Surgery or no surgery for C3 and C4 that have become ossified?

Hello @jtbrown Welcome to Connect. You should get several opinions because your case is not the usual ones that spine surgeons see. If you can take this to Mayo Clinic, I would recommend that because they will have surgeons who do a volume of unusual cases. Bending your neck and causing C4 and C5 to separate might be describing slipping of one vertebrae past the other. If that is significant, it may be able to contact the spinal cord.

A horizontal incision is standard for cervical fusion surgery and mine is like that and hidden in a crease in my neck. No one ever notices it. The spine can easily be accessed behind your trachea and esophagus and they retract it a bit to get behind it. That can cause trouble swallowing or even affect the function of vocal cords which are risks to a frontal surgical path. I had throat pain with swallowing for about 3 weeks.

My surgery was at Mayo. I had spinal cord compression from a ruptured disc that was growing bone spurs in the central spinal canal. A question to ask would be about what to do about the fused C3/C4 and what will likely happen there in the future if nothing is done. That doesn't just happen to a healthy spine. Bone remodels and will grow spurs from pressure on the end plates (that abut the discs). Do you have good bone quality or is there possibly of some compression happening like that which happens with osteoporosis and compression fractures? Have you had an injury that led to this current condition? Will it continue to fuse and entrap nerves or the spinal cord? That is something a lot of surgeons won't want to touch because it fused itself and because levels at C3 are risky to work on because of the nerves for life support of your heart and lungs exiting the spinal cord near there. Bone quality or lack of it can affect the success of spine surgical outcomes. This is why Mayo or another medical center of excellence would be a good choice. Mayo is known for taking more difficult cases that others refuse which may give you a better chance of getting in if you have insurance that Mayo accepts.

It does sound like you are headed for some spinal fusion which will change your ability to bend your neck and turn your head. There may be different ways that surgeons will solve this, so that is why several opinions would be helpful before you go forward with surgery. I would highly recommend my neurosurgeon at Mayo, Jeremy Fogelson. He can review your case if you apply for care at Mayo if you request him. He does both fusion and artificial disc surgeries and teaches lab courses for other surgeons in these techniques. Here is his profile.
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624

Hello Jennifer. Thank you for the quick and knowledgeable response to my questions. I’m from Canada. Because of the high dollar exchange rate the Mayo Clinic is something I would love to do but I can’t afford it. My bones are fine other than some arthritis. I’m 68 years old and fairly healthy. I played hockey all my life. I’m not sure if this problem was a result of a couple of awkward falls causing possibly whiplash. I’m trying to send an ex-ray of my neck that was done in April of 2023 . Thanks again.John.

John, this is pretty fascinating.
Even though this doctor sounds like the thinking physican we're all looking for, you should get a second opinion.
I wonder how many doctors would try to fuse the next segment.
I suspect you are in for some long needed relief.

Thanks for the reply. It’s definitely not an easy decision to make with only one assessment . We only have a couple of surgeons that can perform this in my town .These symptoms I’ve been dealing with for 8 years now and are progressively getting worse. The hardest part is this procedure may not help .Thanks again

@jtbrown John, I understand, Mayo wouldn't be available because of Canadian healthcare. I hope your doctors in Canada can provide some relief for you. Does that limit you in where you can get a surgical opinion or how many opinions you can get?

I do see what you describe which looks like a disc turning into bone between C3 and C4. To my eye, it looks like C4 may be slightly rotated backward which would put pressure in front on the disc above it. Uneven pressure can cause bone to remodel in an attempt to stabilize the spine. I also see what looks like bone spurs on the forward edge of C6. Do you see where that looks rough? I see what looks like some cloudiness in the disc above it. Is that also growing bone? Whiplash injuries can cause spine problems even years later. I had a whiplash that injured my C5/C6 which is common for that type of injury, and 20 years later, my disc herniated and I had bone spurs pushing into my spinal cord. I'm not sure if physical therapy could help prevent discs from ossification if you can maintain proper movement. That might be a question to ask, and of course if you are headed to surgery, there will be a right time to do that after enough healing and authorization from your treating surgeon.

Some people can grow extra bone after a trauma or surgery with a condition called heterotropic ossification. Here is a link to describe it.
https://my.clevelandclinic.org/health/diseases/22596-heterotopic-ossification
This mentions that if you have heterotropic ossification, that it may be related to ankylosing spondylitis. If that is the cause of your bone growth, it is an inflammatory condition that may need some attention to try to stop the progression.
https://my.clevelandclinic.org/health/diseases/ankylosing-spondylitis
Here is a discussion on ankylosing spondylitis where you may meet other member discussion the condition.
Spine Health - "Ankylosing spondylitis: anyone else?"
https://connect.mayoclinic.org/discussion/ankylosing-spondylitis/
Also FYI, please crop off any personal information if you post imaging to protect your identity. You are welcome to post imaging.

Hi Jennifer. The surgeons in Thunder Bay would have to send a referral to other specialists in Toronto or Ottawa. Unfortunately pride gets in the way of asking for more opinions with some surgeons. I will definitely look at the websites you forwarded me and read them. Thanks for your help and very informative reply. Thanks again. John.