Cervical Disc Replacement vs Fusion

@quickray Welcome to Connect. At the time I was headed toward spine surgery, The M6 artificial disc was in clinical trials and it was described as having more natural movement than other artificial disks. One question that comes to my mind would be why a calcified disk is an issue. They should explain what they mean by not fusing right. Artificial disks are screwed into the bone, and don't fuse to the bone. Bone quality is very important. Also if there is any instability or side, forward or backward movement of one vertebrae over another, it may disqualify a patient for ADR. During the clinical trials, 4mm of movement was a dis-qualifier. I had 2mm of movement, and my surgeon would have done ADR if I had wanted that, but said I was not a great candidate for it with that much movement.

I had a C5/C6 single level fusion and did that without any hardware. I had just a bone disc spacer and stayed in a brace until fused. My body doesn't like foreign materials, and I had so many problems wearing pierced earrings that I had to give them up, so that was a good choice for me.

I did not loose much movement in my neck because C1 & C2 do most of the head turning with a little bit of help from C3 & C4. Maybe 1% would be from C5, but my range of motion is normal and the same as before my surgery for head turning. What I can't do is touch my chin to my chest, but it is very close, and spine bending tricks like somersaults or back bends are out of the question. Normal functioning and walking around, driving etc is fine.

Running or any sport pounding your spine is going to put wear and tear into the equation. Once you have spine surgery, it isn't automatic that you will have more problems at adjacent levels, but extra wear and tear is not going to help, and bad posture will add extra stress. If you have good posture and stack the vertebrae ergonomically, you have a better chance to lessen the wear over time. You may want to switch to exercise that is gentle like an elliptical jogging machine or simple walking.

Artificial disks can fail, screws can pull out, and the body can grow bone around an artificial disk trying to stabilize it. There is medical literature that describes all of that. Adjacent segment disease can happen both with artificial disks or fusions, probably to a slightly lesser degree with artificial disks, and if your body reacts to foreign materials like mine, that wouldn't be good. I found out how much I reacted to titanium by breaking my ankle and having plates attached to my bones. Because I had only one spinal level fused, I was able to opt for no hardware. I agree with you that fusing 2 levels seems a bit much and it could possibly be for the extra insurance money that would be earned by the surgeon and not as much for your benefit. Many surgeons are conservative and would not do another level unless it was really bad. You might need some more opinions from surgeons on this. Get as many as you need.

There is also a lab in Chicago that tests for immune responses to surgical implants. However, an allergic or immune response can develop after a period of time after the hardware is in your body, so a test that says you don't react isn't always a predictor of future issues, but it could catch a response if you have it now, and then you could consider a fusion with only a bone spacer like I did. I encourage you to keep asking questions of the surgeons and reading medical literature. The lab is https://www.orthopedicanalysis.com/

Are you considering getting another surgical opinion?

Also, when you say “if there is any instability or side, forward or backward movement of one vertebrae over another, it may disqualify a patient for ADR.” How exactly is that determined? Does the MRI show it? Is there another test I need to have performed?

Just trying to understand what sort of due diligence should be done prior to the surgery. When meeting with the surgeon who wanted to do the disc replacement, during the initial consult he said I’d be an excellent candidate for it. But I’m thinking, “how do you know I’m not allergic to the titanium” or something like that, you haven’t done any additional tests.

Wow, thanks so much for your informed response!

I somewhat want to get another opinion but I’m starting to feel silly that I keep going to different surgeons.

I’d love to get another opinion, just wondering how I can confirm a surgeon is a good one aside from the standard Google reviews you find.

My primary care doctor is the individual who referred me to the surgeon who wants to perform the disc replacement. The surgeon was the first to do it in the state I live in and is “the best neurosurgeon he knows.” The other two I just found off Google.

Is there a good resource to check aside from Google or to search?

@quickray Welcome to Connect. At the time I was headed toward spine surgery, The M6 artificial disc was in clinical trials and it was described as having more natural movement than other artificial disks. One question that comes to my mind would be why a calcified disk is an issue. They should explain what they mean by not fusing right. Artificial disks are screwed into the bone, and don't fuse to the bone. Bone quality is very important. Also if there is any instability or side, forward or backward movement of one vertebrae over another, it may disqualify a patient for ADR. During the clinical trials, 4mm of movement was a dis-qualifier. I had 2mm of movement, and my surgeon would have done ADR if I had wanted that, but said I was not a great candidate for it with that much movement.

I had a C5/C6 single level fusion and did that without any hardware. I had just a bone disc spacer and stayed in a brace until fused. My body doesn't like foreign materials, and I had so many problems wearing pierced earrings that I had to give them up, so that was a good choice for me.

