C6-C7 bulge, symptoms are mild, doctor wants to do ACDF. Seems hasty.

Posted by jcford73 @jcford73, Aug 18 3:04pm

I'm 48 and started having pain about 3 months ago in May. I can pinpoint a certain neck position that makes the pain more acute. If I aggravate it, I get left arm pain and muscle spasms in my back. Normally pain is a 1-2 but it can get up to a 7-8 if I overdo it.

So I talked to my doctor and he sent me for x-rays then an MRI.

"Broad base disc protrusion 5 mm causing compression of thecal sac and both traversing nerve roots."

He referred me to a spine specialist. It was a month's wait to get an appointment. Doc sent me to a pain management place in the interim. They wanted to do an epidural steroid injection. The spine specialist said the epidural wouldn't help. He said I need to do the surgery.

I guess this is why we have the saying "When all you have is a hammer, everything looks like a nail."

I'm scheduled for surgery in a couple of weeks. I've never had major surgery before. I have no shortage of anxiety and uncertainty about it. My head is full of questions all being shouted at once. Is the doctor being too hasty? Should I give it more time? Should I try the epidural? Rehab? Will surgery get rid of the pain? Will it make the pain worse? Is my pain minor enough that it isn't worth the risk? How can I go about getting a second opinion? Will insurance cover it?

Spiraling a bit, I guess.

Talk me down?

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@jcford73 Dear JC,
Welcome to Connect. I have been where you are now, scared to death, but what was different for me is that surgeons didn't want to help me, and I spent 2 years going through this, and charting the progression as everything got worse. I was begging for help an no one was listening, that is until I came to Mayo.

Lets' see if we can narrow down the issues…Did the surgeon's attitude or personality induce the fear, or is it because this news is a shock that you were not expecting? Did the surgeon spend enough time answering your questions? What questions are unanswered? Do you trust the surgeon? How do you determine if pain is minor and therefore not a threat? Do you want a second opinion? Did you feel pressured to make a decision?

Here is what we know. You can cause extreme pain by changing your neck position. This is a key point, because that is your proof that moving the spine causes pain. So how much is 5 MM? It's a lot when it's pushing into your spinal cord (which is surrounded by the thecal sac). That may be the herniated disc material that squished out of a ruptured disc and it can develop bones spurs alongside it that will poke the spinal cord. It is broad based spanning the spinal cord and nerve roots. I also had 5mm of protrusion into my spinal cord with bone spurs that doubled in mass within 9 months. The inflammation from the disc nucleus material induces bone growth as the body tries to stabilize the spine. There can be bone growth around the nerve roots too.

Sometimes "a nail is a nail", but sometimes it is a big spike like the kind that holds a railroad track onto the ground so the train can safely pass at any speed. So what happens when there is a giant spike pressing into your spinal cord? Lots of things… for me, I had pain everywhere in my body, numbness, tingling, muscles jumping spontaneously in my legs, limping because I couldn't walk correctly or empty my bladder all the way, and finally, all I had to do to induce a big electric shock through my entire body was to bend my neck.

So how about if a person just doesn't bend their neck? Think about what would happen if that person was in a vehicle involved in a traffic accident. Suddenly the car stops, but the force of the collision throws their head in the direction they had been moving. What happens to that person during the accident if there already IS a protrusion into the spinal cord? That is a question that you do not want to experiment with because the answer may be permanent nerve damage or paralysis and loss of function in the part of the body those nerves service.

Steroid injections work by reducing inflammation and that may buy a little bit of space for a little while, but it won't fix anything, and the body dissolves the medication over time. Surgeons use these to put off doing surgery, and sometimes because they don't want to do surgery. You got a very honest answer from the neurosurgeon about the injections. Kudos to them. I had one as a diagnostic test, and it did take away my existing pain for only 5 days, and it also caused a new burning electric pain in my hand because of the injection that took months to subside. The injections have some serious risks, and risks of paralysis or death if done wrong. I didn't say that to scare you, and many patients do benefit from them. There is a right time for surgery, and getting multiple opinions from surgeons would probably confirm that. Will insurance cover second opinions? You have to call and ask, and my insurance covered 6 opinions. Surgeons also give preference to the more urgent cases. That may be why you were offered surgery so soon rather than waiting a month or two.

