Spinal surgery anyone???
TV ClubHouse: Archive: Spinal surgery anyone???
Wendo | Sunday, November 30, 2003 - 03:59 am     Ok, I have had some medical issues the past two months and I'm at a point where I would like some advice and/or other opinions from you all here at TVCH. Firstly, has anyone here had any Spinal issues on the board? Herniated disc, spinal stenosis, cervical pain, etc., etc.? Here's my deal. The second week of October I woke up on a Wednesday with severe and acute back, shoulder and upper arm pain. Initially, I thought I just slept really, really funny and figured it would pass. (And, I had had some stiffness in my neck the prior months that would be fine in an hour or so.) However, by Thursday, it did not improve and I made an appointment with my internist. Unfortunately, by Thursday night I couldn't take the pain anymore (it was shooting down my right hand by now) and went to the emergency room. Basically, they gave me a narcotic, some vallium, suggested it was a locked muscle and to see my doc in the morning. I did, and she prescribed physical therapy and an anti-inflammatory. I went through three physical therapy sessions and showed no improvement. (In fact, I was getting weaker in my right shoulder and arm.) Also, I began getting numbness in my index and middle fingers. Not completely numb, just loss of sensitivity in them, toward the finger tips. And, my whole hand tingles at times. (Noticibly at the computer because I'm reaching out while using the mouse.) So, an MRI was ordered for my Cervical and Thoracic are of my spine. The results came back and the main problem reads as following: "Posterior disc osteophyte complex at C6-7 with superimposed right foraminal disc extrusion which extends slighly caudally. This is causing moderate to severe right neural foraminal narrowing." Basically, I had herniated my disc between cervical vertabraes 6 and 7 and the material is pressing my nerve root. (Hence, numbness and tingling.) Also, there is bone growth (the osteophyte or bone spur) that could be causing problems too. My internist referred me to an orthopedic surgeon for additional conservative therapy. (Since the anti-inflammatory is conservative too.) He checked me out, noted the weakness and referred me to the pain clinic and Pain doctor for an epidural steroid injection. A week later I was on a table, under flouroscopy having a 17 gauge needle inserted in my upper back, a catheter threaded up to my C6-7 spinal area and steroids injected. (Not a pleasant experience in the least.) I then followed up with the Ortho doc several days later. (By this time the acute and severe pain had subsided. Though, minimal pain still existed as well as the hand symptoms.) He basically said I did not need to see him again unless I have pain redevelop and to continue to follow up with the Pain doc for the final steroid injections. (It's a three shot course.) When I asked about the numbness and tingling, he said it may subside or not. If not, I may have to "live with it." I did get a second injection and the pain doc referred me to physical therapy. (The Ortho hadn't and the pain doc felt I should have it.) Well, as many of you know, I'm a graphic designer/artist. And, I'm right hand dominant. This situation is interferring with my work. Not only that, but my neck is stiff and sore. Not severe pain when this situation started, but it is uncomfortable and rather tiring. Anyway, to make my long story even longer...I decided to get a second opinion. (I figured, it can't hurt.) This time, I went to a Neurosurgeon (since I'm having an obvious nerve issue) who came highly recommended. (Other doctors see this Neuro doc for spinal and nerve problems.) He took a look at my films, examined me, and stated that I have a pinched nerve due to the herniation and bone spurs. He has recommended surgery. The procedure would entail a small incision on the right front part of my neck. The Neuro doc would remove the herniated disc. The Ortho doc he works with would widen the area (to help remove pressure off the nerve), insert a bone plug secured with a titanium plate. (Basically, a fusion of the C6-7 vertabraes.) I have tentatively scheduled the surgery for Jan. 26 (though it can be cancelled up to 24 hours prior.) I can't have it sooner due to family Christmas plans. Plus, the time from now until the possible surgery date allows for the symptoms to possibly dissapate. So, that's where I'm at. However, I know no one else who've had anything like this. None of my friends or family. I've been reading up on the internet as well as lurking at some neuro boards. Opinions about this type of medical issue range extensively. Some think the ACDF procedure (what I would have) would work great. And that ACDF's have a 90% success rate in reducing symptoms. Others say, no way to spinal fusion. Yet others recommend minimally invasive surgery (basically endoscopic.) Ugh, it's just so overwhelming! LOL! So, I was hoping that maybe one person out there in TVCH land might have been through something similar and could post their thoughts and opinions. I would SO welcome them. Sorry for the length! |