I did not loose much movement in my neck because C1 & C2 do most of the head turning with a little bit of help from C3 & C4. Maybe 1% would be from C5, but my range of motion is normal and the same as before my surgery for head turning. What I can't do is touch my chin to my chest, but it is very close, and spine bending tricks like somersaults or back bends are out of the question. Normal functioning and walking around, driving etc is fine.

Running or any sport pounding your spine is going to put wear and tear into the equation. Once you have spine surgery, it isn't automatic that you will have more problems at adjacent levels, but extra wear and tear is not going to help, and bad posture will add extra stress. If you have good posture and stack the vertebrae ergonomically, you have a better chance to lessen the wear over time. You may want to switch to exercise that is gentle like an elliptical jogging machine or simple walking.

Artificial disks can fail, screws can pull out, and the body can grow bone around an artificial disk trying to stabilize it. There is medical literature that describes all of that. Adjacent segment disease can happen both with artificial disks or fusions, probably to a slightly lesser degree with artificial disks, and if your body reacts to foreign materials like mine, that wouldn't be good. I found out how much I reacted to titanium by breaking my ankle and having plates attached to my bones. Because I had only one spinal level fused, I was able to opt for no hardware. I agree with you that fusing 2 levels seems a bit much and it could possibly be for the extra insurance money that would be earned by the surgeon and not as much for your benefit. Many surgeons are conservative and would not do another level unless it was really bad. You might need some more opinions from surgeons on this. Get as many as you need.

There is also a lab in Chicago that tests for immune responses to surgical implants. However, an allergic or immune response can develop after a period of time after the hardware is in your body, so a test that says you don't react isn't always a predictor of future issues, but it could catch a response if you have it now, and then you could consider a fusion with only a bone spacer like I did. I encourage you to keep asking questions of the surgeons and reading medical literature. The lab is https://www.orthopedicanalysis.com/

Are you considering getting another surgical opinion?

FYI - are you SURE you react to titanium? It’s supposed to be a pretty minimally reactive metal. It’s usually the chromium that is used with the titanium parts that patients react to is what I was told by a surgeon - I guess - was told - it’s because there is nickel incorporated into the chromium that most patients react to?! Made perfect sense to me as I cannot wear jewelry with any nickel in it at all. I must wear 14K hold or higher or I definitely react - itching, burning, redness, skin breakdown. I have the reaction whether it’s “cheap” jewelry or some metal parts on medical stuff like when metallic parts on orthopedic equipment/braces touch my skin.
Because it’s so problematic for me, when I needed certain replacement joints the company was able to manufacture the custom made joints (more $$$) for me without chromium. My joints have been in place 15 years with NO issues.

@wisco50 Most people don’t react to titanium implants, but some do. No metals are pure, they are alloys being mixed with other metals to improve strength. Years ago when I had pierced ears, I tried everything …. gold, platinum, surgical stainless steel, silver, even covering an earring post in a plastic sleeve and always, I reacted. When my ears were first pierced, everything was fine. I had metals in dental work starting from childhood that affected me unknowingly and made my allergic asthma worse. Asthma also came on in adulthood and I did not have it as a child.

When old dental work began to fail 4 years ago, I had it removed and got ceramic dental implants. I was metal free for the first time in my life from the beginning when I was a kid. My health and asthma improved a lot immediately. Then 4 months later, I broke my ankle badly and became the owner of titanium plates and screws on my bones. My asthma got worse again right away. 6 months after the ankle surgery, I started getting patches of chronic hives covering half of an upper arm or the inside of a thigh. It would start where clothing was tighter because it was systemic, and slight rubbing started the histamine reaction. If I rubbed or scratched at all, the hives multiplied even with individual welts up to a half inch in size. It was unbearable without being on antihistamines all the time. I had to wait at least a year for the ankle bones to heal before I could have the plates removed. It also caused some slight pigmentation of skin over the plates and it throbbed all the time and was warm when I touched it. All the metal was removed at a year and a half past the injury and it resolved the issues. I do still have some pain related to scar tissue and weakened ligaments that is intermittent and I’m stretching to relieve it. I don’t have chronic hives now without taking antihistamines.

These conditions can change after a certain period of exposure. I did take a blood test for allergies to surgical implant materials and metals prior to having spine surgery , and it did not indicate any problems, but clearly after breaking my ankle, I developed a problem to something in the hardware. I chose a single level spinal fusion with only a bone disc spacer and no hardware because I thought there could be potential problems. I had a dental crown with titanium in it, and some others that were something else for years. Perhaps that primed my body for a later reaction. I hope I don’t need to experiment again with foreign materials. Also the recovery from the ankle fracture was much more painful and longer recovery than the cervical spine surgery.

Jennifer