Self fusing discs-surgery or leave them?

[Katie]

Like most patients, I have conflicting opinions from several surgeons.

My C5/6 level is severely compressing my spinal cord, and the 4/5 is bad but not as severe. Hoffman and hyperreflexion tests are strong and positive on both sides, which confirms compression of the cord. Bladder & bowel problems have been getting worse and I have weakness on the left side, with some clumsiness and dropping things, plus numbness of my left arm and hand when walking.

Three doctors have said this is an emergency situation, and requires urgent surgery to prevent quadriplegia if I fall or am in a slight accident at any time.

The fourth and last one said that the others were over reacting and that it looks like the 5/6 may be starting to self fuse and the best thing would be to leave it alone, at least for a year. That any damage done to the cord is not going to get better, but will not get worse either. He also thinks that the 4/5 level is not bad enough to warrant surgery.

My question is this: If the 5/6 is indeed starting to fuse on its own, even slightly, how difficult and safe is it to break that fusion and do ADR or a man-made fusion, restoring the height to where it should be? He said the vertebrae are almost bone on bone. The discs are most definitely badly herniated and there are also osteophytes impinging on the spinal cord.

A new MRI was done last week and may change his opinion, but it looks like the compression is even worse now. The MRI they all used for their opinions is almost two years old. I have sent out the new MRI and will wait to see what they all say now.

Aren't most bad levels often very close together or almost bone on bone? My lumbar levels look almost as bad and he is happy to do ADR/fusion there, as is everyone else. Here's the kicker....the last surgeon is the only one I have been able to see who is covered by my insurance. Everyone else will require me to win an upcoming insurance appeal as I cannot afford their costs, at least not for five levels.

[fuzzy]

2 Answers for you from what I have learned.


Self fusing:

I was told the same thing about my low back years ago. Live with the pain, the disks are so far gone the vertabrae will autofuse soon and then the pain will go away. Just don't worry about the neurological symptoms, the neurosurgeon told me. I felt I was too young to suffer with this kind of disabling pain that long hoping it would autofuse one day! I waited too long due to this guys comments! When the day came I was also told the same. Do lumbar first, let heal and then see how much is left and decide on neck surgery. Well, I need it!

Myelopathy is concidered serious and at the same time you do have a chance for at least some improvement of your neuro symptoms by surgical decompression. In many studies I have read it is recommended prompt surgery in this type of case. Here is one:

Cervical Spondylotic Myelopathy: Arguments for Surgery

And another:

Cervical Spondylotic Myelopathy Requires Prompt Surgery

One you are self fused you can't undo that as far as I know. Then it would be a procedure to make room for the spinal chord as needed.

If the disks are pushing on the spinal chord they need to be removed and replaced with whatever something. Hopefully adr, otherwise fusion.


Oh I didn't read you whole post. You say your insurance will not pay for "emergency treatment" with any of the other surgeons? And you have to file appeals? Even for a decompression and fusion procedure? Can you try to find the right doctor that is part of your network and offers you the right treatment? Even out of network you should be able to ge coverage for a nessesary treatment especially of it is not a multilevel ADR "experimental procedure".

[Katie]

Hi fuzzy,

I want to reply to this:

"Oh I didn't read you whole post. You say your insurance will not pay for "emergency treatment" with any of the other surgeons? And you have to file appeals? Even for a decompression and fusion procedure? Can you try to find the right doctor that is part of your network and offers you the right treatment? Even out of network you should be able to ge coverage for a nessesary treatment especially of it is not a multilevel ADR "experimental procedure"."

I am in Canada. Perhaps that explains a lot ;-) The surgeon that will do my lumbar but not my cervical is in another province. Because he is in the same country, my province must pay for it.

Unfortunately I have been unsuccessful in trying to find a surgeon who will treat me in my home province for over two years. The only two I saw way back when said that they see half a dozen like me every day, and to go home and take more pills. Period. Everyone else has a wait list over a year long and will not accept new patients.

The other surgeons who have strongly recommended that my cervical needs immediate surgery are from out of the country. One is in NY and the others are in other countries. But they all agree on my neck. Only my Canadian doctor is not worried. ????

