Cervical Disc Replacements instead of more fusions

Posted by babypanda @babypanda, Apr 22 9:37pm

I had ACDF surgery on 2 discs in July. The surgeon said other discs would eventually need surgery, too. Unfortunately I am starting to have intense neck pain again along with numbness in my hands and morning headaches. I was hoping to see if anyone here had disc replacements instead of discectomies with fusion. I don’t want to lose the ability to turn my head that I have left. I’ve read insurance covers it until age 60. I’m 58 so I need to know what my options are. Thank you!

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@babypanda I'm not sure what cervical levels are giving you trouble. Head turning is done mostly by C1 and C2 with a little help from C3 and C4. If C1 or C2 were affected and fused, you would loose head turning, but exactly how much would have to be answered by a surgeon if C3 & C4 were still able to twist. It would be limited at lot. C1 & C2 are shaped like a ring that turns on top of a post. The other discs have a little ability to twist, but not the same movements C1 & C2. I don't know that an artificial disc is approved for levels right under the skull and there are many different devices. Having 2 adjacent levels needing disc replacement also limits what devices can be placed there. There are some risks to them, and they can fail with breakage, displacement of screws that migrate, and if a failure happened right under the skull, it would be very dangerous. Some artificial discs are not approved for levels adjacent to fusions, and that would also be a question to ask.

One reason for increased pain may be scar tissue from your surgery or muscle spasms. Have you seen a physical therapist for an evaluation in case you could improve without further surgery? Insurance companies also regulate if they think surgery is necessary, and if you don't fit their definition before age 60, they might not cover it. I am wondering why that is, and if it could be related to declining bone quality with aging and their charts on statistics regarding artificial discs.

Something you may be interested in is Myofascial Release therapy which can loosen the restricted scar tissue from surgery as well as other restrictions in the body. It is specialized training. My PT does this, and it has helped me a lot. I had a C5/C6 fusion 6 years ago. Here is the link to our MFR discussion.

-Neuropathy -"Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
I also have thoracic outlet syndrome (TOS) which is a compression of nerves and vessels as they travel through the shoulder between the collar bone and rib cage. That can be more common in spine patients where the spine condition was caused by an injury that may have also damaged the areas where these nerves travel. It is important to diagnose where the pain is coming from before surgery, so you know if spine surgery will fix it or not.

Here is some information about TOS. MFR therapy is very helpful for TOS.
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/
Did your surgeon indicate which spine levels wold be problematic in your future?

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Wow! Thank you for so much information. The disc that were removed and fused were c5 and c6. The surgeon gave me two options as far as the surgery went: fuse a couple or go ahead and fuse them all because my neck is in bad shape from degenerative disc disease along with central & foraminal stenosis and bone spurs. Both discs had calcified and completely compressed with one disc being sequestered and squeezed out into a piece the size of a pebble. My surgeon is very skilled, but has the worst bedside manner I’ve ever encountered and explained as little as possibly. I’m thinking the disc above or below are causing the most pain (c4 and/or c7) since they have more pressure on them. I know I’m probably don’t qualify for artificial discs, but I’m losing mobility everywhere at this point.

My neck has been much worse since I had an infected hip replacement removed along with a massive staph infect (surgery was Feb. 7). I ended up in a nursing home for a month due to the IV antibiotics and the hospital bed just about killed me. My PT used to do MFR on my middle back (facet syndrome in thoracic vertebrae) but now uses dry needling instead because his thumbs were getting arthritic from doing MFR for so many years. The PT said I’m financing his retirement after 21 years as his patient. I’m going to ask my pain mgt doctor to send me in for more PT because I’m afraid of screwing something up on my own with the hip spacer. I walk 3 sessions a day between 10-20 minutes and my best friends are I’ve packs and a heating pad. 🙁

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Hello @babypanda. You will notice I have moved your post to the Spine Health Support Group. I see you have connected with @jenniferhunter who has shared a lot of information with you. Are you considering a second opinion given your distaste of your doctor's bedside manner and to be fully sure before proceeding?

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Hi! I’m actually going to ask my hip surgeon for a referral. He’s been the most caring, compassionate, and conscientious surgeon I’ve ever met. As far as my spine surgeon, I lost faith in him when I had been dragging my leg for months and went to him thinking it was my lower back (I’ve got 4 bulging Lumbar discs, stenosis, etc…). He’d told me six months earlier that I’d need a laminectomy soon so I went in assuming I’d just be signing up for back surgery. Long story, but after cervical & thoracic MRIs to go along with a lumbar MRI from the ER, he said he didn’t know what was affecting my leg and to just take 2 Advil. Take 2 Advil? He didn’t offer any referrals or advice. I had to find a new doctor on my own who, thankfully, recognized I had a Trendelenberg gait. The timing was perfect since I didn’t know my hip had a staph infection percolating in it that was so bad the hip aspiration cultures were growing out of control by day four. Sorry to blather on, but I feel like my life is just waiting for the next doctor appointment. I did not expect to feel 98 at age 58. 🙁

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Fusion causes degeneration of the discs above and below and of course limits movement. Artificial discs however are designed to give you mobility without causing further degeneration. The USA and Canada are approved for 2 levels of cervical and 2 levels of lumbar disc replacements. It's all private and less you have insurance that will pay, the cost is totally yours. Germany is at the forefront of artificial discs and is the only country that does multi-level. Four months ago, I had five cervical artifical discs implanted and structurally the surgery was a complete success. The soft tissue eg muscles, ligaments etc. are still readjusting and is a work in progress. There are a number of skilled and reputable doctors. You can send in your medical imaging for a consult at no charge. That would be the first step. Secondly, get a quote so that you have the whole picture before you make the medical and financial commitment. It's not cheap. If you have to pay yourself, Germany is a cheaper option than the USA. I have a medical background so I understand the differences between fusion and artifical disc replacement. I also spent many, many hours researching it. I would be happy to share that with you.

