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Questions for the Neurosurgeon before I sign up for surgery

This is an interesting time, because a lot of elective surgeries are going to be postponed due to Coronavirus. I believe my option for surgery that I was given, is elective (replace 2 discs in neck due to severe and moderate stenosis). That being said, I have follow-up questions with the neurosurgeon and wondered if it is out of line for me to ask if I can due a "Teledoc" with him rather than come in for the appointment since it's not somewhere I *need* to be. As for my questions, I have the following, and wondered if anyone can chime in with some of their own that I may have missed:

1. Why are we replacing these discs?

2. Do they both get done at the same time?

3. Is this surgery considered a fix or just to slow the progress?

4. Will it keep me where I'm at today with my symptoms or will it improve/resolve them?

5. What is the success rate and your success rate of this surgery?

6. How long is recovery time?

7. What hospital is this procedure done in and how long is the stay in the hospital?

8. How long does the surgery take?

9. How long before I can go back to driving and all my other normal activities (physically active a lot in yoga, hockey, hiking, etc.)

10. Will I have full range of motion with the movement of my neck after surgery?

11. What will out of pocket cost of surgery be and how much does insurance cover?

12. Do I risk any paralysis with this surgery?

13. Do I risk any damage to vocal chords with this surgery?

14. How do I start the procedure to get this surgery scheduled?

15. How long do I have to decide if I want to proceed with this surgery?

16. Do I need another MRI if I wait too long?

17. Are there any medications necessary and how do they affect the liver? (I have liver disease)

18. Can I take my normal medications immediately after surgery is done?


This is all I have for now, please please feel free to list anything I may have missed so I can ask the neurosurgeon. 

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Comments

  • Sounds like a well thought out list of questions to me.

    Chip

  • memerainboltmemerainbolt IndianaPosts: 4,713

    There may be a few in the link below to help you out.

    Questions to Ask Your Spine Surgeon Video

    Sandra


     
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  • Thank you all for the suggestions. I have about 25 questions to ask now, but some may get answered in other questions I ask so it may reduce. I actually am able to get in with a "Televisit" because they are not taking any in person visits at this time unless it's an extreme emergency. Fair enough and makes it easier for me since I only have follow-up questions and not an urgent need to be at the office (which, depends how I feel that day, could be difficult to get to with my struggle on driving because of this). If anyone can think of any more, please feel free to add between now and Wednesday. Thanks!

  • memerainboltmemerainbolt IndianaPosts: 4,713

    luckyman316

    A couple more to add to your list.

    Will I have to wear a collar? Do you recommend PT?
    Sandra

  • luckyman316 - Just had a thought, you'll likely need clearance from the doctor managing your liver condition before this surgery.  Also, you should point out your liver condition in the presurgery anesthesia interview.

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  • Thanks @stiffneck7 and yes, I will be talking to my liver doctor in 2 weeks before I proceed with anything.

  • So I got MOST of the answers I was looking for. The neurosurgeon was impressed with my ability to ask the questions and how well thought out they were. 

    -He went over my condition, basically describing to me that YES, my spinal chord is being compressed and that is happening at level C5-6 & C6-7.

    -When asked about disc replacement surgery, I could not make out what he was saying, because at first it sounded like he wanted to do a total disc replacement at these levels when I last spoke to him but now it sounds like he wants to do a fusion at these 2 levels. But I could not make out if it was telling me the discs will be removed, replaced and then a fusion. I need to ask him more but the way he described it to me is that the procedure he wants to do, would be much easier on me. He did mentioned he'd rather do 2 levels than 4, since technically 4 solves all the problems, but he said that the other discs weren't compressing on the spinal chord so he did not feel it was necessary just yet but could be considered down the road. The surgery is considered minimally invasive.

    -I asked about my neck not having it's natural curve now, and how the surgery would be with that.. would it help or would it help restore the natural curve. He said yes, at that levels he'd be working on (which have a disc out of place) it would.

    -He was very upfront and honest in telling me that I'd probably feel like someone beat me up for 2 months after the surgery but once I hit that third month, I'd see improvements and very quickly... I'd feel best at 6 months and fully healed from the inside at 12 months.

    -He could not answer if the surgery would resolve symptoms but he did say I'd be 80% better than I am today and it could be considered a fix for the problem.

