Surgery for merely neck pain?--Dr Hoogland

[Lee]

Hi all

A whiplash a yr ago left me with C5-6, C6-7 protuding into my spinal chord by 50%. No shooting or burning pain down the arm despite the bad situation as shown on MRI. I have tightness/ soreness in neck,shoulders,head,upper back. Transient numbness in fingers now gone. .

I read with deep empathy the immense pain my fellow spinies are undergoing and wonder if anyone out there has gone for an operation just out of a nagging "pain in the neck" and how effective it is. I read that surgery is most effective for alleviating symptoms from nerve compression and not as suitable for treating neck pain alone. I have visited Dr Hoogland at Alpha Klinik (in Apr 07) who advised percutaneous nucleotomy for 2 levels.

My main concern is the chord compression which means I cannot afford to fall again though Dr Hoogland said research has proven a large percentage of people taken off the street has chord compression without knowing and continue to lead lives normally. He thinks that this shouldnt be a concern(?!)

In addition I am worried that if i leave my problem unattended, it might lead to bone spurs or further degeneration, by then minimally invasive method would not be possible. Especially since the entire system is now unstable. Dr Hooglands' view is I should not decide on surgery based on this as no one knows the future. Only operate if the pain is unbearable. Problem for me is the pain is very bearable provided I dont have to work but I would have to go back to work at some point (long hours in front of computer) as I have been on medical leave for a year! I am very reliant on my twice-weekly chinese massage.

I live in Singapore. Singapore professors have advised fusion to stop movement and hence all pain but I am against this method since it would put pressure on my other levels which are already showing sign of degeneration though I am only 28. I belong to the category where my pain is not bad enought to warrant the risk of an operation (1 in 1000 for death/ paralysis risk) but it does interfere with the quality of my life.. hence i feel i ve been living in limbo for a good one year... a recent MRI shows my condition is the same... throwing me back into limbo..

Would appreciate any advice/comment re how effective is a scope surgery in treating pain in the neck only, the danger of leaving chord compressed and anyone who has been operated on by Dr Hoogland or done a cervical scope surgery?

regards,

[KL Aguilar]

Dear Lee,

Ahtough you sent me a PM, I am going to try and answer your questions here because the information might be helpful to others.

First, I am going to suggest that you post more specific info from your MRI so that others with similar issues can share their stories or compare their symptoms with yours.

Dr. Hoogland is very well respected in the world of percutaneous or endoscopic discectomy.

Although he stated that the cord compression shouldn't be a concern to you, perhaps he meant that yours was not so severe as to be a major concern although 50% sounds very severe--that is another reason to post specifics from your MRI. My MRIs state the diameter for the spinal cord space and my worst level is compressing the spinal cord to 7.9 mm, while the minimum space needed is 10 mm.

As for whether or not you should have surgery, only you can decide that. However, in my personal opinion, pain should not be the only determinant for surgery; prevention of spinal cord damage is more of a reason.

In regard to which surgery you should be looking at, my belief is that one should have the least invasive surgery that is effective for the situation.

I had a three-level cervical endoscopic discectomy (basically the same surgery as Dr. Hoogland described to you) in 2000. It resolved most of my symptoms most of the time; a few times each year, I had bouts of muscle spasms that were relieved with a few days of prescription muscle relaxants. However, I had a bone spur at one level that was left in place and that bone spur has continued to grow. I was able to work and live a relatively normal life with few restrictions.

Six years and seven months later, I suffered a new injury, re-injuring the same three levels plus one more. I was in excruciating pain, to the point that simply walking a few steps made the shoulder pain much, much worse; the slight movement of my arm felt like a knife being dug in. My left hand suffered wrist drop and claw hand. I could not raise my wrist or use my fingers at all. The wrist drop and claw hand slowly resolved, but more than one year later, my left hand still does not function normally.

If I were in your exact situation, I would do the following things:
1) find out exactly how severe the spinal cord compression is and how much you are at risk for cord injury (some of this can be determined from the MRI
2) get a second opinion from someone who does alternatives to fusions and fusions (most spinal surgeons only do fusions)
3) continue to do research on your own and learn as much as possible about your specific problem
4) research all your surgical and non-surgical options
5) assuming that your symptoms don't dramatically progress, allow yourself the time to make a truly informed decision prior to surgery.

Disclaimer: I am not a medical professional and what I have advised is based on my personal experience as a cervical patient.

[Lee]

Hi KL Aguilar

Thanks for your reply. Is discectomy the same as nucleotomy? My C6-7 is 6.3mm and C5-6 9.4mm

What symptoms did you have when you did your surgery in 2000? Was your compression effectively relieved as shown on new MRI? Did your discs grow healthy again (from black to white on MRI)? Dr Hoogland's opinion (6 mths ago) is that no one can tell for sure what kind of damage a compression on the chord will lead to in future.. As of now since I dont have any weakness, gait problem etc.. I can wait.. althou knowing that my chord is under constant pressure worries me.. and is frustrating..and im worried that when symptoms do surface, they might be irreversible..

[KL Aguilar]

Hi Lee,

I do not know enough about nucelotomy to answer your question, but I believe there is a detailed description on the Alphaklinik's website. A discectomy is when part, or all, of the disc is removed. In a cervical endoscopic discectomy (CED), approximately 10% is removed.