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@amandajro

Hello @babypanda. You will notice I have moved your post to the Spine Health Support Group. I see you have connected with @jenniferhunter who has shared a lot of information with you. Are you considering a second opinion given your distaste of your doctor's bedside manner and to be fully sure before proceeding?

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Hi Baby Panda. I just had five artifical discs implanted in Germany. I am also a massage therapist and even if I was offered, I wouldn't want five fusions. The surgery was highly successful from a structural perspective i.e. the spine. It's a work in progress to bring the muscles, tendons etc. to where it needs to be. Yes, it's expensive. The USA and Canada are approved for two cervical ( and lumbar) levels which you have to pay for. Germany is the pioneer and only country that does more than two levels. Am happy to provide more info. Sandpiper

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@sandpiper49

Fusion causes degeneration of the discs above and below and of course limits movement. Artificial discs however are designed to give you mobility without causing further degeneration. The USA and Canada are approved for 2 levels of cervical and 2 levels of lumbar disc replacements. It's all private and less you have insurance that will pay, the cost is totally yours. Germany is at the forefront of artificial discs and is the only country that does multi-level. Four months ago, I had five cervical artifical discs implanted and structurally the surgery was a complete success. The soft tissue eg muscles, ligaments etc. are still readjusting and is a work in progress. There are a number of skilled and reputable doctors. You can send in your medical imaging for a consult at no charge. That would be the first step. Secondly, get a quote so that you have the whole picture before you make the medical and financial commitment. It's not cheap. If you have to pay yourself, Germany is a cheaper option than the USA. I have a medical background so I understand the differences between fusion and artifical disc replacement. I also spent many, many hours researching it. I would be happy to share that with you.

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@sandpiper49 This is very interesting. Could you share the manufacturer's name and the name of the artificial disc devices that you had implanted? I am a surgical patient too (C5/C6 fusion without hardware) and I like to know what's going on in spine surgery. One question, do your artificial discs have any spaces in them where bone tissue can grow to help hold it in place or is that done simply by screws alone?

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Prodisc C was the disc selected for me. There e over 30 types of discs although there are probably favourites that are used most often. They need to fit hence the custom selection.
A slot is made in the bone and the disc slides into the slot. There isn't, nor can there be, spaces. The discs need to fit snugly. There are no screws except during the surgery as part of the process of implanting them correctly. Your body will produce new bone which will grow around the implant. The surgery is done via the front of the neck which is how you access and remove the damaged disc. Think about it, leaving any kind of space jeopardize the security of the disc. It isn't intended to slide around between the vertebra. You can actually Google an animation of the surgery which is very enlightening.

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@sandpiper49

Fusion causes degeneration of the discs above and below and of course limits movement. Artificial discs however are designed to give you mobility without causing further degeneration. The USA and Canada are approved for 2 levels of cervical and 2 levels of lumbar disc replacements. It's all private and less you have insurance that will pay, the cost is totally yours. Germany is at the forefront of artificial discs and is the only country that does multi-level. Four months ago, I had five cervical artifical discs implanted and structurally the surgery was a complete success. The soft tissue eg muscles, ligaments etc. are still readjusting and is a work in progress. There are a number of skilled and reputable doctors. You can send in your medical imaging for a consult at no charge. That would be the first step. Secondly, get a quote so that you have the whole picture before you make the medical and financial commitment. It's not cheap. If you have to pay yourself, Germany is a cheaper option than the USA. I have a medical background so I understand the differences between fusion and artifical disc replacement. I also spent many, many hours researching it. I would be happy to share that with you.

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Thank you so much for sharing this information. It's totally amazing really. I have two questions. Is this considered experimental? Would a good insurance plan pay for the surgery? I love to swim long distance. I had to stop because of my neck. Would you have that side turning movement now after your surgery? Thank you in advance for your reply. Nancy Holzheimer

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@sandpiper49

Prodisc C was the disc selected for me. There e over 30 types of discs although there are probably favourites that are used most often. They need to fit hence the custom selection.
A slot is made in the bone and the disc slides into the slot. There isn't, nor can there be, spaces. The discs need to fit snugly. There are no screws except during the surgery as part of the process of implanting them correctly. Your body will produce new bone which will grow around the implant. The surgery is done via the front of the neck which is how you access and remove the damaged disc. Think about it, leaving any kind of space jeopardize the security of the disc. It isn't intended to slide around between the vertebra. You can actually Google an animation of the surgery which is very enlightening.

Jump to this post

My friend went to Germany decades ago for a ADR of L5-S1, I think was a Prodisc something. May I ask which medical tourism company you used? Medicare won't pay for ADR yet and I've been told I need C5-7 fused. I had L4-5 fuse 3 yrs ago and the pain is back worse. I'm now getting a Spinal Cord Simulator, 3 neurosurgeons said surgery wouldn't help. I really need a spine transplant but….

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