    -According to him, he performs a little over 100 of these types of surgeries a year and his success rate is considered 100% since nobody has had any complications or failures.

    -My symptoms and condition is considered progressive  so he'd consider it permanent.

    -There are no real alternatives to surgery short of "wait it out and see if anything will improve or just stay where it's at". His alternative was to present another surgery going through the back of my neck, instead of the front, which he said would be more difficult to perform.

    -Recovery time would be expected to be about 2 months, and while I'd have to wear hard collar and use a bone stimulator every day, he did say I could return to driving normally in about 2 weeks and then light activity such as a light workout within those 2 months. Full recovery/heal time would be 6-12 months.

    -Normally the procedure is an outpatient procedure but, he'd still keep me there for a 1 night stay. He gave me a choice of 3 hospitals, including the one he was most comfortable with (which unfortunately is in a horrible neighborhood). However, since this surgery is considered elective, with the recent pandemic... I could not get it done for AT LEAST a month. However, I have until August to decide on this. Once August hits, I'd need another MRI but likely this would not be an issue since my condition is severe enough to warrant one.

    -He did suggest that if the condition got much worse, he could convince the hospitals to get me in within 2 weeks should I need it and at that point it's not considered elective.

    -The surgery would take 1 1/2 hours for him to perform. I asked what other staff would assist him and he said just a physician's assistant, unless one of the other neurosurgeons was available to assist but usually they are too booked up to do so. So basically it's him and one other person. Not sure how I feel about this one.

    -Regarding range of motion, he said I would not have full range of motion but I'd have better range of motion than I have today because I'm limited on that with my current condition.

    -He could not answer the question about cost, and told me to check with their billing department.

    -There is less than an 8% chance of paralysis with this surgery. He mentioned I'm more at risk for paralysis WITHOUT surgery should I let this go too long and it gets much worse.

    -There is a risk that vocal chords could get damaged, but he said they do everything they can to try and avoid that and said going through the front will be easier to move some muscles around.

    -He mentioned no medications would be necessary after the surgery, not even pain killers, just the bone growth stimulator. He did say to stay away from the anti-inflammatory stuff (including Fish Oil) as it could slow down the healing tremendously. My concern here is the medications I am for my liver, which is known to cause some bone density loss in some patients, hence why I need to run it by my doctor.

    I think I covered everything but still have questions concerns on a couple of things. The main one being about the artificial disc replacement vs fusion. If he is suggesting a fusion now, then what made him change his mind over telling me I needed an artificial disc replacement at the first appointment. Obviously the concern of 1 neurosurgeon working on me is there with only a P.A. with him, but I have more comfort knowing the success rate is 100%. And the last concern is how I react being on medications and with a liver condition (meds are for the liver condition). 

    Anyway, lots to think about over the course of the next 2 weeks to start. I'd like to get my life back to be honest. This neck issue has been hindering me for far too long.

  • Luckyman,

    Thank you for your thorough writeup.  I’m in the same situation as I need to have ACDF at C5-C6.  I was scheduled to have surgery in a few days but it was cancelled last week due to COVID19.  Your post actually cleared up a few questions that I would’ve had.  I’m just looking forward to surgery and it can’t happen soon enough!  My level of discomfort as well as anxiety is a 10/10 all of the time.   I’ll keep my fingers crossed for the both of us.

  • So I have a following up with the neurosurgeon next week and was thinking of additional questions I need to ask him or things I need to tell him. So I wanted to write it down here, in case I missed something. If I have anything else or if I should ask anything else (I think surgery is still elective in my state and can't be performed yet), I'll add here later. Here they are:

     Present symptoms

    -Neck being extremely tight at both upper and lower levels, occurred while driving and stopped at a red light and both arms had tingles and started to go numb while I felt like I was going to pass out. Neck feels unstable if I look left or right as well, more prominent when sitting down or driving.

    - Symptom makes it feel like something is cracked at the upper cervical level. When seated at rest, I need to constantly pull my head/neck up like I am trying to decompress it to find minor relief.

    - Hearing lots of bones rattle around in neck, they don't feel "in place"

    - If driving, I can sometimes feel the legs and feet tingle as well and thus get weaker. 

    - Arms are still weak and I've have had loss of muscle since this in both arms and legs. Legs are better some days, walking helps.

