What to expect from c5-c6 fusion surgery?
February 25, 2016 8:14 AM Subscribe
YANMD. I am having surgery in March to correct a horrendously slipped disc (or two or three; I'm unclear thus far as to exactly how much they're operating). I have many questions, some of which I will be asking my neurosurgeon. Some questions here will help me with that conversation; I'm looking for feedback from people who have undergone this, and from medical folks who know about this sort of thing. Details inside.
For a few months I've been having really awful symptoms--difficulty walking, numbness, tingling, burning, hypersensitivity to heat/cold/touch, etc--that finally, after a pretty solidly sedated MRI, have been nailed down as:
(quoting from my discharge summary)
1) At C3-4 level there is a small right intraforaminal disc protrusion causing minimal narrowing of the right neural foramen.
2) At C4-5 level, there is a small osteochondral bar, partially effacing the ventral thecal sac but with no evidence of cord compression at this level. Minimal narrowing of the bilateral neural foramina is seen at this level.
3) At C5-6 level, there is a prominent osteochondral bar with significant disc bulge and superimposed left paracentral/foraminal disc extrusion, resulting in spinal canal stenosis and cord compression with associated altered intramedullary signal intensity. There is also severe narrowing of the neural foramina bilaterally.
4) At C6-7 levels, there is a prominent osteochondral bar with a central disc protrusion, indenting the ventral aspect of the spinal cord but with no associated intramedullary abnormal signal. Mild narrowing of the neural foramina bilaterally is also evident.
All the above information came from a hellishly long series of MRI scans. (They found some other stuff too, having another MRI next Monday to look more closely... so that'll be the subject of next week's question.)
On to the questions:
For medical folks...
1) What are the actual risks (links to statistics would be great!) for this kind of surgery? The neurosurgical resident who I spoke to kinda handwaved away the risks, and I'd like to know what I'm getting into. Answers won't change whether or not I have the surgery, I'd just like to know exactly what I'm getting into.
2) Handwavy Resident said they'd likely only operate at one location, C5-6. Am I misreading when it sounds like C6-7 also sounds pretty serious, and should I be pushing my surgeon to deal with it while he's in there? What's the likelihood that fusing two vertebrae together will cause more stress further up and down, causing future problems with the other sites they identified?
3) For the sites where they almost certainly won't operate (3-4 and 4-5), what is the likelihood of those degenerating over time, necessitating further surgery down the road?
4) Handwavy Resident said they'd be removing the disc(s), replacing with a carbonite mesh (yes I said something about Han Solo at that point), and fusing the vertebrae together. How much mobility am I going to be losing?
For everyone...
5) What is a realistic recovery timeline? Assuming no complications from surgery, what do the next 6-8 weeks look like in terms of pain, mobility, and ability to get back to work? (NB: I cook for a living, so I'm on my feet ~10+ hours per day, with associated movement all the time.)
6) Again assuming no complications, what kind of long-term effects am I looking at in terms of reduced mobility, and how likely is this to affect job prospects down the road?
7) How do I not lose my goddamn mind while recovering? I live in Toronto, and I'll be staying with my sister for at least a week or two after surgery. Given that it's likely to be rainy, possibly slushy at the time, I'll be pretty well housebound to avoid falls etc.
Nobody here is my doctor; I'm asking for general medical information with the understanding that every case is different.
For a few months I've been having really awful symptoms--difficulty walking, numbness, tingling, burning, hypersensitivity to heat/cold/touch, etc--that finally, after a pretty solidly sedated MRI, have been nailed down as:
(quoting from my discharge summary)
1) At C3-4 level there is a small right intraforaminal disc protrusion causing minimal narrowing of the right neural foramen.
2) At C4-5 level, there is a small osteochondral bar, partially effacing the ventral thecal sac but with no evidence of cord compression at this level. Minimal narrowing of the bilateral neural foramina is seen at this level.
3) At C5-6 level, there is a prominent osteochondral bar with significant disc bulge and superimposed left paracentral/foraminal disc extrusion, resulting in spinal canal stenosis and cord compression with associated altered intramedullary signal intensity. There is also severe narrowing of the neural foramina bilaterally.
4) At C6-7 levels, there is a prominent osteochondral bar with a central disc protrusion, indenting the ventral aspect of the spinal cord but with no associated intramedullary abnormal signal. Mild narrowing of the neural foramina bilaterally is also evident.
All the above information came from a hellishly long series of MRI scans. (They found some other stuff too, having another MRI next Monday to look more closely... so that'll be the subject of next week's question.)
On to the questions:
For medical folks...
