Re:Help I'm confused

[donkl]

I really am in the land of confusion. I have a had a problem with my C-5 disc pressing on my nerve for many months, and causing me all kind of pain, and I am really lost on what to do. (Had epidurals, disc compression, physical therapy) One surgeon says a foraminotomy, but I've read where that could really mess up your neck muscles cutting back there, and one doctor suggested a ADR, but I am concerned with facet joint pain, or I could do a fusion, which I really don't want to do. Could someone enlighten me to the right direction?

[Dan-O]

No experience in that area myself...sorry to see 230 people view this and nobody reply...odd?

Good luck my friend!

[Justin]

I really am in the land of confusion. I have a had a problem with my C-5 disc pressing on my nerve for many months, and causing me all kind of pain, and I am really lost on what to do. (Had epidurals, disc compression, physical therapy) One surgeon says a foraminotomy, but I've read where that could really mess up your neck muscles cutting back there, and one doctor suggested a ADR, but I am concerned with facet joint pain, or I could do a fusion, which I really don't want to do. Could someone enlighten me to the right direction?

There really isn't "one" right direction per se. A lot is based on your individual pathology. If you are concerned about facet joint pain, you can have diagnostic injections preoperatively to see if your facet joints are pain generators. At the very least, you should have 2-3 surgical consultations.

[spinches]

I was offered a foraminotomy for my C 5-6 and 6-7 problems. They can be done with minimally invasive procedure, and I was told by most of the docs I consulted that the recovery is easier than major procedures, like fusions. My primary care doctor said she had a foraminotomy herself to address a bulging herniated disc and she got relief of all symptoms and no recurrence after 17 years. On the other hand, one of the surgeons I consulted said he didn't like foraminotomies for people with my condition of cervical radiculopathy because they tend in his experience to be temporary fixes. That is, if the nerve compression is caused by a disc getting thinner, pressure will increase again on the cervical nerve as the disc continues to collapse. Another surgeon I consulted didn't think a foraminotomy would be helpful to me because I also have stenosis around the spinal cord, not just compression of the cervical nerves. After all the consults I did, the overall impression I got of foraminotomy is that it is a relatively safe procedure that is well-tolerated by most people, and does relieve symptoms for people who primarily have cervical nerve compression, but the results may or may not last very long.

I decided on ADR because I have both cervical nerve and spinal cord compression.

Sandra

[Katie]

I had severe compression at C4/5 & 5/6. Several surgeons, excellent ones, suggested that I have both levels treated with either two ADRs or a hybrid (one level of fusion and one ADR). I sent one more set of images out to Dr. Luiz Pimenta in Brazil, and along with my lumbar issues, he recommended doing only the worst level, the C5/6.

He used the NeoDisc from Nuvasive, very non-invasive as far as the incision, etc. goes. It is a silicone disc covered with 'mesh' for lack of a better term, that sits between the vertebrae. One screw in the side of each vertebrae hold the mesh covering the disc in place until the bone grows into the mesh. There are no 'fins' or metal imbedded into the bone.

I have a tiny line in the natural fold of my neck from the incision and it is barely noticeable. The best part is that it almost completely reversed all the neurological problems I had been having...lack of coordination, numb arms & hands, inability to walk on my heels or toes, etc. I was told by other surgeons that those would be permanent, but thankfully they were wrong. I was also told by surgeons here at home that the surgery was far too dangerous and that I should just live with it. The surgeon I finally chose said despite how badly herniated it was, the surgery itself was fairly basic (at least for him ). I am very glad that I didn't let the 'best in the country' here touch me.

All that to say that shopping around is critical to the results you get in the end. Just because they are the best in your area doesn't mean they are good.

I sent my images out to almost a dozen surgeons all over the world until I found one that felt right. As Justin said, that is one of the best pieces of advice we can give you....get lots of opinions from the best doctors out there. Most do not charge for a consult, or if so, it is fairly minimal considering the level of expertise you are getting.

I hope this helps...it is very scary and overwhelming when first starting this journey. We'll try to provide as many road maps as possible

[spinches]

I learned a number of things as a result of going through 7 surgical consults in addition to the neurologist (and the radiologist I never met who dictated the MRI report). One thing is that surgeons read the MRI according to their own understanding and experience. They are accustomed to seeing the structures of the neck live, and when they look at the MRI they compare it with what they have seen in surgeries. There was quite a range of opinions about the degree of abnormality in my cervical MRI. Most disagreed with the radiologist, who diagnosed the most severe levels of pathology. The surgeons were divided 3 to 3 about whether I should have one or 2 discs removed, with one doctor saying I did not need any removed. A second thing I learned is that surgeons tend to want to use their favorite toys and games. The ones who are enthused about ADR all offered that only, the guys who are known for fusion offered that only, and the guy known for microsurgery offered foraminotomy and some other thing (micro-laminoplasty?) he does.

I agree completely with Katie. Get a lot of opinions from the most respected doctors in your area and internationally. Getting all these opinions was very stressful for me at first, but was not terribly expensive. I learned that the field of spine surgery is not an exact science. Surgeons opinions are influenced to a significant extent by professional belief systems, by the teachers who trained them, the stance taken by federal regulators, and to a dismaying extent, by who is paying the bill. In addition, there are no perfect surgical solutions for spine problems. Some of the procedures have been around for a long time and have the advantage of being well-known and practiced, but have other disadvantages. Other procedures are more promising, but have not been used long enough for anyone to be certain about long-term performance. When I was first diagnosed, I fully expected that I would consult 2 or 3 surgeons and receive several consistent answers pointing in one direction. I had to give up that expectation entirely. I had to do a lot more research on my own than I normally do when I need medical help.

In the end, I found a world-renowned surgeon who reached the same conclusions I had about what I needed. He also gave me detailed explanations of why he came to those conclusions, and the explanations were based on his actual clinical experience, not just speculation about what could happen with a new technology. I had the sense that he looked at my whole clinical picture and the dilemmas I am facing and took everything into account when he offered his recommendations. If he opens up my neck and decides he has to change his approach, I will still feel I made the best possible choices I could. I could have gone with one of the other overseas surgeons I consulted as well, but the final decision was a "gut" choice.

Keep at this. The process does unfold and will resolve in some direction as you get more information.

[Katie]

If he opens up my neck and decides he has to change his approach, I will still feel I made the best possible choices I could.

This. I had enough confidence in my surgeon to trust his judgement.

As it was, that actually happened, and my surgeon stopped to ask my husband's permission to change the plans for my lumbar that we had discussed pre-op. (He worked on both lumbar and cervical levels in the same surgery) Since he had taken so much time explaining everything to us beforehand, my husband understood and was able to make a decision quickly. We didn't get that feeling of confidence from most of the others we had met. Interestingly enough, it was the ones with less experience that fit into that category