So no, I am not able to get treatment unless I pay for it dearly. In order for my government insurance to pay for ANY out-of-country back treatment, be it ADR, fusion or whatever, a doctor from my province must first say that it is necessary surgery to prevent loss of life or tissue damage, AND that it cannot be done in my province 'in a timely manner'. Timely is not explained. Six months, ten, a year? No one will say.

So I am stuck between the devil and the deep blue sea. Either I accept the neighbouring Canadian doctor's opinion and have the lumbar fixed but not the cervical, and risk quadraplegia, or I hope and pray that I can win my appeal for out-of-country funding in a month or two and go to NY and get several hybrids done right away. I can't even get fusion, even if I wanted some. No one will see me, and the ones that did pushed me out the door with no treatment plan.

So far there is no in between. I have been fighting for this for over three years, before I knew what an ADR was. I just knew I hurt like he** but could not get either surgery or pain medication for a long time. Even when the 2007 MRI came in, the home provincial doctors did not take it seriously. The new MRI from last week looks much worse. I sent it to the NY doctor to get his reaction. He did not want me to go home without surgery several months ago, from looking at a two year old MRI. I'd like to be a fly on the wall when he opens the new one.

Fuzzy, thanks for all the feedback and links. It really helped.

[dshobbies]

Katie, I hear you.

Sorry to step on your post but I'm so frustrated I could spit I've been fighting with my insurance company for 2 months now over a prescription. It was originally the pharmacies fault because their 'technician' inputed the wrong doctor when entering it into their computer but despite my repeated phone calls, no one gave a s--t. Then, on Friday I got a letter from Blue Cross asking me why I'm not taking my drugs as prescribed by my doctor - via refill history.

I know you're in Canada and your health care system is difficult to maneuver but ours suck too! And I do believe if Obama gets his way it's about to become worse

Thanks for letting me vent and I'm really sorry you're getting the MRA (medical run-around). Money solves so much but no one has any anymore, if ever. Perhaps we should all move to Argentina!

Good luck, I know your decisions are difficult, Dale

[JKDE302]

this thread is very informative....thank you

[Eddie G]

My Prodisc at L4-L5 is autofusing. A doctor at Johns Hopkins offered me injections and/or surgery (more of the same crap that hasn't helped me yet). My NY Surgeon doesn't want to keep cutting me open. My last surgery in November was awful and I don't want to go through any more surgeries. I'll have to live with the pain and hope for some miracle medical breakthrough from our miraculous medicinal massive.
Good Luck, I know how you feel!

[Katie]

So Eddy, they tried to do a fusion and it didn't work? Can you give me a few more details please? What do you mean that the last surgery was awful?

Sorry that you are in such misery.

[mmglobal]

I don't think there is any 'one size fits all' answer to most spine questions. I've seen literally dozens of adr procedures on completely collapsed disc spaces, including many autofusing segments. There really isn't any 'breaking of the fusion. The annulus and ligaments become more and more calcified, showing the autofusion halo on xray. The more calcified, the less flexible, but it's really not like solid bone and is not immovable (in the cases I've seen.)

These types of surgery require experience, finesse and patience on the surgeons part. It may be much more dangerous to 'brute force' your way to enough disc space to accomodate ADR or fusion cage; but much less dangerous for someone with a lot of experience to carefully release just enough of the annulus and ligaments necessary to achieve the appropriate disc hight, while preserving the necessary stability of the system.

Mark

[Katie]

I was assuming that the surgeon was also worried about causing a lot of new pain from stretching the ligaments, etc. so much? That is called distraction pain, isn't it?

Mark, thanks so much for the clarification on that. I thought that discs that auto-fused would be pretty solid. I'm glad you straightened that out for me. How often does that pain occur and how long might it last on average, taking into consideration that everyone is an individual. More levels done = more stretching and pain, I would think.

And Eddie, I see that I misquoted your post. Your Prodisc is starting to fuse? How is that possible? Is there an excessive amount of bone building up all around the disc so that it isn't moving like it should? I hadn't heard of that complication before.