    - There has been some bowel and bladder problems. Not losing control but they have occurred more

    - Lying down on my back, if I get up, I feel woozy/lightheaded and neck  goes weak and head feels it will roll off. I need to support myself sometimes to stay up (Does not happen every time but more often). I'm ok laying on side & stomach

    - Tinnitus still occurring since this started in 2013 (hence why I believe it's more upper cervical)

    - Feel like I'm too weak to support myself going up an escalator and I may fall backwards. Never used to happen before. I'm ok going down escalator.

    - Unable to sit in movie theaters, arenas or stadiums. Not only does it cause pain in the neck but it also messed with my visual perceptions

    - Visual disturbances, especially if I have to drive at night, mainly come from my neck feeling crunched and compressed while driving (Avoiding night driving at the moment)

    - Sitting down while moving my head up and down, I feel lots of snapping and popping mostly at the upper levels (tendonitis?) 

    - Pain is mostly at the upper cervical level

    Additional Questions

    - Ask Neurosurgeon to explain the procedure again and go Over MRI from Feb in Detail to explain where problems are and why he's suggesting these levels

    - How much progression do we see from a 2015 MRI to a 2020 MRI?

    - What would you recommend if this was a family member, wife/gf, etc?

    - Bring up issues with Upper Cervical, as they seem to be causing me problems as well

    - Any additional imaging or testing we should do in case something was missed on the originals?

    - Is there any non-surgical treatment I can attempt to improve this (what's recommended? Dis Compression? Bracing?)

    - Will I be fitted for a neckbrace before the surgery?

    - Do I need to donate my own blood? If so, why?

    - What are the qualifications of the physician's assistant helping?

    - What side effects or potential risks/complications can I experience from surgery

    - Why are we only fusing 2 levels?

    - Why choose a fusion over ADR?

    - What side effects or potential risks/complications can I experience from surgery

    - Is this surgery basically decompressing the discs?

    - Will the fusion lead to degeneration at other levels? What are the long term consequences of the procedure?

    - Are you cleaning out the arthritis too and if so, only at those levels?

    - Will it improve things or just "leave it where it is today"?

    - What if you get in there and see something different or worse than you expected or more than the MRI showed? What will be done?

    - What if something is cracked or broken that did not show up on any imaging? What if it's very 

    - May a friend or family member spend the night with me in the hospital?

    - How do you manage the pain in the hospital?

    - Will I need any special beds or chairs after surgery?

    - Who would you recommend for a second opinion outside of the practice?

    - Who can I call if I have questions post surgery and what is the process for communication?

    - Can I ascend a flight of stairs after surgery and if so, when could I start doing that (Important to me because my bedroom is upstairs and I live alone)?

    - When can I resume normal household chores (cooking, dishes, laundry, taking out trash) and what kind of help will I need after surgery?

    - What symptoms after surgery would warrant immediate medical attention?

    - How soon after surgery can I start Physical Therapy?

    - How many times will I need to see you after surgery?

    - How long will I need to be out of work, especially for a desk job where I can work from home if needed?

    - When could I return to more strenuous activities such as playing ice hockey/gym

  • luckyman316lluckyman316 Posts: 41
    edited 05/22/2020 - 3:48 PM

    Update here after my follow-up questions, there was a lot to cover but I got all the answers I needed. 

    -First off, at this point, my surgery is no longer elective. It's needed and while it is not considered an emergency, it is considered an urgent one within these next few months.

    -I would not be able to get in though until June or July due to how booked out they are/

    -He went over my MRI in detail and said every level of my neck has a herniation, some worse than others. But where he drew a line seemed like from C3 and below that, so I have to wonder if he meant from C3-C7 I have herniated discs.

    -He didn't have any prior MRIs from years ago since he's a new doctor and said having that won't change anything. Fair answer.

    -He would absolutely suggest this surgery to a family member (I'm sure they get this a lot)

    -I brought up issues with upper cervical, but the concern seemed to be more from C5-C7 based off the MRI since it was compressing/pinching the spinal chord and probably causing damage to it.

    -No additional testing they can do at this time but if I get to August, probably another MRI to get the latest is needed. What he has now is all he needs. 

    -Only non-surgical treatment he could suggest was like 2-3 months of PT to help strengthen the neck and more posture correction, but that won't fix the problem and only surgery will.