Weinermr | Sunday, November 30, 2003 - 07:00 am     Wendo, I had a very similar experience in 1993. I was laying on the bed on my back one day. I went to sit up, and I felt an odd sort of twitching in my neck area. Within a day I started feeling intense pain radiating down my left arm. I went to see the family doc (who I no longer see) who decided it was bursitis of my left shoulder. He gave me a saline shot in the shoulder, and a prescription for prednisone, and sent me home. Within another day or so the pain had become excruciating and was now radiating down the left arm and into my left hand. My left thumb, index finger, and middle finger were feeling numb. I couldn't stand the pain any longer, and went to the ER. At the ER they took X-Rays of my neck and spine. The ER doc told me sort of matter of factly that he figured I had a herniated disk, and should go see an orthopedist. The ER doc gave me a prescription for extra strength Vicodin, which I started taking, and blissfully, I was spared that intense pain. I went to see the orthopedist with my X-Rays in hand. He agreed that I probably had a herniated disk, and sent me for an MRI. The MRI confirmed I had a herniated disk between C5-C6. The ortho said I needed to see a neurosurgeon, and gave me a prescription for more extra strength Vicodin. It took a few days to get in to see the neurosurgeon, and by then I was popping those extra strength Vicodin as frequently as I could. The pain was unbelievably intense. The neurosurgeon recommended surgery to remove the herniated disk, and insertion of bone to fuse the spine at that location. I also wanted a second opinion and went to see another neurosurgeon. The second neurosurgeon wanted to do the same surgery. However, the first neurosurgeon wanted to use cadaver bone to fuse the spine, whereas the second one wanted to remove bone from my own hip to use in the surgery. After doing some research, I determined I didn't want my own bone material used. In that case, there are two surgery sites that require healing, instead of one. Recovery time is longer, and there is often more residual pain in the site where the bone was removed, than in the area where the bone was inserted. Very soon afterward, I went for surgery. In my case, steroid injection was not an option, and physical therapy would not have been effective. The herniation was too severe, and the pain without it being masked by Vicodin was unbearable. The surgery was just as you describe. A small incision in the right front area of the neck, removal of the herniated disk, and insertion of bone to fuse the spine between C5 and C6. Recovery went very well. After surgery, I was fitted with a neck brace, which I had to wear for six weeks, 24 hours a day. I was not allowed to swivel my neck, or remove the brace, except to bathe and to shave. You will not have the same shaving issues as I did. LOL I had to learn to shave without turning my head or moving my neck. The neurosurgeon said I could go back to work after 3 weeks, and I did so. That was probably too soon. I should have taken longer. I slowly weaned myself off of the Vicodin, and started popping Advil instead. I was never physically addicted to the Vicodin, but I believe I became psychologically addicted to anything that would relieve any amount of pain. I did't want that excruciating intense pain I had felt to return. Eventually I got sick of pills, and stopped taking Advil or anything else. The pain went away completely, which was more confirmation to me that my dependence on them had been mental, not physical. I'm not without some reminders of the herniated disk. I was left with a very slight loss of sensation in the left thumb and index finger, which affects the dexterity, but doesn't prevent me from doing anything I want to do. My neck tends to stiffen up, especially when it gets cold. I always try to keep it warm so that won't happen. I am always flexing my neck and stretching the muscles whenever I can in order to keep it limber and avoid that muscle tightening. It's a very minor annoyance, and has become a routine part of my life. In my own case, I don't believe I had any alternative other than surgery. I would recommend it to you, unless there is some other way to relieve your pain and prevent any nerve damage. If you have any questions, I'll do my best to answer them. Good luck with whatever you decide to do. P.S. You can barely see the scar on my neck, and most people don't see it at all. Even when I try to point it out to them, they can't find it. LOL |
Ketchuplover | Sunday, November 30, 2003 - 07:43 am     (((Wendo & Weinermr))) |