1) What are the actual risks (links to statistics would be great!) for this kind of surgery? The neurosurgical resident who I spoke to kinda handwaved away the risks, and I'd like to know what I'm getting into. Answers won't change whether or not I have the surgery, I'd just like to know exactly what I'm getting into.
2) Handwavy Resident said they'd likely only operate at one location, C5-6. Am I misreading when it sounds like C6-7 also sounds pretty serious, and should I be pushing my surgeon to deal with it while he's in there? What's the likelihood that fusing two vertebrae together will cause more stress further up and down, causing future problems with the other sites they identified?
3) For the sites where they almost certainly won't operate (3-4 and 4-5), what is the likelihood of those degenerating over time, necessitating further surgery down the road?
4) Handwavy Resident said they'd be removing the disc(s), replacing with a carbonite mesh (yes I said something about Han Solo at that point), and fusing the vertebrae together. How much mobility am I going to be losing?
For everyone...
5) What is a realistic recovery timeline? Assuming no complications from surgery, what do the next 6-8 weeks look like in terms of pain, mobility, and ability to get back to work? (NB: I cook for a living, so I'm on my feet ~10+ hours per day, with associated movement all the time.)
6) Again assuming no complications, what kind of long-term effects am I looking at in terms of reduced mobility, and how likely is this to affect job prospects down the road?
7) How do I not lose my goddamn mind while recovering? I live in Toronto, and I'll be staying with my sister for at least a week or two after surgery. Given that it's likely to be rainy, possibly slushy at the time, I'll be pretty well housebound to avoid falls etc.
Nobody here is my doctor; I'm asking for general medical information with the understanding that every case is different.
i got a lot of helpful info in my recent HELLISH NECK DRAMA askme
posted by poffin boffin at 8:22 AM on February 25, 2016 [1 favorite]
posted by poffin boffin at 8:22 AM on February 25, 2016 [1 favorite]
Anyway my personal advice is to get a second opinion and a third one as a tiebreaker if needed. The first (nonsurgeon) doctor I saw was kind of eh, I don't think you need surgery, and the pain mgmt guy I'd been seeing for 3 years to deal with the DEMONIC FUCKING PAIN was like that dude is nuts u need the surgery for sure, and the third guy (nerve specialist) I saw was like "you have a very rare nerve condition in your left arm that is unrelated to your neck" and I could see him wanting to dissect me and was like ok thanks bye.
Then I saw 3 separate surgeons, all of whom gave me the exact same advice for the exact same procedure in the exact same areas, which definitely made me feel 100% more confident that I was doing the right thing no matter which doctor I chose. IDK if Canada's healthcare system allows you to get a zillion opinions for the same condition but if it does then by god you should get them, the peace of mind is really significant for mildly to moderately anxious people like us.
(i have not had the surgery yet so idk anything about recovery stuff)
posted by poffin boffin at 8:31 AM on February 25, 2016 [3 favorites]
Then I saw 3 separate surgeons, all of whom gave me the exact same advice for the exact same procedure in the exact same areas, which definitely made me feel 100% more confident that I was doing the right thing no matter which doctor I chose. IDK if Canada's healthcare system allows you to get a zillion opinions for the same condition but if it does then by god you should get them, the peace of mind is really significant for mildly to moderately anxious people like us.
(i have not had the surgery yet so idk anything about recovery stuff)
posted by poffin boffin at 8:31 AM on February 25, 2016 [3 favorites]
Get more opinions. The consensus among medical folks I have spoken to who aren't surgeons is that you should avoid spinal surgery for as long as possible unless paralysis is a concern. Fixing one area very often leads to problems in other areas. I decided not to have neck surgery for my herniated disc after talking to several people who said the surgery fixed one problem and caused others. Be very, very sure that this is your best option before you have surgery.
posted by biscotti at 9:19 AM on February 25, 2016 [3 favorites]
posted by biscotti at 9:19 AM on February 25, 2016 [3 favorites]
Seconding poffin boffin:
Get a second opinion from a clinic TOTALLY UNRELATED to the one you're at now. The goal is that the two doctors have never gone over the file with each other. Do this even if the first doctor claimed that they've already gotten second opinions, reviewed your case with the board, WHATEVER. If the second opinion differs from the first, seek out a THIRD opinion, hopefully as a tiebreaker.
This really ought to be the standard for ALL invasive surgeries. Make sure that the surgery will be the best for you, and that there's nobody you can access that could possibly do it better. You deserve the best possible care.
