Severe central Canal Stenosis on MRI

@vennas217 Hello and welcome to Connect. You have a complex decision to make that doesn't come easily. It is great that you have had 2 expert consultations. Surgeons may make recommendations based on their own preferences and can be biased in what spine implants they want to use because of familiarity. Other surgeons may offer other ideas. To answer you question, this will not heal on it's own, and intervention by a surgeon is to prevent further damage and loss of function. As you know, this can happen without a lot of pain symptoms or nerve pain. It's kind of pot luck which nerve axons are getting compressed in the central canal because it is a big bundle of everything. If your disc is collapsing and creating bones spurs, that will likely continue and press further into the spinal canal and cause further symptoms. You mentioned a white spot. If that is inside the spinal cord, that may be myelopathy or myelomalacia which represents some spinal cord damage because of compression. If you are seeing a white spot in the vertebrae bones, that may be a hemangioma which is kind of like a birth mark and those usually are benign. https://my.clevelandclinic.org/health/diseases/spinal-hemangioma. Your surgeon should explain to you what you are seeing.

I was making the same choice 8 years ago for my C5/C6 disc that had collapsed by 50% and I had a disc osteophyte complex pressing 5 mm into the my spinal cord. Here are some questions to ask yourself and help you understand your decision. These are things to think about, and you may come up with other questions.

Do you have good bone quality? Anything that needs to be anchored to the spine with screws depends on good bone density to support it.

Do you have sensitivities to foreign materials in your body, such as dental work, metal piercings, etc?

Do you have allergies?

What physical activities do you participate in, and how do you expect that to change after spine surgery?

Do you have the patience to stay in a neck brace for 3 months if you were offered a fusion without hardware? That may seem like an unusual question, but this is how they did cervical fusion before the hardware and plates were invented. It is a valid option if your surgeon is willing. Per my surgeon, it heals better with a natural bone disc spacer. This can be donor bone or bone taken from your hip that may cause hip pain that can be permanent. Surgery with hardware will also require patience in healing. People heal at different rates.

Have you researched your surgeon's reputation and standing in the medical center? Do you know his personal success rate for the procedure that is offered? Did you search for any state medical board disciplinary action? What is their rate of infection or re-operation if a failure occurs? Is the surgeon respected by his peers? Can you find published medical literature authored by the surgeon? What is their main area of interest? Does the surgeon specialize in spine procedures only and is not a general surgeon?

What do you expect for your ability to move your neck after surgery in a fusion vs artificial disk procedure?

Do you have a good physical therapist for rehab?

...... and yes, I had a very successful fusion of C5/C6 done without hardware and I stayed in a neck brace 3 months, and then did rehab. That turned out to be the right choice for me. I have allergies and asthma, and had dental work that affected my allergies. I realized that when all the old dental work was removed and replaced with safer ceramic materials. Later, I found out when I broke my ankle that my body did not like titanium, so I made a good choice for spine surgery. Spine implants may have bone that grows around them and through them, and may not be able to be removed later. That is a good question to ask if it can be removed if there is a problem. Not everyone will have that issue. I had to give up pierced earrings years ago because I reacted to everything, so that was my clue even though when I had this tested before my surgery, it didn't find any reactions to common implant materials. If you should need a surgery later on an adjacent disc, the choices will be limited by what the first surgery was. Artificial disks may not be qualified to put next to a fusion. A few artificial disks may be cleared to use on 2 levels next to each other. Artificial disks are also limited if you have any instability of one vertebra level slipping past another. 4mm of movement was enough to disqualify during the clinical trials. You can fuse multiple levels which of course limits your normal movements and will change your existence. If you have only one bad level lower in your neck like me, after surgery, you may feel similar to how you felt before surgery. Forward or backward bending is not possible, and I don't do anything to stress a movement like that. I also do not do any sports or activities that will pound pressure on my spine such as power boats, jet skis, etc. I take care and keep up my core strength because I don't want to go through spine surgery again. That being said, it was not as bad as I thought it would be.

My neck movement is the same as before surgery because most of head turning is done by C1 & C2 with some help from C3 & C4. I cannot touch my chin to my chest anymore, but it is very close. I would expect with a fusion that includes C4, you would loose a slight bit of head turning. Ask the surgeon how much.