    -My symptoms are 100% being caused by this problem. While he said he can't promise symptoms will all go away, he said it will definitely improve things.

    -I don't need to donate my own blood.

    -The qualifications of the PA are a little unclear. Sounds like 2 years of schooling and they have worked with him for years, but there wasn't much info on that.

    -No fitting of neckbrace here, what they have is fairly standard in sizes

    -Risks or complications of surgery include risk of any surgery like you can have a heart attack and die, get an infection and since this is the spinal chord, paralysis if something went wrong.

    -He's only fusing 2 levels because doing more would be a very serious undertaking (not sure if for him or me though). As far as ADR, he had mentioned he does not do ADR at these levels as it's not recommended and won't fix the stenosis. When I spoke to another neurosurgeon a few weeks back (over phone since appointment was out of network and over $500 out of pocket for me), he mentioned the same but he also mentioned doing an ADR at levels 3-4 but posterior. Wonder why this one did not suggest it?

    -The fusion could lead to more degeneration at other levels, and those already started for me anyway. So more surgery could be needed.

    -He won't over how they will be removing the discs, cleaning off the arthritis, putting bone back (with cage and plate) etc. 

    -He will only be addressing what is being done at those levels. They won't even look at the others. But if they saw something worse, they would "take care of it"

    -No friends or family members can spend a night with me in hospital

    -Pain in hospital gets managed with medication & he said I won't need any special beds or chairs for at home (Though many people are suggesting a recliner to make it easier)

    -I can definitely ascend a flight a stairs after surgery but don't do it like 30 times a day and try to limit it at first.

    -Try not to do any major household chores for 2-4 weeks. He basically starts lifting the 5lb restriction between week 4-6 and then up to 20lbs and then week 8 a little more and then by 3rd month they get into more, etc.

    -PT could probably start after 6 weeks depending how I am doing

    -I'd see him at the 2 week mark, 8 week mark, 3 month mark and sometimes at the 6 month mark

    -Any emergencies go to ER and an emergency would be if I can't breathe or if I went paralyzed. Any other concerns, call the office and they put me through to someone. It's their procedure.

    -I'd be out of work 2 weeks but that depends on healing. Some folks do return earlier, some later.

    -Strenuous activities like sports could possibly be returned to after 3 months (I found this a positive)

    -He did recommending someone for another opinion when asked, said that normally patients that go to them never have issues as well so they never have to see patients from that practice but have seen patients from others.

    Anyway, I have YET to schedule the surgery. That's on me, but I have to wonder if I should seek a 3rd opinion just to be sure that a 2 level fusion is enough or if I really need to be looking at more for a complete fix. I've never had a true major surgery in my life so it does get scary for me. I also need to prep with asking for help from friends, family, getting all the stuff I need, etc. Anyway, wanted to share the answers I got here. I'll keep you guys posted!

  • Sounds like he answered all your questions which is good. I had C4-C7 surgery a little over 2 years ago, if you think of anything else I will be happy to tell you my experience.

    Chip

  • luckyman316 - The answers that your possible surgeon gave you sound pretty much like what I was told and experienced with my three single level ACDFs over 11 years.  My surgical fusions were at C3/C4, C4/C5 and C6/C7.  My body auto-fused C2/C3, C5/C6, C7/T1 and down through my upper and mid-thoracic.  My cause was severe whiplash that degenerated the facet joints. From taking to people I know that have had surgery for spinal stenosis, I don't know anyone that had an ADR implant.  Also, from my experience, I think this surgeon is being a bit over optimistic when me makes comments that you will likely be able to resume strenuous activities post-op at three months.  Maybe he has different techniques than I experienced, but my guidelines were a lot longer.  Each case is different, because via follow-up x-rays, the surgeon can pretty much determine how the fusion is progressing.  Also, please be advised, surgery from the back of the neck most often has a lot longer recovery time. 
     Whatever path you take, I wish you all the best.

  • @challenger thank you! I did miss 2 things with him that I meant to ask, maybe you have answers based on your experience. What are they measuring pre-op blood tests to make sure you are ok for surgery and what would disqualify you?

    I think the other issue I'm concerned about is if I have low bone density and what occurs with this if I'm on medication that may be causing me bone density loss (not confirmed yet but it's been known to). Doubt you know an answer to this but I fear a fusion ends up failing due to this.

