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Answers about Controversial Trends in Spine Care

Spine Health | Last Active: Jan 16, 2023 | Replies (35)

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@cbove2

I am new using Connect - was seen at Mayo 1/18/22 for review of my cervical MRI. The PA said I have spondylosis at C5-6 and C6-7 and would need surgery in the future, i.e., disk replacement with fusion. i asked about the new motion preserving spine surgery and was told only applicable if I was 30 years old or younger. I googled around and Dr. Jeffrey Cantor has a great website and YouTubes about cervical stenosis. He talks about surgery with the misonix early enough to avoid fusion. He also has a place on the website to upload MRI images for a second opinion. I uploaded my MRI this weekend and will see what they say. I also plan to contact Hopkins for a consult. You mentioned Becker's Spine - I signed up a couple of years ago and get their daily email.
I tried to contact the Mayo neurology PA by calling the dept. and leaving a message - I wanted to ask questions about the misonix and pre-emptive surgery. My call was not returned yet.

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Replies to "I am new using Connect - was seen at Mayo 1/18/22 for review of my cervical..."

@cbove2 Hello, I am a Mayo cervical spine surgery patient. May I ask a bit about your diagnosis and how a surgeon would address it? That matters a lot in what procedure is done and from what approach.

A Misonix tool is for cutting bone very precisely and I am sure it is valuable, but there will be situations where the tool is of little value that involves something other than bone. I looked at Dr Cantor's website, and he doesn't explain what his approach is. Promoting a new technological tool doesn't tell the whole story, and you need a complete picture to understand the entire problem and various solutions for it.

Fusions are not necessarily bad, and it depends on where it is and how much movement is normal in that part of the spine. Head turning is accomplished by C1 through C4 with very little assistance from C5 or lower levels. I have a single level fusion at C5/C6 and my movement is the same and in normal range with one exception. I cannot touch my chin to my chest, it's darn close though. I have no hardware; only a donor bone spacer. The advantage is the fusion bond is stronger than any hardware to be screwed in, there will never be an immune response to foreign materials place inside, there are no screws to become dislodged or migrate, and the bone retains some of it's flexibility. I know that may sound odd because bones are rigid, but they do flex a bit because of the protein matrix in them. I am over 5 years post op and all other levels are fine. Sometimes adjacent segment disease is going to happen anyway, and even to people who have not already had a fusion. Adjacent segment disease also happens with artificial discs, but possibly at a lesser rate. That is something to ask a surgeon about.

Motion preserving hardware can fail. The spine can try to stabilize it by growing bone around it. There can be allergic reactions to metals that are now part of the spine.

The decision you make needs to be based on all the opinions and information you get, and not just the opinion of one surgeon who loves a specific tool. As much as a new paint brush doesn't make someone a good artist, a high tech tool doesn't make someone a good surgeon. They bought a tool and are using that to market themselves. The tool can make surgeries better if it is in the right hands.

You need to learn the benefits and risks of each procedure and when is the time right to do it. In general, I think active young people tend to want artificial discs so they can get back to activities with shorter recovery times. Fusion healing and bone growth takes time. For me, it was 3 months until the fusion process began to set. Think about how an aging spine will affect the procedure that you choose, and will you have good bone quality as you age? For me, the choice to avoid foreign materials in my body was huge... and I was right about that because when I broke my ankle and lived with some internal titanium plates, it caused pain, inflammation, and I had chronic hives for months that no one could explain. I had them removed after I had healed for a year, and I have not had hives since then. I used to have pierced ears and had to give that up because I reacted to every type of metal that was used, so none of this really surprised me.

It is good to get a lot of respected opinions before you choose. I also watched as many presentations at surgical conferences that I could find online as they discussed different cases, how to solve problems and what to watch out for. Sometimes, the risks are not spelled out so clearly to patients, but when surgeons talk to each other, they are pretty honest about the pitfalls because they are there to teach. One thing to look at is how respected a surgeon is in his (her) own field. Are they presenting and teaching at the spine society conferences every year? Are the institutions they are affiliated with respected? Keep in mind, some surgeons are in this for profit and they may own their surgery centers. Take that into consideration when you are trying to decide if you are getting an objective or a biased opinion.

Can you explain what it means to use a Misonex tool early enough to avoid a fusion in the future? I don't know what that means. Has the surgeon fully explained why he thinks this tool has improved benefits and in what situations it is beneficial?