I have not had any further issues with adjacent segment disc disease, but I also do stretches and fascial release on tight muscles that my physical therapist showed me. I also have no hardware adding further rigidity to the spine (more rigid than natural bone itself). I think that this will help me avoid adjacent disc disease because I also relieve the extra pressure from muscle spasms. Time will tell, but 8 years past spine surgery with no further issues is a pretty good track record. I also had an excellent surgeon at Mayo, one of their best.

What is most important to you of these issues up for your consideration? Will you be seeking more surgical opinions? ( I had 6 opinions. )

@vennas217
If your spinal cord is compressed or flattened due to a disc bulge or herniation, you want to have surgery to decompress so you don’t get worsening symptoms and permanent spinal cord injury. I am a 55 year old female who had ACDF surgery on c5c6 when 52 due to flattening for an extended period with some permanent damage. It started with neck and shoulder pain and daily headaches and it worsened over time with a long list of symptoms but I was misdiagnosed for a while. It is usually considered a time sensitive surgery to prevent progression from the severe stenosis.

@jenniferhunter @dlydailyhope
Thank you.
I play racket sports and have always been a very active person. Haven't had any surgery until now so I am not sure about my body accepting titanium or any other hardware. We will have to see.
And yes, the white spot is in the cord, indicating myelomalacia.
I have decided / accepted that surgery is my only option.

But since two doctors have given different methods (spinal fusion vs Disc replacement ), i am not able to decide which one is the better option.
I would like to continue playing sports , "google" says disc replacement will provide a better range of motion post surgery. From the replies above, it seems like both have had fusion, which seems to be the more common option preferred by doctors?

I have sought a third opinion , for which my appointment is three weeks from now. I hope I dont have to go in for a surgery before that.

@vennas217
I have decent range of motion with fusion but there is risk for levels above and below fusion needing surgery again. I had fusion at c5c6 but now have a new herniated disc at c6c7 so may need surgery since herniation is going into central spinal canal and causing new compression of spinal cord and symptoms. Fusion may be needed if stability is needed to prevent too much movement. Your racket sports and activity level may have caused the disc issue but your surgeon will be best to determine if fusion or no fusion is best for your spine and activity level.

@vennas217 This may help. The NFL will allow a player to play football after a single level cervical fusion. This was the case for Peyton Manning, the quarterback who left the Indianapolis Colts after the fusion, and then played for the Denver Broncos going on to the Superbowl. A 2 level fusion would have disqualified him. My surgeon told me that.

Also look into failures of artificial discs. There are some discussions here about failure of a Mobi C artificial disc. Screws can pull out, and the failures of the Mobi C I have heard about involved a sideways displacement or slipping of the 2 sides of it. If I remember correctly, I think the Mobi C is qualified for a 2 level replacement. Surgeons are trained by the manufacturers on how to implant their products, so you will find surgeons loyal to a particular design. That doesn't mean there aren't other good options, but you can only have surgery for a specific one of these with a surgeon who uses them.

Spine Health -"Would you consider this Mobi-C failed and what would be the next step?"
https://connect.mayoclinic.org/discussion/would-you-consider-this-mobi-c-failed-and-what-would-be-the-next-step/
There is also an M6 artificial disc. This was in clinical trials at the time I had my spine surgery, but it was designed to create a more natural movement of the disk.
https://m6disc.com/
This discussion may be of interest.
Spine Health -"artificial disc replacement"
https://connect.mayoclinic.org/discussion/artificial-disc-replacement/
With racket sports, you may be recruiting neck muscles when you swing if you are putting a lot of effort into it. If you did go with an artificial disc and it failed, a re operation would likely be a fusion to replace it. There are a lot of artificial disc manufacturers and it is worth looking up what they tell you about to find out how it works, and if that would be compatible with your wishes. It is worth discussing your desire to play racket sports with your surgeon.

This is a comparison.
https://www.spine-health.com/treatment/artificial-disc-replacement/artificial-disc-vs-anterior-cervical-discectomy-and-fusion
A lot is said about fusions increasing the stress on adjacent discs raising the risk of a future fusion surgery due to disc damage. Artificial disks are marketed as lowering the risk. There is truth to this, but adjacent segment disease may also happen with an artificial disc at a lower rate. It also happens to people who have had no spine surgery.

Hopefully, you'll learn more at your third consultation. Get as many opinions as you need to make an informed choice and to be comfortable with the surgical plan. You need to be able to get onboard and trust the surgeon 100% to have a good outcome.

Thank you very much! This information is extremely helpful.
Will keep you posted on what the other surgeon says. Trying to see if we can expedite the appointment.