  • @stiffneck7 thanks for sharing here. I'm concerned the symptoms I'm experiencing are more from upper cervical than lower, but since the MRI is showing more of the damage at lower that is what I am addressing first. I see you mentioned C3-C4, what symptoms did you experience from those? Do you recall? And did the fusion help all of this?

  • They check several things with the blood test, I don't know all the specifics but I know they check blood sugar and TB, the doctor told me some of the things that they looked at, but most of it is over my head.

    I also had to have several x-rays before surgery to look at bone density, I think those are a first step and if anything looks bad there is more testing, but everything looked fine on all of my scans and I didn't need anything further.

    Chip

  • I would try the PT course while you wait for surgery.

    I also had several herniated cervical discs, with 1 of them pressing on the spinal cord. Only that 1 was treated surgically. I am now 3 months post op and am having a lot of problems with the other levels. The stress has increased on the other levels because there is now 1 less level to do the work and take the load. And there is almost nothing I can do to treat them. Because I need to be careful with the 1 level that has had surgery and is still healing in. I feel I am now doomed to have more and more surgery over the next years.

    I wish I would have done PT before the surgery. The other levels would have been in a better state and more able to take up the extra stress. And who knows, maybe the 1 level that was pressing on the spinal cord might have been better also with PT and maybe no surgery would have been needed. I will never know for sure.

    Also, your surgeon said:

    -I'd be out of work 2 weeks but that depends on healing. Some folks do return earlier, some later.

    -Strenuous activities like sports could possibly be returned to after 3 months (I found this a positive)

    I got the same advice. And was out of work for 2 months. I only started working again because I feared loosing my job. Even after 3 months I do not feel ready to work (deskjob). And returning to sports after 3 months... I can't even sit on a bike and look straight forward. Let alone ride it for a few meters. All I can do now is walk. On flat surface. I tried a 8km hike last weekend with 200 meters of climbing and the pain was horrible.

    Do the PT and hope for the best. Good luck.

  • @OswaldOtte thank you for sharing and for telling me a little of your story. I've already been through 3 months of PT with very little relief that would last maybe for a few hours. Chiropractor care which would last 2 days or so, but got me very sick. No medications or steroids but I was diagnosed with the start of cervical myeolopathy with a neurosurgeon (a spine specialist also said no on another opinion I had). I can assure you, my life has NOT been the same since my neck issues. My latest is I'm not able to drive for long or be a passenger in the car now because of the weakness coming from the neck and I have no support there, so long trips are a big no no and even a 10 mile ride as a passenger the other day was terrifying for me. If I ever need to get back into the office, I won't be able to right now for work because of how bad it is. Walking has been ok for me but other activities I do struggle with. Playing sports is not even a thought right now for me even before a surgery. I've been told my a neurosurgeon that my surgery is now urgent after he said I could try and wait. I could absolutely try PT again, but it may be very temporary for me.

    Like you, I have other levels above that have minimal stenosis and herniated/bulged (2 of them) already. I'm actually concerned with those and I'm afraid they may already be getting worse without surgery and with the little PT I can do at home right now. I also feel like my neck is not stable due to all of this, so I pray the surgery will help with that along with the strength... especially since the 2 levels below are listed as moderate and severe stenosis (I'm very shocked with a spine specialist sees severe stenosis and doesn't suggest surgery to be honest)

    Anyway, thanks for sharing.

  • I'm back here for more Q&A. First off, I have my surgery scheduled for end of July. 2 level fusion C5-7. I've gotten a few opinions (and will get 1-2 more) but almost everyone agreed that the C5-7 must ABSOLUTELY be addressed first and the ACDF there was the way to go. So I am sticking with the first surgeon who was taking this approach as they have seen me longer and already has a surgery in place for me. That being said, I did see an Orthopedic Spine Specialist who told me I can absolutely wait this out.... but every neurosurgeon thus far as told me this is an urgent surgery. Being that I've gotten symptoms of myelopathy that are not resolving at all, it's time to do something sooner rather than later. 

    I have a few goals in mind, one of the main ones clearly is making sure I can walk, talk, sing, eat, etc. But one of the first main goals is to be able to get back to driving like a normal human again, something I have been struggling with since they started 7 years ago (and I had no idea this was my problem them, I actually thought it was because of a chronic illness I discovered along the way). This past year has seen myself struggle and get worse before my very eyes. I've pushed through enough and now, I will not be pushing any more. While I understand this is to stop the progression of the disease, I'm PRAYING, that I regain a good amount of function back over time.

