Decision re: artificial disc replacements in cervical spine

@nadiachar
I had ACDF surgery on my c5-c6 due to cervical myelopathy. I was 52 at the time. I was misdiagnosed for over 5 years and now have some permanent spinal cord injury. My cord showed flattening/effacement and I had bone spurs/osteophytes and disc bulge causing stenosis. My symptoms were daily headaches, neck/shoulder pain and knots, tinnitus in ears, arm/hand weakness/numbness (regularly dropped things/handwriting worsened), bladder control issues, heaviness in legs/slowness in walking when I used to walk very fast (even when my brain wanted my body to move faster, it wouldn’t), etc. Cervical myelopathy is slow spinal cord injury over time. It is really only stopped from progressing through surgery. They used my own bone from my bone spurs to use in the fusion “cement” at c5-c6. After surgery, most of my symptoms improved except for residual arm/hand weakness.

Now, I have a new broad disc herniation at c6-c7 which is pressing on my spinal cord and nerve roots causing new myelopathy and bilateral radiculopathy symptoms. I recently had right hand carpal tunnel surgery and also have ACDF surgery planned for c6-c7 surgery in 2 weeks (3rd week in May). My myelopathy symptoms have returned and this time are major balance issues, arm/hand weakness, some neck pain, bladder control issues/frequency and slower walking. I am 55 and a single parent of a teen and want to stop the spinal cord injury from progressing further. After surgery, I will then have c5-c7 fused and will have some limited range of motion turning my head/neck but it is worth it not having many symptoms below the level of my spinal cord compression which could become permanent.

Have you been to a neurologist for EMG/nerve conduction studies of upper and lower limbs? Did your orthopedic spine specialist check your reflexes and watch you walk/your gait for signs of myelopathy?

There is not enough information in what you wrote for us to help you. And I can say that because I’ve had two cervical spine surgeries and I have all the stuff that has been posted here. When I was on the table having my surgery not until they opened me up could they actually See that my bones were going to be too soft to hold the screws and the fusion and the complicated surgery they were going to do on me. Indeed that was the case, and they had to do an emergency surgery through the backside and fuse more and stick a rod in my back. First surgery would’ve been great and I would’ve had mobility. I haven’t had in 60 years second surgery not so great because I’m really round shoulder and my body fights the rod. The answer for you is to go to the best orthopedic surgeon, cervical orthopedic surgeon you can find and that you trust. I had four opinions Till I found my cervical surgeon who also did my lumbar surgery. I had another spine surgeon for my hip replacements but he didn’t do spines. On top of that I also went to many other specialist who did treatments like injections, pain, management, cytology, and a whole bunch of other stuff who tried to give me an accurate picture, and that accurate picture could only be determined through various treatments overtime until my particular circumstance was whittle down to the obvious: which was in my case that cervical surgery didn’t present like the orthopedic surgeon expects and we were taking a chance with my surgery. Ucsd has a great orthopedic surgical department and a great kinesiologist. All of my joint replacement surgeries had complications. I would never do them overseas. I only trust World class university surgical teams who hired the best to evaluate these kinds of things. You should at least get the best evaluations collaborations you can find among your surgeon and come up with a plan you can trust. It wasn’t only my bones which is what orthopedic surgeons tend to that complicated my problem. It was my muscles which had which had glued together and we’re tying on the ligaments which were tying on the bones. So my two surgeries on my cervical spine did not resolve my pain. I am 68 years old and a life of stress on my body means that I’m never going to be without some modicum of pain at this point, but I’m OK with that. I had the best work that could be done on my body. I told my surgeon he can’t retire before I die because I need him, lol. This isn’t a one off. You should find a place you can call home. Good luck.

Thank you very much for sharing. It helps a lot to hear of the experiences of others.
I have seen an orthopaedic surgeon in Canada and had consultations with two neurosurgeons from Germany both of whom I trust. I do not think I have overt signs of myelopathy at this time but wish to decompress my spinal cord and improve the biomechanics while still a candidate for disc replacement to avoid it. Auto-fusion is occurring so the window will close. I wish you the very best in your upcoming surgery. It must be really difficult to be single-parenting while going through this. I hope you get the support you need to heal and recover well.

I think I accidentally responded to you in the wrong place, sorry! I hope you will see it below under another response posted for me.
Thank you both for sharing. I am trying to learn as much as possible as I make my decisions.

@dlydailyhope It sounds like you are going in the right direction. You already know what's involved since you've had one procedure already. I think your head turning will be the same as it is now after this surgery. Most of that is done by C1 & C2 with some help from C3 and C4. It will make your spine stiffer and take away some forward bending or arching backward. I'm glad you are sharing your journey so others may learn from you. Good luck with your surgery.

Flattening of the cord is worse than effacement. The trouble is that the discs effacing the cord may collapse further. There are minimally invasive partial disc removals that could help at other levels. The artificial discs are having great success. Which country would you be traveling to? You have to be careful with your choice of surgeon.

Thank you for your further explanation. Very helpful. I am planning to go to Germany. One surgeon suggested replacing 4 cervical discs at once. The other told me that if he looked at c3-c4 and c4-c5 in isolation, he wouldn’t recommend disc replacement but with consideration of the condition of c5-c6, it could be justified. If I am interpreting correctly, the hope is that better biomechanics at c5-c6 may slow degeneration at adjacent levels enough to spare them but I may require further adr’s in the future. I cannot imagine trying to fund another surgery later however and afraid of being left to progress to a crisis situation and then big fusion in the public system in Canada. It feels like a brutal decision- 4 discs at once at age 53 versus the one most needed. I am very grateful for experienced and/or educated thoughts on this and do not have access to a neurosurgeon without vested interest to guide me. Who does right?

I have 4 titanium discs (C3-C6). Surgery was done in 2021. No pain or seemingly, no restrictions. Am not really conscious of it. Apparently, had severe compression prior to it with numbness in both arms. Now, everything feels normal.

What an awesome report. How was the recovery? Where did you have it done? Do you remember the name or “design” of the hardware? Elastomer?

I live in Colorado. My surgeon is Lonnie Loutzenhiser at Panorama Orthopedic and Spine Center. I was 68 at the time. In fact, he just repaired by spine at L4 with another titanium disc (from a horse accident) April 3rd. Doing well with that and back to my treadmill.