Also, try and see a couple of chiropractors. Your mileage may vary depending on who you see and what kind of chiropractic they practice. Many doctors are quite disdainful of chiropractic as a meaningful way to manage health concerns, but in my experience it can change your life.
posted by beware the frog person at 9:58 AM on February 25, 2016 [1 favorite]
Get a second opinion from a clinic TOTALLY UNRELATED to the one you're at now. The goal is that the two doctors have never gone over the file with each other. Do this even if the first doctor claimed that they've already gotten second opinions, reviewed your case with the board, WHATEVER. If the second opinion differs from the first, seek out a THIRD opinion, hopefully as a tiebreaker.
This really ought to be the standard for ALL invasive surgeries. Make sure that the surgery will be the best for you, and that there's nobody you can access that could possibly do it better. You deserve the best possible care.
Also, try and see a couple of chiropractors. Your mileage may vary depending on who you see and what kind of chiropractic they practice. Many doctors are quite disdainful of chiropractic as a meaningful way to manage health concerns, but in my experience it can change your life.
posted by beware the frog person at 9:58 AM on February 25, 2016 [1 favorite]
My mom had spinal surgery that included fusion a few years ago. I honestly can't remember any of the specifics so I don't know how similar the situation is medically to yours, YMMV, etc.
She was having pain in her back which became horrible pain running down her leg and was causing difficulty walking. She worked for doctors when she was younger who said spinal surgery was awful and they would never have it. My mom felt the same way until she realized she really wanted to be able to walk around and travel and enjoy life.
It was the best decision she ever made. The doctors said she would still have some back pain, but the pain in her leg and difficulty walking would be gone. That's exactly what happened.
She stayed at our house for two weeks. They had her up and walking with a physical therapist at the hospital very quickly, and so she was able to get around on her own to go to the bathroom, etc. It was slow, and she used a walker, and she was only allowed to do stairs if we were there to help. She slept a lot and watched a lot of TV, but also made herself get up and walk around periodically, which was important for her recovery.
She had nice pain meds which she took for a few days and antibiotics. The worst part was that because of all the antibiotics she got oral thrush which worked its way down to her stomach before she realized what was happening. So for the first week she wasn't hungry and nothing tasted good. We were frustrated because she didn't want to eat anything, but we knew she needed to eat to recover. Once she called the doctor and got the thrush taken care of, it was all good.
One thing that was helpful was to have an armchair with a very straight back so she could sit in it comfortably.
After she went home she started physical therapy which was hard but also really great for her. She had the surgery in late December and in March she took her trip to Ireland and even kissed the blarney stone, which requires some serious back and neck bending.
If you want more details just mail me and I can ask her anything you want.
posted by thejanna at 10:30 AM on February 25, 2016
She was having pain in her back which became horrible pain running down her leg and was causing difficulty walking. She worked for doctors when she was younger who said spinal surgery was awful and they would never have it. My mom felt the same way until she realized she really wanted to be able to walk around and travel and enjoy life.
It was the best decision she ever made. The doctors said she would still have some back pain, but the pain in her leg and difficulty walking would be gone. That's exactly what happened.
She stayed at our house for two weeks. They had her up and walking with a physical therapist at the hospital very quickly, and so she was able to get around on her own to go to the bathroom, etc. It was slow, and she used a walker, and she was only allowed to do stairs if we were there to help. She slept a lot and watched a lot of TV, but also made herself get up and walk around periodically, which was important for her recovery.
She had nice pain meds which she took for a few days and antibiotics. The worst part was that because of all the antibiotics she got oral thrush which worked its way down to her stomach before she realized what was happening. So for the first week she wasn't hungry and nothing tasted good. We were frustrated because she didn't want to eat anything, but we knew she needed to eat to recover. Once she called the doctor and got the thrush taken care of, it was all good.
One thing that was helpful was to have an armchair with a very straight back so she could sit in it comfortably.
After she went home she started physical therapy which was hard but also really great for her. She had the surgery in late December and in March she took her trip to Ireland and even kissed the blarney stone, which requires some serious back and neck bending.
If you want more details just mail me and I can ask her anything you want.
posted by thejanna at 10:30 AM on February 25, 2016
Friend just had a disc replacement in that same area. If at all possible it has a much better long term outcome in cervical cases from what she was told. She is doing amazingly well.
posted by fshgrl at 10:47 AM on February 25, 2016
posted by fshgrl at 10:47 AM on February 25, 2016
My husband has had 2 fusions (3 levels total) in his lumbar spine so things may be different for the cervical area but here's our experience:
1) The may only schedule the surgery for one level and see how the other level looks when they go in (that's what happened with the 2nd surgery, there wasn't enough information on the MRI to justify 2 levels to the insurance company but once they got in they saw it needed it too). You need to decide with your doctor what they should do. Our worst nightmare happened: 1 level fusion surgery with the warning that he will need another but they didnt know when. Well that when was less than 3 years later (really less than 2 but I was job searching once we found out and we decided to wait until the new job to do the 2nd surgery). If you can avoid that, I highly recommend it.