    I've never been through a surgery in my entire life, but I do have questions and more questions. So here are more for the Neurosurgeon I'll be seeing next week and then July will be running around for all pre-Op stuff after that:

    1. I have a very big herniation at C3-C4, this has been there for at least 6 years and not getting better. I understand the C5-7 surgery is what is being done as it's considered severe, but what can we do with this as well (especially since it should it impinged on the spinal cord 6 years ago and it feels like it's about to break or crack on me now).

    2. Will I be given a bone growth stimulator after the surgery?

    3. How will my medication for a chronic illness, which may possibly cause bone density loss, affect the fusion?

    4. What will be put in between my vertabrae? Donor bone/cadever bone? My own bone? Other material?

    5. Why is my post-op visit 2 weeks later scheduled as a virtual visit? How are you seeing any x-rays that way to look at the fusion or removing any stitches this way?

    6. What if I need another surgery such as a jaw surgery? 

    7. What can I do before PT to help speed things up a bit with the healing and fusion (any light exercises outside of walking?)

    8. I'm noticing lots of posterior osteophytes on my report, yet we are going with an anterior approach. How do these get addressed with an acdf?

    9. I'm in the middle of a dental procedure for a dental implant. It may be a few more months before I finish this. Is this ok to still do? (The tooth is already pulled)

    10. Since we are so close to the 6 month mark of the last MRI I had, could we do a MRI or CT Scan before the surgery to make sure nothing else is caught at this point?


    Anyway, I'm sort of trying to push for him to address multiple issues, because the suffering is unbearable at times. Most of my days are working from home and just sleeping now. I can barely get out like I used to for sure as it's a major struggle over all. I'm not even sure how I'll make it to the hospital feeling this way (or make it make it back if the surgery doesn't ease this).... thankfully it's not TOO FAR but it's still quite a ride for me after all said and done. I'll update as more comes along the way.

  • Adding to this:

    11. What is foraminal stenosis and does this get addressed during an ACDF?

    12. Can I get a DEXA scan done so we know what bone density we are dealing with?

    13. I clench my jaw when I'm asleep, will this be a concern during surgery?

    14. Am I going to have a catherer put in (I'd prefer not to)

    15. Even though it's not on my MRI or clear, do we see something at T3-T4 level that is alarming?

    16. What is flattening the ventral thecal sac mean and the difference between flattening and flatten?

    17. Why are we opting for ACDF over a posterior laminoplasty?

    18. When you open me up, are you seeing the entire cervical spine or just the areas you will be working on?


    Discuss what I want to return to after surgery:

    Basics of Breathing, Eating, Walking, Talking almost immediately

    Get all the strength back in my body, legs & arms

    Driving, I need to be able to get back to driving normally and I'd like to be able to take a cross country road trip if possible one day

    Ensure I have good range of motion looking up, down, left & right without any issues

    Flying, travel,  yoga, going back to attend events at stadiums and arenas, playing ice hockey

    I think I have everything covered for myself. I want to make sure this surgery and any other they do, goes as perfect as possible.

  • memerainboltmemerainbolt IndianaPosts: 4,713

    luckyman316

    I must say, your list of questions for a neurosurgeon has surpasses our list. With your permission, I would like to bookmark your thread for other members to read in the future.

    Thank you,
    Sandra

  • @memerainbolt feel free. The neurosurgeon has answered all questions without hesitation. I'm still scared and nervous about this surgery. I'll share some answers I had today.

  • memerainboltmemerainbolt IndianaPosts: 4,713

    Thank you so much. Good luck today!!

  • Based upon everything I have read, here is more information. Please remember, this is only specific to my case and nothing else. Your situations may be extremely different:

    -I brought up issues I'm having with C3-C4. I was told it's a big herniated disc but my C5-C7 is more of a concern/problem and with the ACDF surgery there, some time and PT then this may be able to be solved. My pain level is an 8 or 9 around here and I actually feel like there is a bigger issue that has not been found. Explained it sounded like something was dried up and crumbling away, and was told it sounds more like a bone issue or possibly muscular problem. I'm still convince it's the disc that is now deterioating. We discussed what else can be done here via a surgical approach. They would opt against an artificial disc because they are not FDA approved and also said a fusion may be bad so soon here, especially with a fusion at C5-7, as both fusions could put strain on C4-5 which already is a disc bulge with minimal stenosis.