At 48, what are you goals for the rest of your life? This is the choice you have now. What else do you need to know about all this? I was a patient who was terrified of surgery, and I had enough time to challenge myself and beat my fears, so when I met my surgeon right before my spine surgery at Mayo, I held his hand and I thanked him for helping me. Gratitude can help overcome fear by replacing it with a positive emotion. It had been a very long road getting to this life changing moment and during those 2 years while my spine was falling apart, I was also taking care of a physically disabled dying parent. That was the hardest time in my life, and right after my dad passed, I got a call from Mayo to come and choose my future. I jumped at it, and the surgery not only changed my life physically, but everything I did to overcome my fears changed me for the better. It was an opportunity in disguise.

What are your questions now? I will do my best to help.
Jennifer

REPLY

Thanks for your reply. The specialist they sent me to wasn't with Mayo. It's Barrow Brain & Spine in Chandler, AZ. I don't distrust the surgeon. I just don't know him. I talked to him for all of 5 minutes and I had never heard of Barrow. Not that I know any spine surgeons at Mayo, but I at least somewhat know the place (Phoenix) from the oncology side. And I know Mayo tops the lists for best hospitals in the US. I'd like to get a second opinion there. I'm worried if I actually switch to Mayo for the surgery that it will screw up the insurance or mean a months-long delay or something.

REPLY

@jcford73 JC, getting second opinions about spine surgery is normal, so I don't think your insurance will question it. However, that takes time, and you would wait for a consult at Mayo. I think a second opinion at Mayo is a good idea, but that is your choice. I agree that a 5 minute meeting with a surgeon doesn't leave a patient feeling settled when this is a new sudden diagnosis and your head is just spinning. I have heard of Barrow and think they have a pretty good reputation. I looked and they are ranked #40 in the country by US News and World Report.
https://health.usnews.com/best-hospitals/area/az/st-josephs-hospital-and-medical-center-6860280/neurology-and-neurosurgery
Mayo in Phoenix is ranked #26 for neurosurgery.
https://health.usnews.com/best-hospitals/area/az/mayo-clinic-6860019/neurology-and-neurosurgery
You can also look up individual surgeons in US News and World report.

One difference with Barrow is that it is a large physician owned practice, where Mayo is not. Doctors at Mayo are employees of the Mayo Medical Foundation and they get paid a standard salary whether they do surgery or not, so there is no financial bias in surgical decisions. One of my consult opinions was a surgeon at a physician owned surgical center, and it was just a 5 minute meet the surgeon and he told me what he could do. He was very pushy and scared me by telling me I had significant spinal cord compression and then refused to answer my questions about surgery. That may have been his personal style, but it left me anxious. At Mayo, where I had my surgery, my consult was much longer. The Mayo surgeon reviewed my imaging with me and explained the problem, and discussed my options. He answered a lot of questions. His nurse also answered a lot more questions as I was waiting for my surgery. I didn't feel like I was being rushed into meeting a quota for the number of patients that need to be seen to be profitable.

I spent a couple years reading medical literature about spine surgery which is how I head about Barrow. I also read a lot in Becker's Spine Review which publishes a who's who among spine surgeons and facilities listing thinks like Surgeons to know, and research that is being done, as well as surgeons who are elected to top positions at hospitals and spine foundations. I learned a lot by looking for research online from a doctor that I am interested in. Sometimes you can only find an abstract, but it tells you what their interests are. I also just trust my gut from the in person appointment. If the surgeon doesn't seem interested in helping me, that is a red flag for me. I also ask how long the ACDF procedure would be, and the answer at the doctor owned facility was 30 minutes, and at Mayo it was an hour and a half with the surgeon, and with a half hour of prep time before he steps in. I felt like they were taking time and using safety measures, and not just rushing through. The Mayo surgeon did 2 smaller surgeries a day or one major surgery, and the private practice doctor did about 10 ACDF procedures a day. That may be telling as to why they hurry through appointments. I didn't want to feel like I was on an assembly line.

This comes down to your decision to either accept your scheduled surgery, or to delay it and get a second opinion. You may want to contact Mayo and ask how long a wait there would be to be seen there. Then there is a wait to get on the surgery schedule, so you could be adding several months to the timeline. You would need to call your insurance too and make sure any facility is in network and that you have coverage for a second opinion, and that Mayo would accept your insurance. What can happen at private facilities is that a surgeon can be in network, but maybe a person doing anesthesia or measuring nerve function may not be, and there can be a surprise bill not covered by your insurance. Ask those questions so you will know that everything is covered because this is very expensive. At Mayo all providers are employees and not in private practice. You have to judge how you feel day to day and if you can keep yourself safe in your condition.

There may also be different ways to solve the problem. I did not want hardware on my spine because I was concerned about immune responses to foreign materials and metals in my body. My surgeon at Mayo did my fusion with only a donor bone graft and I stayed in a neck brace for 3 months. I had a lot of problems with metals in pierced earrings and had to give them up. Patients talk about being about to feel metal plates in their neck or pain related to hardware and weather changes.