Prior to the three-level CED, I had constant shoulder blade pain, pain at the base of my neck, pain that radiated down my left arm, occasional "electrical shock pains" down my left arm, frequent numbness and tingling in my left hand, and occasional numbness and tingling in the right hand. Eight weeks or so post-op, almost all of my pre-op symptoms were relieved, except for some numbness in my fingertips and occasional bouts of muscle spasm pain in my shoulder blades.

I cannot say for sure that the compression was relieved as shown in a new MRI since I did not have one for more than six years--my insurance refused to pay for a new MRI as I had no ongoing symtoms.

I do not believe that discs will become healthy post-op. Black discs indicate that the discs are becoming dessicated and are degenerating. I have no idea what operation would fix that--nothing that is currently being done unless it's brand new. The purpose of endoscopic or percutaneous surgery is to remove the part of the disc that is compressing nerves or the spinal cord, not to repair the disc itself.

As for the space for the spinal cord (6.3 mm at C6-7 and 9.4 mm at C5-6), do you know what is reducing the space? Do you have a herniated or bulging disc that is pushing against the spinal cord or do you have bony growths that are reducing the space?

[Lee]

Hi KL Aguilar

I believe it is my herniated discs causing the compression as no doctor has yet mentioned bony growth though my MRI report did mention "spondylosis". Can you tell if there is bony growth just from the MRI pictures?

Can i ask what kind of pain you were experiencing in yr neck and shoulders? I would classify mine as more of "nagging discomfort,tight,stiff,sore,very tired" although my chinese massage therapist has told me from her experience that I have considerably high threshold of pain. Did your pain go away slowly after the op or you experienced immediate relief after surgery? Were you under general or local anaes? How often were your occasional bouts of spasms after that?

You mentioned you underwent surgery for "prevention of spinal chord damage". Since your symptoms do not sound compelling, dont you think it is kind of a pre-emptive action? This is something i think of a lot. Now my symptoms though nagging and frustrating are still bearable. But I am thinking long term, to prevent any irreversible damage since my chord is badly compressed though Dr Hoogland has advised otherwise 6 mths ago. That surgery should only be done if i really cannot take the pain.. I hv sent Alpha my latest MRI and still waiting for their diagnosis.

What led to your new injury?

[KL Aguilar]

"I believe it is my herniated discs causing the compression as no doctor has yet mentioned bony growth though my MRI report did mention "spondylosis". Can you tell if there is bony growth just from the MRI pictures?"

I personally cannot tell if there is bony growth, but any doctor or radiologist can. The medical term for bone spurs is osteophytes. Spondylosis is not bone spurs.

"Can i ask what kind of pain you were experiencing in yr neck and shoulders? I would classify mine as more of "nagging discomfort,tight,stiff,sore,very tired" although my chinese massage therapist has told me from her experience that I have considerably high threshold of pain. Did your pain go away slowly after the op or you experienced immediate relief after surgery? Were you under general or local anaes? How often were your occasional bouts of spasms after that?"

The pain was usually the way you describe: nagging discomfort. Sometimes others could feel a knot. Sometimes the pain felt as if something was forcibly pushing into the blade, almost knife like.

All the pre-op pain disappeared immediately following surgery although I suffered discomfort after the surgery, mainly a feeling of a sore throat, as if I were getting a cold. I was under various amounts of local anaesthesia: sometimes I was more or less asleep and then they would call my name and ask me questions. The occasional bouts of spasms happened between 2-6 times per year and sometimes seemed to be related to things I had done (long car rides, more exertion than normal, stepping off a curb wrong and suffering a severe jolt.

"You mentioned you underwent surgery for "prevention of spinal chord damage". Since your symptoms do not sound compelling, dont you think it is kind of a pre-emptive action? This is something i think of a lot. Now my symptoms though nagging and frustrating are still bearable. But I am thinking long term, to prevent any irreversible damage since my chord is badly compressed though Dr Hoogland has advised otherwise 6 mths ago. That surgery should only be done if i really cannot take the pain.. I hv sent Alpha my latest MRI and still waiting for their diagnosis."

I did not undergo my first surgery for prevention of spinal cord compression although that was part of the reason. I had surgery the first time mainly because I was unable to live a normal life. At times I was in too much pain to function well at work and at home. I was the sole support of four people: myself plus three children. I could not hold it together at work and do a good job. I came home and basically just tried to pull myself together for the next day. This time I will be undergoing surgery because 1) I am at too much risk for a spinal cord injury, 2) because the doctors will not release me to go back to work (again because I am at too much risk for a spine injury), and 3) because my left hand does not function normally. I was very lucky to have my "claw hand" resolve on its own; two surgeons told me it wouldn't. If anything else happens, the claw hand is likely to return and may not resolve.

"What led to your new injury?"

I had several heavy boxes of teacher editions in the back seat of my car. The one I needed was in the middle. I lifted the box over another one and turned to place it in a cart. As I bent down, I felt a searing pull from my neck to my shoulder blade. At the time, I did not realize how badly hurt I was, but within a week I was in excruciating pain, and about two to three weeks later, I woke up with my hand in a claw.