Wendo | Sunday, November 30, 2003 - 02:47 pm     Weinermr, wow, thanks so much for you in depth post. Other than the fact that our sites were one level different (yours C5/6 and mine C6/7), I had/have the exact symptoms as you. Virtually identical. I'll echo your comments about that initial pain, excruciating. Nothing I've ever experienced before; just so exhausting too. Part of the reason I posted is because I'm getting/reading so many different options that are available that it's just so overwhelming. However, reading that your surgery was a success is comforting. Anterior cervical discectomy with fusion is the standard of care for this type of injury. And, should I go forward with this surgery, I do feel positive about it and comfortable with the Neurosurgeon I'm seeing. Additionally, I am realistic and understand that there is always the possibility that the outcome won't be as positive as I hope. (That's true of most surgeries, imo.) But, as I said, there are just so many different possible options out there, each with its own cheerleaders; ya know? For instance, some would never do fusion because, well, you're fusing vertabrae. You can lose range of motion and pain can persist. (Did you, or do you, have less range of motion in your neck as a result of the surgery?) Additionally, with fusion, you run the risk of additional herniations in the disc levels above and below the fusion. (Because they compensate for the loss of flexibility.) Have you had any further neck issues and/or pain? (Also, do you regret having the surgery or are still happy with it to this day, 10 years later?) Another option I've read about at this spinal message board is Minimal Invasive Spinal Surgery. Instead of going in, removing the disc and fusing, the procedure is done endoscopically. The surgeon goes in and only trims/removes the material that is impinging the nerve root or spinal cord. Recovery time is virtually nil and no collar needs to be worn. This procedure is done by a few doctors, but a Dr. Jho is most known for it. (I believe he developed it.) As I wrote above, though, the standard procedure is ACDF and most NS's will utilize it because it's proven. (It does have an overall 90% success rate.) In addition to the two above, clinical trials for Cervical Disc Replacement are going on with the possibility of approval in 2004. That entails a prothsetic disc made of metal (usually titanium) and polyethelene (a plastic, smooth part.) The plastic part is sandwiched between two metal parts, inserted into the disc space and acts a disc. Of course, I could continue with the conservative therapy. That would mean having the last steroid injection and using medications for pain management. As far as the numbness and tingling, if it's not gone by three months, it likely won't go away without surgical intervention. So, you see! How does a patient know what to do??? Especially when you have a wide variety of options with their own naysayers and supporters. I just want to make the right decision. Well, anyway...I thank you for posting your situation, what you did, and the outcome. Knowing that the ACDF is proven and that it can provide good results does help. Ketchuplover, thanks for the hugs!!! |
Kristylovesbb | Sunday, November 30, 2003 - 03:16 pm     Hugs from me to you Wendo! I was in a car wreck about five years ago. My neck hurt a little upon the impact and I was treated in the ER. Two weeks later I am in the worst pain I have ever experienced in my life, having a baby did not hurt as much. Pain was in my neck, radiated to the left shoulder and arm. I cried for days before I could get in to see Neuro Dr. I could not lift my arm to wash my hair, could not lift anything with that arm. I cannot express to you the amount of pain I was in. Anyway Neuro Dr ordered MRI, it showed a herniated disk C5. Dr. prescribed anti-imflamatory drugs, said he used a conservative approach to these conditions, did not recommend surgery as he felt sometimes you end up in worse shape. I did not have surgery and eventually I got better and the pain left after a couple of weeks. It has been five years now with no pain whatsoever. I know this may confuse you as one had surgery and one did not but I wanted to give you my feedback from my experience so you could determine what is best for you. Good luck to you and Gods speed in your recovery, hope I have been of some help to you. |
Wendo | Monday, December 01, 2003 - 08:17 am     Kristylovesbb, No, I appreciate your comments, not confusing at all. I want to hear different opinions and outcomes; what people did in similar situations. It certainly sounds like you responded to the conservative therapy. That's part of the reason I scheduled the surgery for the end of Jan. If one doesn't respond to conservative therapy during the first three months of the injury, you never will. So far, it's been two months (8 weeks.) Fingers are still numb and my hand still tingles. However, I do feel it's important to wait the full time to see if the conservative therapy will work. As to the pain, no need to explain it, I know. Oh boy, do I ever. Like you, it was the worst pain I've ever experienced. Again, I appreciate your comments. |
