Smart to Wait? ACDF

@hmcski To answer your question about possible permanent damage... in a word, yes. When nerves are compressed long enough or with a lot of pressure, they can die and dissolve. That is like someone cutting wires out of the middle of a cable, so it no longer transmits electricity through the damaged section. This can happen to the spinal cord, and MRIs may show whitish areas of permanent damage called myelomylacia. Radiculopathy is compression of a spinal nerve. If nerves are decompressed with surgery, they can heal slowly if the damage is not too great. The problem is that it's hard to know exactly when the point of no return happens. There is also the possibility that another injury when you're already compromised could make this so much worse.

I understand hesitancy, and rushing into surgery isn't usually a good idea. Take the time now to explore what your options are, so if you get worse, you are ready to make a decision on your care. When nerves are damaged and die, the muscle they serve starts to wither away and you loose strength and function. Recoveries are better when nerve compression is addressed early. I have had spinal cord compression and surgery to free my spinal cord and fuse C5/C6. I had a great recovery and reclaimed the coordination in my arms that had been lost. I do think I've lost some strength, but I also have thoracic outlet syndrome which causes compression of nerves/vessels in the shoulder.

@hmcski
I do believe you can wait and get conservative treatment like physical therapy and pain injections. Over time, your spinal cord/nerve roots that are compressed can be injured and may be permanent. Your surgeon can advise on how long you can delay surgery before any permanent damage.

I had ACDF on C5-C6 in 2022 due to spinal cord compression injury, radiculopathy, bone spurs, disc bulge, etc. I have some permanent injury to my spinal cord which is causing arm/shoulder/hand weakness. I was misdiagnosed for over 5 years. I am due to have ACDF on c6-c7 due to a new herniated disc once my insurance company stops giving my surgeon and me the runaround covering the surgery. They are trying to delay and avoid paying for my procedure (coverage ends 5/31 and new coverage starts 6/1).

Jennifer and dly ...your words are indeed wisdom. God bless all and wish you only the very best. : )

@hmcski Thank you. Have you had a full work up for your symptoms? Thoracic outlet syndrome is often missed and may be more common in spine injury patients because it may be caused by a whiplash.
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
It can cause arm pain symptoms, and so can radiculopathy and that should be evident on MR imaging. That of course may confuse a diagnosis. When I went to Mayo, they did confirm that I had TOS in a vascular lab with blood pressure cuffs on my fingers and moving my arm into different positions measuring when it was cutting off blood flow due to the compression from TOS. I clearly did have a collapsed disc with spinal cord compression, and they determined that the spine was the bigger problem. I have continued working with physical therapy for TOS and it has been 8 years since my spine surgery.

Wishing you the best.
Jennifer

Thank you Jennifer! I had the same question as I have to make a decision about lumbar laminectomy and fusions at L3-S1.

My spine is a problem but inflammation is a bigger problem. Two years ago a synovial cyst formed and urgent surgery was being planned. With prednisone and after restarting my biologic the synovial cyst was reabsorbed. I was opposed to a fusion so the surgeon told me to call when I was ready. The pain isn’t very bad so I haven’t called. Should I be rechecked at intervals or should I wait until I’m ready for surgery?

Pain was going to be the deciding factor. However the surgeon that wanted me to do the surgery said it wasn’t about the pain anymore.

@dadcue Mike, I would recommend followups with your spine specialist according to their recommendation. Some patients can have significant spinal cord compression and not feel pain. Imaging will tell you if you have compression of nerves or the spinal cord. It may produce pain symptoms, and maybe not. If you do have pain or symptoms of dysfunction, you may want to consult your specialist.

Several MRIs over the years have all confirmed compression of my spinal cord and exiting nerve roots. The MRI reports are tagged with "urgent action required." The problem is the pain coincided with flares of my autoimmune condition. I took prednisone and other anti-inflammatory medications to quiet things down. The biologic I'm currently taking seems to prevent the flares from recurring.

I have symptoms of dysfunction but my gait is still "functional." I have an antalgic gait but a rollator helps. The surgeon says surgery isn't likely to improve anything but surgery may slow down the progression. I'm afraid surgery might make everything worse so I avoid going to the neurosurgeon as much as I can. Surgery will also involve a "lengthy time to recover."

My last visit with the neurosurgeon was over 2 years ago. I was encouraged to call to make another appointment when I was ready to do the lumbar fusion. I'm still not ready for surgery so I guess there is no need for me to call.

I don't think there has been too much progression but I don't really know. I don't feel much of anything below my waist anymore. I only wish for things to stay functional. I have had cauda equina syndrome (CES) symptoms in the past but only during flares of my autoimmune condition.

I developed heterotopic ossification after my knee replacements. The orthopedic surgeon said I shouldn't have anymore surgeries. I don't know if that meant spine surgery too.

"Immunologic processes involving cytokines and chemokines, which are prominent in various rheumatologic conditions, contribute to the pathogenesis of heterotopic ossification and may be reduced with early treatment with biologic therapeutics."
https://pmc.ncbi.nlm.nih.gov/articles/PMC4417939/

@dadcue Mike, having diminished feeling below the waist is a significant symptom. I also understand the complication when you have heterotopic ossification and how surgery may trigger that because of the inflammation involved in healing. That does put you in a tough position. Spinal cord compression can cause incontinence of bowel or bladder as well as issues with balance and walking.

I do remember another spine patient on Connect a few years back who had become so disabled by spinal cord compression that he was wheelchair bound. He also had significant constipation problems so bad, that his doctors wanted to do a colostomy. He didn't know there was a connection of that symptom with his spinal cord compression. He did have spine surgery and then was able to avoid a colostomy. Also he regained the ability to walk again after some months of rehab. He set that as his goal after surgery and he achieved it.

Perhaps with research, an answer may be found as to solve your spine problems without causing bone formation in the wrong places. I encourage you to keep on searching through medical literature, and search names of authors and publications cited in the footnotes to see if there is more research going on. Another good place to look would be government clinical trials.