MULTI-LEVEL CERVICAL DDD - SHARE INSIGHTS ON SURGERY PLEASE!!!

I concur that you need to have MANY opinions!!! You will be driven crazy as they will be all different. However, you will learn what you need to in order to make the right decision. Took my orthopedic surgeon a few years to get clear it was time for surgery. NOW, I understand why. My case became complicated as the screws in the frontal surgery did not hold. My bones fell apart upon opening. They had no idea! Had to return for extensive backside work to stabilize everything. I lost mobility. I eliminated some pain that made life intolerable. Some pain did not get relieved (my initial problem began 60 years ago at age 7 with whiplash, compounded by the second whiplash at 33 and arthritis. If you have numbness/tingling in your arms, hands, or fingers it tells you surgery can do something. Otherwise, they go in clean you out and stabilize. But they DON'T deal with myo-muscular issues - so you will still have those after surgery. (which I do). My idea would be to go to myofascial deep tissue release, botox, epidurals, corticosteroids (within reason), RFA, and all the possible sidebar treatments (acupuncture) and then visit with a variety of orthosurgeons. There is NO one size fits all solution here. Good luck!

I think the reason is arthritis is progressive and adjacent segment problems are the same with ADR and ACDF. He also said he is the one who converts failed ADR to ACDF and the scar tissue makes it a very difficult surgery.

@cyp238ress
I would only consider surgery if you would be able to decompress spinal cord/nerve roots/nerves that are know to be causing your symptoms. If it is not clear what is causing your symptoms, it would be good to delay surgery until you try other non-surgical treatments and get more testing. I have been on a journey for 8 years trying to get answers and treatment for my long list of symptoms. It has been a process of ruling out some things and treating what could be diagnosed. I am now at a point the lumbar pain/weakness/numbness are the significant remaining symptoms to address. When I spoke to the surgeon, he said that I may still have residual symptoms from cervical myelopathy injury (delayed diagnosis) and SFN/PN. But the lumbar surgery (possibly laminectomy and fusion, see surgeon tomorrow to discuss options post updated MRI) should be able to help relieve the severe central/foraminal stenosis L4-L5, stabilize my spine since vertebrae is moving/slipping over other vertebrae, and neurogenic claudication restricting blood flow/impacting nerve signals.

You may want to see if you could get a myelogram test to pinpoint the nerves impacted to see if surgery would help relieve any compression. If CIDP is a possibility, you may need a full work up to see if your immune system is attacking your nerves indicating surgery may not help relieve the symptoms.

Pray you get answers asap. 🙏

@dlydailyhope

I've been at this for two years, and it's still not exactly clear to me how surgeons are determining the pain generator(s). I had a very noticeable reaction to a C6-7 ESI in December, so I think that is positive. But, the recent EMG was essentially normal. So conflicting signals there.

I'm extremely depressed because it is occurring to me that my problem is probably less nerve impingement and more arthritis, and the arthritis is throughout the cervical chain, so no way to correct it, even with fusion. I have noticed a lot more muscle spasm and crepitus when I turn my head. The crepitus is definitely from the arthritis, but the muscle spasm I'm just not sure. That is the key - what is causing the unabating muscle spasm? I also have swelling and numbness in my feet, but is this from the neck stuff, or from the pre-existing neuropathy? Argh....

@cyp238ress
I empathize with your depression. I am there, too.

My surgeon told me not to rely on EMG for assessment of spine/spinal cord/nerve root/nerve health. I have “normal” EMGs (except for carpal tunnel) but many neurological symptoms in limbs. This means the symptoms are tied to my spinal cord/nerve roots/nerves. Your upper/lower limb muscle nerves may be okay but the central/peripheral nervous system may be having problems sending/receiving the right signals from your limbs. I also have DDD/spondylosis/arthritis throughout my spine and the thickening of the joints/bones and bone spurs that form plus disc bulges/herniations can irritate/compress spinal canal/cord/foraminal nerve roots. Pain can also be caused by modic changes to vertebrae.