    -I will indeed be given a bone growth stimulator

    -Bone density loss is a tricky situation, but they try to use the smallest screws possible with the hardware going in, so the screw doesn't break apart the bone or come out should extra bone density loss get caused. Suggested I stay on Vitamin D and Calcium supplements as much as possible.

    -I forgot to ask about what kind of bone goes on there. I am going to send a follow-up there since it's only one question, but I seem to recall him saying it could be a donor bone or a some other material.

    -Post-Op visit is virtual just to see how the wound is healing. Stitches are self desolvable. No X-rays done this soon. They won't expect to see a fusion 2 weeks into the process. Usually he likes to start to check at 6 weeks and again at 3 months and further out if needed.

    -If I needed a jaw surgery, I'd be ok to get it.

    -Try to stick with walking for exercise. Don't do anything for PT until I get clearance from him. Was told he normally doesn't refer people to PT but for my case, he wants to since I've set a lot of high expectations.

    -Posterior osteophytes are bone spurs at the back of my vertabrae. It's the vertabrae's way of trying to heal itself. However, these bone spurs are pressing against the spinal cord now. Their goal with an ACDF is to remove the pressure off of the cord from the compression from these bone spurs. Their hope is that the heal occurs faster there as well. They don't clean out ALL the bone spurs but sounds like some do get cleaned out. The hope is that the bone spurs don't grow.

    -The dental procedure needs to be put off for a few months until after the surgery is done. They don't want any of the bacteria from wounds and other areas to cause a major problem during surgery.

    -No new MRI scan needed since I'm still within 6 months from the time I had my last one. Still would like one myself though to rule out any other major issues or anything that has progressed.

    -Foraminal stenosis is the narrowing of the space the roots and nerves are coming out of. This does get addressed during the operation.

    -They won't do DEXA scan and would refer me to a specialist for that if needed. Being that I know I have low bone density, they said my last one probably would not have changed by much and that if they measure the lumbar and femur, which they do, the same can be assumed for the bone density in the neck.

    -I will not need to have a catherer put in (thank goodness!)

    -Jaw clenching won't affect the surgery at all

    -He glances at T3-T4 and said it was hard to see if something was there. It looks like there could be something small but it was too cut off at that point to tell on the MRI.

    -Flatten and Flattening mean absolutely the same thing. The ventral thecal sac is the stuff around your spinal cord

    -I did not even mention the posterior laminoplasty. I actually want to stay away from it after hearing recovery horror stories from some.

    -They are only going to see the part of the cervical spine they are working on, and not the rest. This means this is probably going to be a very minimal invasive surgery. This also disappoints me a bit too because if there are problems at other levels, they may not see it, and I'd love for them to address if needed. They do an x-ray when I am on the operating table though, so maybe that can catch something.


    I believe I covered it all. I made it clear I wanted to return to a lot of things, so set my expectation bar high from this surgery. His response was that a lot of what I'm saying was difficult anyway prior to surgery, but he still thinks he can get me 80-85% "better and there" after all said and done.


    I'll follow up with how I'm doing after surgery is done end of July. He did say that we all hope to get out of surgery somehow and that is his hope for me, that we have a miracle that doesn't require me to have surgery. I still do have the option to tell him "Let's not proceed with surgery" up until the point when I am knocked out from the anesthesia. 

  • Follow up here for myself. I'm still going to seek 2 other opinions, from surgeons who are actually pushing the Mobi-C artificial disc replacement. I want to see what they say before I go in for surgery there. I may feel more comfortable knowing I can get C3-4 done with an artificial disc. I am presenting many problems up at that level, so I believe it's a two fold issue for me right now that absolutely can and should be addressed in 1 operation. I'll be bringing the same questions to those surgeons depending on what they tell me to do. I've even thought about bringing myself to the ER a few times because symptoms and pain have become unbearable at times. Last night was one of those times.

  • memerainboltmemerainbolt IndianaPosts: 4,713

    I have a question. Why do you want the Mobi-C artificial disc replacement? Just curious.
    Sandra

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