Smart to Wait? ACDF

@hmcski To answer your question about possible permanent damage... in a word, yes. When nerves are compressed long enough or with a lot of pressure, they can die and dissolve. That is like someone cutting wires out of the middle of a cable, so it no longer transmits electricity through the damaged section. This can happen to the spinal cord, and MRIs may show whitish areas of permanent damage called myelomylacia. Radiculopathy is compression of a spinal nerve. If nerves are decompressed with surgery, they can heal slowly if the damage is not too great. The problem is that it's hard to know exactly when the point of no return happens. There is also the possibility that another injury when you're already compromised could make this so much worse.

I understand hesitancy, and rushing into surgery isn't usually a good idea. Take the time now to explore what your options are, so if you get worse, you are ready to make a decision on your care. When nerves are damaged and die, the muscle they serve starts to wither away and you loose strength and function. Recoveries are better when nerve compression is addressed early. I have had spinal cord compression and surgery to free my spinal cord and fuse C5/C6. I had a great recovery and reclaimed the coordination in my arms that had been lost. I do think I've lost some strength, but I also have thoracic outlet syndrome which causes compression of nerves/vessels in the shoulder.

@hmcski
I do believe you can wait and get conservative treatment like physical therapy and pain injections. Over time, your spinal cord/nerve roots that are compressed can be injured and may be permanent. Your surgeon can advise on how long you can delay surgery before any permanent damage.

I had ACDF on C5-C6 in 2022 due to spinal cord compression injury, radiculopathy, bone spurs, disc bulge, etc. I have some permanent injury to my spinal cord which is causing arm/shoulder/hand weakness. I was misdiagnosed for over 5 years. I am due to have ACDF on c6-c7 due to a new herniated disc once my insurance company stops giving my surgeon and me the runaround covering the surgery. They are trying to delay and avoid paying for my procedure (coverage ends 5/31 and new coverage starts 6/1).

Jennifer and dly ...your words are indeed wisdom. God bless all and wish you only the very best. : )

@hmcski Thank you. Have you had a full work up for your symptoms? Thoracic outlet syndrome is often missed and may be more common in spine injury patients because it may be caused by a whiplash.
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
It can cause arm pain symptoms, and so can radiculopathy and that should be evident on MR imaging. That of course may confuse a diagnosis. When I went to Mayo, they did confirm that I had TOS in a vascular lab with blood pressure cuffs on my fingers and moving my arm into different positions measuring when it was cutting off blood flow due to the compression from TOS. I clearly did have a collapsed disc with spinal cord compression, and they determined that the spine was the bigger problem. I have continued working with physical therapy for TOS and it has been 8 years since my spine surgery.

Wishing you the best.
Jennifer

Thank you Jennifer! I had the same question as I have to make a decision about lumbar laminectomy and fusions at L3-S1.

My spine is a problem but inflammation is a bigger problem. Two years ago a synovial cyst formed and urgent surgery was being planned. With prednisone and after restarting my biologic the synovial cyst was reabsorbed. I was opposed to a fusion so the surgeon told me to call when I was ready. The pain isn’t very bad so I haven’t called. Should I be rechecked at intervals or should I wait until I’m ready for surgery?

Pain was going to be the deciding factor. However the surgeon that wanted me to do the surgery said it wasn’t about the pain anymore.