You may need surgery if they can confirm that the proposed procedure(s) will address/relieve your symptoms. It is important to fully understand risks/pros/cons and recovery time/expectations.

Hi, I’m a 42yr female in Australia, i had ADCF C6/7 done almost 2 years ago, after injuring myself a work 3 years ago.
My pain was like a deep aching burn feeling with muscle spasms and numbness it starting behind my shoulder and ran down my entire arm into my thumb and 1st 2 fingers, I never had neck pain!!

Dr intially thought I had shoulder bursitis, I had 2 cortisone injections 3 months apart in the right shoulder, did physio 3 times a week until finally about 7 months later I seen a neurosurgeon, mri showed degenerative disc disease, significant foraminal stenosis at c5/6 and c6/7 with bone spurs and cord impingement at both levels
I had epidural injections in both C6 and C7 nerve roots which only made things worse, this is when the neck pain well and truely kicked In and I started losing range of motion when turning my head, was like my head was too heavy to hold
I continued physio for another 3 months with no improvement, this is when my neurosurgeon decided to put me under the knife.

Waking from surgery, I complained of stronger neck and arm pain and a burning buzzing feeling in the right side of my face running down into my right leg and foot, it was brushed off like it was all in my head.
3 months post surgery, I was in more pain, I was also suffering from colour and temperature fluctuations in my right arm/hand, I had an EMG results came back normal but the neurologist immediately referred me to pain management as he suspected I had complex regional pain syndrome.
The pain specialist and neurologist both agreed and diagnosed me with right upper quadrant CRPS 3 months post surgery.
the following 6 months, things only worsened again with pain and loss of function in my right leg/foot which by this stage the leg and foot were also suffering from colour and temperature fluctuations.
One year post surgery, multiple different neurosurgeon visits, I was told my surgery was successful regardless of the ongoing pain and loss of function, I was then diagnosed with right sided ipsilateral CRPS.
I feel as though someone has drawn a line down the centre of my body and everything on the right has this painful burning pressure, my limbs burn to the point they feel frostbiten, I struggle daily with mobility issues as I can no longer put full pressure on my right leg, I have lost almost all strength in my right arm and hand, even holding a pen is an issue.

January this year I had a week long ketamine infusion and a lumbar punch to check for any autoimmune component, no improvement, but the new EMG showed denervation of C6 and C7
Over the last 6 months, I have had multiple nerve blocks, both cervical and lumbar which once again only flared things up.

The way the last neurosurgeon explained things to me, the longer a nerve is impinged more chance of permanent damage, sort of like having furniture on carpet, leave it there too long and even though you move it the imprint stays…

My pain specialist and neurosurgeon now want to implant 2 separate spinal cord stimulators, one in cervical and the other in thoracic spine, I go for the trial in 2 weeks, petrified is an understatement!

My advice, tackle this head on, advocate for yourself, get multiple opinions and go in hard and fast.
I suffered with arm pain for 12mths before drs finally decided to operate, now all I do is wonder if they acted faster would I still be in this position or would I have my life back

Hopefully you sort something out and start feeling better soon xx

I have had extensive treatment for DDD. So far I have had 8 surgeries for joint replacement or disc repair. My first surgery was on all the discs in my neck. I complained for years of the pain and spasms in my neck. Oh you are too young to have arthritis, serious damage, etc. In 2001 I was referred to a neurosurgeon who held up the MRI and showed me the damage I had on my spine. Every disc was either herniated or bulging. I had everything listed in the literature; spinal foraminal stenosis, scoliosis, spondolethesis, osteophytes and arthritis. plus bone malformation in my left shoulder. The doctor said I had 5 to 1o years of damage, finally someone validating pain that got worse and worse and caused damage since I was 35 yrs. old. I was 54 yrs. old at the time of the first surgery. I worked full time and was a single parent with a family. I could not lift my arms more than 5 inches and was in pain from hell. In 2003, I needed more work on my neck, all cervical discs were removed and replaced with cages and screws and a titanium bar to support my neck. In 2005, I had surgery on the whole lumbar spine the outcome was better, but not paradise. In 2008, my left hip was replaced when I woke up, I couldn't move my foot and had a dropped foot. I did extensive PT in water and after 18 months the function in my ankle returned. In 2010, just to keep things interesting, I contracted sepsis of my epiglottis and was placed in a medical coma, survived and found I had brain damage and could not read or write. I was forced to leave my job permanently and go on SS disability at 61 yrs. old. In 2012, I started having neck and thorax pain, however, at that point I became inoperable and was offered a morphine pain pump. I never even cleaned out my office. Since then I have had a shoulder replacement, knee replacements and right hip replacement. I had COVID twice and survived with no long term damage. I look at this medical condition as a journey, I tried anything that would keep me walking. I learned that I didn't make the decision for this path of treatment, the pain did. Today I meditate and watch my attitude, was it good? No, but self pity won't give me relief. I have a deep spiritual life that helps me cope with my condition. I hope the outcome for your condition is a good one. Hang in there.