What other questions do you have? What is your biggest concern?

REPLY
@jenniferhunter

@jcford73 JC, getting second opinions about spine surgery is normal, so I don't think your insurance will question it. However, that takes time, and you would wait for a consult at Mayo. I think a second opinion at Mayo is a good idea, but that is your choice. I agree that a 5 minute meeting with a surgeon doesn't leave a patient feeling settled when this is a new sudden diagnosis and your head is just spinning. I have heard of Barrow and think they have a pretty good reputation. I looked and they are ranked #40 in the country by US News and World Report.
https://health.usnews.com/best-hospitals/area/az/st-josephs-hospital-and-medical-center-6860280/neurology-and-neurosurgery
Mayo in Phoenix is ranked #26 for neurosurgery.
https://health.usnews.com/best-hospitals/area/az/mayo-clinic-6860019/neurology-and-neurosurgery
You can also look up individual surgeons in US News and World report.

One difference with Barrow is that it is a large physician owned practice, where Mayo is not. Doctors at Mayo are employees of the Mayo Medical Foundation and they get paid a standard salary whether they do surgery or not, so there is no financial bias in surgical decisions. One of my consult opinions was a surgeon at a physician owned surgical center, and it was just a 5 minute meet the surgeon and he told me what he could do. He was very pushy and scared me by telling me I had significant spinal cord compression and then refused to answer my questions about surgery. That may have been his personal style, but it left me anxious. At Mayo, where I had my surgery, my consult was much longer. The Mayo surgeon reviewed my imaging with me and explained the problem, and discussed my options. He answered a lot of questions. His nurse also answered a lot more questions as I was waiting for my surgery. I didn't feel like I was being rushed into meeting a quota for the number of patients that need to be seen to be profitable.

I spent a couple years reading medical literature about spine surgery which is how I head about Barrow. I also read a lot in Becker's Spine Review which publishes a who's who among spine surgeons and facilities listing thinks like Surgeons to know, and research that is being done, as well as surgeons who are elected to top positions at hospitals and spine foundations. I learned a lot by looking for research online from a doctor that I am interested in. Sometimes you can only find an abstract, but it tells you what their interests are. I also just trust my gut from the in person appointment. If the surgeon doesn't seem interested in helping me, that is a red flag for me. I also ask how long the ACDF procedure would be, and the answer at the doctor owned facility was 30 minutes, and at Mayo it was an hour and a half with the surgeon, and with a half hour of prep time before he steps in. I felt like they were taking time and using safety measures, and not just rushing through. The Mayo surgeon did 2 smaller surgeries a day or one major surgery, and the private practice doctor did about 10 ACDF procedures a day. That may be telling as to why they hurry through appointments. I didn't want to feel like I was on an assembly line.

This comes down to your decision to either accept your scheduled surgery, or to delay it and get a second opinion. You may want to contact Mayo and ask how long a wait there would be to be seen there. Then there is a wait to get on the surgery schedule, so you could be adding several months to the timeline. You would need to call your insurance too and make sure any facility is in network and that you have coverage for a second opinion, and that Mayo would accept your insurance. What can happen at private facilities is that a surgeon can be in network, but maybe a person doing anesthesia or measuring nerve function may not be, and there can be a surprise bill not covered by your insurance. Ask those questions so you will know that everything is covered because this is very expensive. At Mayo all providers are employees and not in private practice. You have to judge how you feel day to day and if you can keep yourself safe in your condition.

There may also be different ways to solve the problem. I did not want hardware on my spine because I was concerned about immune responses to foreign materials and metals in my body. My surgeon at Mayo did my fusion with only a donor bone graft and I stayed in a neck brace for 3 months. I had a lot of problems with metals in pierced earrings and had to give them up. Patients talk about being about to feel metal plates in their neck or pain related to hardware and weather changes.

What other questions do you have? What is your biggest concern?

Jump to this post

Thank you so much for your article my husband is having an issue with his spine. We went to see the orthopedic surgeon yesterday. He said to do mri, and pt, plus steroid meds ( if needed) back braces and come back to see him in 8 weeks.
The doctor seemed to be as expected./ steps forward to surgery. But I still uncomfortable with the future surgery even though the surgeon told us what the problem that the Lumbar 4-5-moveing sideways sometimes while my husband is in motion.
Now my husband has no pain after taking Tylenol 550 mg/ tablets a day for 5 days. We told the doctor about it. He said X-ray showed the problem, And I would like very much for my husband to do stretching and going to see physical therapy.

REPLY
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