Stilllurking | Monday, December 01, 2003 - 09:25 am     Wendo, First I want to say thank you for pulling me out of Lurkdom. I disagreed with so many of your opinions on BB4, that I decided to sign up for TVCH, though I never did respond to your post that had me so riled up. As for your back/neck, I have had several surgeries on both Cervical and Lumber, I don't know where to begin. I had minimal Invasive Spinal Surgery twice, to remove the herniated fragments. I had the first surgery done on C6/C7. This surgery was a sucess of sorts. I would say it relived my pain by 80% but the numbness and tingling in my arm/hand/fingers remained to this day. The Surgery was done in 1991. I also had this done on L5/L6. This did not work at all. It was done in January, 1992. By November of 1992 the pain was so great that the Doctors felt the only option was a fusion, which I had. They fused L5/L6/S1, using bone from my hip along with the metal screws and rods to keep it in place. I spent three months flat on my back waiting for the fusion to fuse and praying for some pain relief. I woke up from the Fusion and told my Dr. that there was something terribly wrong, I had an intense burning in my leg and could barely feel my arm and hand due to the tingling and numbness. It felt as if my arm was asleep. The Doctor said it was probably asleep from laying on the operating table for so long (7 hours) and it would get better. As I stated, I spent 3 months in bed and had no sign of relief from the burning in my leg or the numbness in my arm/hand. I was sent to Physical Therapy which only exasperated the pain. Again I had to have Surgery to remove the metal screws and rods as they felt perhaps they were rubbing on the nerves. This surgery was again a failure. It was at this point that the Doctors realized that I actually had Reflex Sympathetic Dystrophy, which was never considered when I first went to the Doctor for my neck. RSD, is often times not diagnosed properly. With the numbness, tingling and burning pain I origionally presented with in my neck/arm/hand, this should have been one of the first things the Doctors checked for prior to any surgery. Due to the lumbar surgery, the RSD, jumped to my lower limb. You mentioned above that you are being treated by a pain specialist. Prior to your surgery I would suggest that you ask them if you might have RSD (also called; Complex Regional Pain Syndrome or Causalgia). If there is a chance that this is what you have, Surgery is not always the best first step. I can relate to your pain with the series of steroid shots as I also went through those. They had some effect and actually helped with the pain for a few months. Please look into this as an option as I regret to this day not having any knowledge of the subject prior to being operated on so many times. My surgeries actually caused the RSD to spread quicker then if I had not had the Surgeries. My thoughts go out to you, I know what kind of pain you are now living through. If you want some information on symptoms of RSD, to see if they fit with what you have, I have found this site to be helpful: RSDhope.org/Index.asp RSD, is more common in women then in men and is often not correctly diagnosed. Also, Rsd can occur by a slight injury you didn't even know you had. People have stubbed their toes, slept wrong on their neck and woken up to excruciating pain. Good luck to you. I hope what ever route you choose to take, works for you. Good luck. |
Sweetbabygirl | Monday, December 01, 2003 - 11:54 am     {{{{HUGS TO ALL}}}}....however, given my current back pain, I so should not have read these postings, shit!! (runs crying from folder) |
Wendo | Monday, December 01, 2003 - 12:48 pm     Stilllurking, well, I am glad you've come out of lurking to post. Glad you're responding to this post rather than a BB4 post. LOL! Sorry to hear of your problems. Wow. My sympathies. Thanks for your suggestion to check with my Pain Doc about this RSD syndrome. I'm sure the docs haven't considered it because of my MRI results. You can clearly see the disc bulging way beyond its space. If you'd like to see, here they are. I scanned them in: http://home.earthlink.net/~macally2002/MRI/MRIPics.html The one pic certainly shows the material shrinking the space in which the nerves reside. I will ask them about this RSD syndrome, though. Best to be safe ahead of time. Thank you so much! I wish you luck as well. Sweetbabygirl, LOL! No need to run. (((hugs back))) |
Kristylovesbb | Monday, December 01, 2003 - 03:36 pm     {{{{{hugs}}}} to everyone and Weinermr, WOW, you have had some tuff things to go through! |
Danzdol | Tuesday, December 02, 2003 - 06:18 am     Wendo, I guess my doc was too lazy to investigate any further on my case. My symptoms were different but with a diagnosis of the same vertebraes 6-7. I have 2 herniated discs. While on a trip I slightly bent forward and my knees gave out because this horrible pain came down my spine.That's pretty much the position I stayed in for 3 days. In order to get a cab I had to drag my feet inches at a time to walk to it because if anyone touched me I could not stand the pain. If I looked in the mirror I had one of my hips noticeably higher then the other.Much much higher. I was out for like a week, during the vacation! Fast forward a couple of months, I woke up one day and I could not move just like that day. I seemed to be stuck in the same position. I finally made my way to a doctor who said that because of my dance background and having both an epidural and a spinal during my baby's delivery- I had 3 herniated discs caused by wear and tear. He gave me VIOXX-rofecoxib tablets and recommemded pilates and or yoga. I know this is something that is going to be with me until I do something serious about it and I guess I am delaying it. It is interesting to hear your story and see all of the different options you were given.I was given none of those. I don't have time to do consistent pilates and yoga. I did try pilates though and I felt very different. If only I had the time to do it as part of a routine! |