I have much empathy. I too am trying to live with very little difference. I fight mentally all the day, try to walk, very painful in both hips. On and on. So many things that I cannot prioritize my next medical move. Trying to obtain dental work, outrageous cost but have to find a path because I need a pacemaker. May GOD help us, please lord Jesus help!

@cyp238ress Having a steroid spinal injection that helps take away pain is telling you that surgery may be able to fix that pain. It reduces inflammation and buys a little bit of space for your nerves and/or spinal cord. If either bone or a ruptured disc are compressing nerves or the spinal cord, it can generate pain or weakness. When a disc bulges, it disperses weight unevenly, and that can cause bone to change. Uneven pressure on the end plates of the vertebrae cause bone to remodel, thicken or form bone spurs. A ruptured disc that has spilled out the jelly like nucleus causes inflammation and stimulates growth of bone spurs. That is arthritis of the spine.

During spine surgery, a surgeon will reshape bone as needed. They remove bones spurs and enlarge the spaces in the foramen at the nerve roots. They need to prepare the surface for what they are implanting. With fusion, that is s flat surface of a bone disc or cage, and with artificial disks or implants that slide in, it may be a groove that is cut to match the shape of the implant.
A normal EMG is a good thing and tells you that your nerves are working. If the EMG was abnormal, it may be indicating a problem with your peripheral nerves and your doctors will start looking for a different problem.

My neck was pretty noisy before my spine surgery. I had a ruptured C5/C6 that had been bulging for years, and I think it was the disk rubbing on the bone of adjacent vertebrae causing the noise. By the time I had surgery, the disc height had collapsed by 50%. Sometimes noise like clicking comes from facet joints. As a disc collapses, more weight shifts onto the facets and they wear out. Normally 80% of body weight is supported by discs, and 20 % on the facet joints.

Spine issues do cause muscle spasms, and it is common to lose the lordotic curve in the neck as the cervical spine becomes straight. Sometimes it can bend forward (kyphosis). I had lots of muscle spasms before my spine surgery and my physical therapist was treating these and pain with electrical stimulation at the nerve roots. After the surgery that freed my spinal cord from compression, the muscle spasms really calmed down. They had been bad enough to independently rotate my C1 & C2 vertebrae and that caused vertigo.

If you have spinal cord compression in your neck and no other spine issues in the rest of your body, it may cause foot and sciatic pain and numbness in limbs.

With your question about the lordotic curve in ADR vs fusion, a fusion tends to be a straight join that dumps the spine forward a bit. The ADR can allow movement and may allow a more normal curve. That is a question for the surgeon, and specific to the implant. It all depends on how many levels need surgery. if you have a single level that needs a fusion as I did, that doesn't affect my curvature very much and my range of motion is about the same as before surgery.

Keep on learning about your condition and consult as many opinions as you need to make an informed choice. Your story is similar to many spine patients with cervical issues. Find the best surgeon that you can. I had a great result from my surgery, and it changed my life for the better. We are all different with different issues and other health issues that may possibly affect our ability to heal and recover. Learn about all the risks of any procedure and balance that against the benefit you can achieve. Ask questions and advocate for yourself.