2) Back surgeries have gotten much better outcomes because doctors know alot more about spines now than they did 30 years ago. They also don't do surgery for everyone anymore and are a bit more selective so that makes a difference too.
3) With one level, you may not lose a whole lot of motion but with 2 you definitely will, but even then it may not be a ton.
4) Again, this was for lumbar surgery, but expect to be down for the count for a good while. You probably wont be able to do very much for at least 2 weeks. We decided to watch the entire Lost series.
5) I know more than a few people who did have cervical fusions that did turn out well (all the horror stories we heard were from lumbar, which didn't help us feel any better).
6) Fusions will put extra stress on the surrounding discs and vertebrae because they are having to pull more weight than they are used to. Pay very special attention to what your Dr and physical therapist say about limiting movements that will increase that stress.
7) Recovery time: (again, this is for lumbar, so...) we were told it takes 18 months for the bone to be considered done fusing. You may be faster or slower than this. My husband had his 2nd surgery about 8 months ago and is 90% fused. I think from his first surgery, it took about 12 months for the bones to fully fuse.
8) I'm sure you've heard this from the doctor but if you are a smoker, QUIT SMOKING! Of the fusions that fail, upwards of 80% are smokers.
posted by LizBoBiz at 1:54 PM on February 25, 2016 [1 favorite]
1) The may only schedule the surgery for one level and see how the other level looks when they go in (that's what happened with the 2nd surgery, there wasn't enough information on the MRI to justify 2 levels to the insurance company but once they got in they saw it needed it too). You need to decide with your doctor what they should do. Our worst nightmare happened: 1 level fusion surgery with the warning that he will need another but they didnt know when. Well that when was less than 3 years later (really less than 2 but I was job searching once we found out and we decided to wait until the new job to do the 2nd surgery). If you can avoid that, I highly recommend it.
2) Back surgeries have gotten much better outcomes because doctors know alot more about spines now than they did 30 years ago. They also don't do surgery for everyone anymore and are a bit more selective so that makes a difference too.
3) With one level, you may not lose a whole lot of motion but with 2 you definitely will, but even then it may not be a ton.
4) Again, this was for lumbar surgery, but expect to be down for the count for a good while. You probably wont be able to do very much for at least 2 weeks. We decided to watch the entire Lost series.
5) I know more than a few people who did have cervical fusions that did turn out well (all the horror stories we heard were from lumbar, which didn't help us feel any better).
6) Fusions will put extra stress on the surrounding discs and vertebrae because they are having to pull more weight than they are used to. Pay very special attention to what your Dr and physical therapist say about limiting movements that will increase that stress.
7) Recovery time: (again, this is for lumbar, so...) we were told it takes 18 months for the bone to be considered done fusing. You may be faster or slower than this. My husband had his 2nd surgery about 8 months ago and is 90% fused. I think from his first surgery, it took about 12 months for the bones to fully fuse.
8) I'm sure you've heard this from the doctor but if you are a smoker, QUIT SMOKING! Of the fusions that fail, upwards of 80% are smokers.
posted by LizBoBiz at 1:54 PM on February 25, 2016 [1 favorite]
A more general piece of advice - try not to worry too much about the additional findings on your mri report. There is very little link between current state of degeneration and symptoms. Where there is a link, it usually involves serious neurological issues (as you have described).
In fact, I was recently at a CPD course with a surgeon who said that with the exception of the relevant area, he would prefer not to let anyone know the details of their mri findings. Without specialist knowledge, and a direct relationship between mri findings and signs and symptoms, there is no way to tell how important individual descriptions are, and seeing how "broken" the inside of your neck is can lead to much worse symptoms.
You certainly shouldn't push for additional neck surgery, but it is also well worth getting a second opinion if you have any concerns.
posted by fizban at 12:44 AM on February 26, 2016 [1 favorite]
In fact, I was recently at a CPD course with a surgeon who said that with the exception of the relevant area, he would prefer not to let anyone know the details of their mri findings. Without specialist knowledge, and a direct relationship between mri findings and signs and symptoms, there is no way to tell how important individual descriptions are, and seeing how "broken" the inside of your neck is can lead to much worse symptoms.
You certainly shouldn't push for additional neck surgery, but it is also well worth getting a second opinion if you have any concerns.
posted by fizban at 12:44 AM on February 26, 2016 [1 favorite]
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