Allietex | Tuesday, December 02, 2003 - 07:19 pm     Wemdo, all I can say is welcome to the club. You are going to be surprised how many people have had similiar surgeries. My first one was about 26 years ago. I had a deteriated disc in my lower back. I had a spinal fusion. It was very successful. The doctor told me that I could do just about everything I had been doing except league bowling. He also told me I would always have some lower back problems. He was right. The problems I had were minor compared to the original. I was just careful to take care of myself. About four years ago, I began to have problems in the same area, except this time the sciatic nerve was involved. It turned out I had a ruptured disc. I had the injections and all the other options. Finally my doctor told me my only option to lead a normal life was surgery. This time instead of bone slivers to do the fusion, they used something called Brannigan cages. My doctor's partner, Dr. Branningan invented them. I have been having a little trouble lately and may have to have the cages removed. They tell me it is kind of like having a pin removed after it has been used to repair a broken bone. A relatively minor procedure. Interestingly my doctor told me my first surgery was completely intact. The disc that was ruptured was above the first one. I can't give you any advice about whether or not to have the surgery. That has to be your decision. All I can do is share my story. If I had not had the surgeries, I am fully convinced that I would be a semi-invalid today. |
Wendo | Wednesday, December 03, 2003 - 06:24 pm     Ah, a new club I'm included in. Woo hoo! LOL! Danzdol, ouch, I can sympathize with the pain you've experienced. Sounds to me like your herniated discs could be encroaching your spinal cord. That can cause a great deal of pain. Obviously, an MRI or other spinal test would be needed to tell for sure. What kind of doctor are you seeing? Orthopedic, regular GP, or a Neurosurgeon? If you've got nerves involved, then I would go to a Neurosurgeon for a second opinion. You may not get information that is helpful in improving your pain, but, what can it hurt. For NS's, nerves are their specialty. Regarding surgery, the longer you wait to have it after the initial injury, the less benefit you gain from it (from what I've read.) Also, other factors help determine whether surgery will benefit someone with a herniated disc. For instance, the larger the herniation, the more likely surgery will provide improvement. Also, if one has immediate pain that subsides and no chronic pain, again, surgery is more likely to help. There are other things. Anyway, I hope you're able to figure out what to do. Also, I will say this, my doctors didn't recommend much in terms of options. The Ortho recommended nothing other than the conservative treatment; the NS, surgery. The other options available for people with back/disc problems I found myself through research on the internet and asking questions at a health medical board with a section for spinal disorders. Nowadays, I think we as patients have to do most of the work. Allietex, thanks for the info about your fusion surgery. I have to say, most of the info I've received about fusion from people who've actually had them is they're very successful. (Which explains why it's usually the standard of care.) I have heard of the cage therapy. Sorry to hear your hardware is causing problems. From what I've read, it isn't unusual though. Sounds to me as though surgery has been beneficial for you. I have to say, I've pretty much decided to have the surgery. Based on what I've read, people's experiences with it, my specific case and symptoms, I do think the NS was right and that I'm a good canidate with a good probability for a positive outcome. Barring any problems pre-op wise, looks like come the end of January, I'll have it. Glad I'm waiting until after Xmas. LOL! |
Danzdol | Thursday, December 04, 2003 - 01:55 pm     Wendo I say an orthopdeic surgeon. I have kind of ignored it for now even though it's not the best thing to do. I am planning in attempting to have another baby and I am wondering if it's all going to go downhill from there or if I will have problems carrying. I will have to speak to my doctor and get his opinion. I wish you the best with the surgery. I know you will keep us posted.......... |
Wendo | Sunday, December 07, 2003 - 03:19 am     Danzdol, Ah, another baby. Then I would definitely have it checked out at least. Better to know what's what than wonder. I'm sure you'll get the treatment that best for you. The surgery is scheduled for the end of January, thanks for the well wishes. I'll let ya know how it goes... |
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