good candidate for ADR given (1) the severity of the stenosis, and (2) the amount of osteophytes or bone-spurring going on in my neck. In summary, they felt my neck was "too unstable" for ADR.

While I trust both Nick Boeree and Dr. Bitan when they say that I am a good candidate for ADR, I have a hard time getting past the feedback from TBI. I read something recently on one of these forums where someone who had a two-level M6 surgery is likely going to need to have them removed and fused as a result of osteophytes forming at those levels. If I already have some osteophytes, my concern is that I could be in this very same boat. However, on the other side of the coin, I worry that if I fuse these two levels now (5/6 and 6/7) I may end up with my whole neck fused at some point (which is keeping me awake at night)

Anyway, I'm sorry for the long post... but I'm just trying to sort through all of this info in my head As much as I really would prefer to have a two-level ADR with the M6, I think I am leaning toward a two-level fusion because I just worry that I might not be an ideal candidate given the amount of degeneration.

I'm curious... of those of you who have had cervical ADR's -- did you have any osteophyte formation prior to the surgery??

I also attached a recent X ray snapshot where you may be able to see what I'm talking about...

Thanks in advance for the feedback, and sorry I've been MIA for so long. Hope everyone had a great holiday and is doing well!!

Scott

[KBear]

Scott, that's a hard decision for sure. It would also bother me that they feel you aren't a good candidate. I would ask the other surgeons why they don't feel that the osteophytes will be a problem. I also wouldn't let the fear of having your entire neck fused be a deterrent to fusion. I think doctors greatly exaggerate that and even if you need more levels later, maybe it could be done early enough where you could have adr. There are a lot of people who get adr and still end up needing more surgery down the road, so it's not foolproof either.

[scotto74]

Hey KBear, thanks for responding. The rationale side of me definitely agrees with you, but something about getting two levels in my neck fused just scares the heck out of me! I'm still kicking around the hybrid possibility (fusion at 6/7 and ProDisc at 5/6), although I need to decide soon as my surgery is now scheduled for January 25th with Dr. Bitan (I've already postponed once and I am running out of time from a work standpoint). Dr. Bitan doesn't think the osteophytes in my neck are an issue (not sure if that is specific to 5/6) and I also posed the question to Nick Boeree but haven't heard back yet.

The Texas Back info is just really hard for me to set aside, as much as I want to go to Europe and have a couple of M6 discs put in... decisions, decisions.

Thanks again,
Scott

[davemmevad]

Hey There,

Just thought I'd chime in, having been in the same situation and having agonized over ADR vs Fusion - I ended up with fusion at C5-6-7, and am very happy with it . (it was pointed out to me by the MD who ended up doing it, I don't have a lot of space for my spinal cord, and he felt that the extra bone deposits around the ADR implant would be problematic for me, and so fusion it was).

However, what I really wanted to share with ya, is the other piece of wisdom he imparted ... yes we all get hung up about adjacent segments needing more surgery, but we have to acknowledge that we are in the surgeons office due to bad connective tissue (the disc), and really, if we have one that is bad we probably have more. Unless we are dealing with a specific tramatic injury, it is impossible to say if the need for an adjacent segment fused is actually caused by the first fusion, or is caused by our messed up biology continuing to degrade. The studies don't differentiate that at all. Anyway, he convinced me to not worry about it, and it was a good choice for me - ultimately that is all any of us can tell ya

Cheers,
Dave