Herniated cervical disc - Oh my!
Last month I had an appointment with a spine specialist to see what might be done about the herniated cervical disc diagnosis that was made from the MRI of my neck. This doctor seemed like a nice guy, and after about 10 minutes and $280 he had me convinced that my next step should be to have the herniated disc replaced with an artificial one. He started rattling off information after we exchanged pleasantries; lucky for me I knew to have pen and paper handy, and I can translate rattle into scribble pretty well. To his credit, he used mostly words that I could understand, or at least spell.
He did a short exam on my hands and arms and said good - no loss of strength.
Then he told me about something called "anterior cervical discectomy", an operation performed on the upper spine to relieve pressure on one or more nerve roots, or on the spinal cord. The procedure is explained by the words anterior (front), cervical (neck), and discectomy (cutting out the disc). He made that sound so awful that I didn't even bother writing it down. It looks pretty awful in this video, too.
Then he suggested "pro-disc arthroplasty" at the herniation, c5-6. I thought this was the name of the procedure. Turns out it's the name of the brand of disc he uses for the procedure. See image at right. Wouldn't you just love to have one of those babies implanted in YOUR neck?
Arthroplasty (literally "surgical repair of joint") is an operative procedure of orthopedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure.So they're still taking the herniated disc out and putting this cute thing in.
Doc kind of showed me the problem in my neck on a small screen where he had parts of my MRI pulled up. I'm not saying I saw the problem, just that he pointed at the picture and said that it was there. What's on the MRI is nothing like the picture I used at the end of the What do The Tough do post. There's really no comparing the two, to my untrained eye. Below is an MRI image of a herniated disc that seems much more obvious than mine, in the same location as mine, C5-C6:
I think the doctor should have showed me the herniated disc so I could actually see it; I got a copy of the MRIs on CD I'm not able to find it myself. If you've never seen a whole MRI on disk, those things are full of like hundreds of images. It could be that it's there and I'm just not seeing it...
Anyhoo, the doctor also suggested that replacing this disc might prevent the early stage disc disease (degenerative disc disease, bulging disc... whatever) that's is spreading to C6-C7, from progressing to herniation. He then quickly explained what the surgery would entail: 1.5 hours, one night in the hospital, six weeks recovery time. Sounds easy, eh?
Thinking of the $280 I had to pay before I even saw the doc (a lot of docs are demanding up front payment from self-paying patients these days; that's if they will even see them at all), I quickly tried to think of any questions. I told him I have Fibromyalgia (mostly to see what his reaction would be; I don't want to have anything to do with any doc that thinks it's a bogus diagnosis) and wondered if I might have a greater probability of coming out of such a surgery worse off than when I went in. He started to explain to me what FM is; I did my best not to roll my eyes. Then he said that the specific pain I'm feeling in my neck/shoulder/arm/hand is from the herniated disc and that after the surgery that would be gone, but I would still be left with the generalized pain of FM. Barring any complications, of course. In other words, he could not answer my question but he did a good job of talking around it. In remembering the conversation later, I don't think he even knows very much about Fibromyalgia. If something like a neck injury in a car crash can bring on FM, it seems obvious to me that neck surgery could bring it on if you don't already have it, or make it worse if you do.
He also mentioned steroid injections. I tried that once before and it made me MUCH worse than I was before the injections. It might have been that the doc didn't know how to give an injection to a person with FM, but I'm very leery. And then there's the fact that it seems like injections would be treating the symptoms of cervical disc disease, not the problem.
The doctor's answers left a lot to be desired for me, but I knew better than to push it. I moved on to financial considerations of having such a surgery. He made that seem pretty easy too. Maybe he really can work miracles. Then he seemed anxious to be on to something or someone else so he told me to call to schedule an appointment next. I asked 'for what?' He replied 'to schedule the surgery,' and we were done.
When I got home and googled some of the terms I had written down, I was kind of surprised to find out that the cervical disc replacement the doctor spoke of had only been FDA approved since 2007. There appear to be NO statistics on long term effects of the surgery.
Then I had the idea to call the doctor's office to ask about the possibility of physical therapy, which they also do in his office. The answer came back: No. Your pain has been going on for too long for PT to help. Huh. He just said NO.
Here's the very simplistic website that the spine specialist I saw referred me to: understandingspinesurgery.com.
Here's the type of website I WISH my spine specialist had referred me to: NeckPainExplained.com.
And finally, after very careful consideration, here's the information I'm going to go by for now. It's a pretty radical departure from what the spine specialist advised. It's all on Dean Moyer's website, Rebuild Your Back, and in his books. Dean is also a founding member of the Healthcare Blogger Code of Ethics.
"Regardless of what terms you put it in; it is essentially a partial amputation. There is no way to get around it. The part of your disc they’re going to remove is never going to grow back.
"What you have to ask yourself is, would you agree to that procedure if it were another part of your body? Say a finger or hand, for example.
"If you had an injured hand — and there was any chance that it could heal and be rehabilitated — would you take that chance or would you just give up and go for the amputation?"
The Final Stage: Total Disintegration
"Eventually these dried out damaged disks will totally disintegrate. When this happens the vertebrae in the lumbar region will begin grinding against one another. They may lock up and fuse together leaving the rest of the vertebrae to do all of the work.
"This is very serious. Once the disk has disintegrated, there is no chance of reversing the situation. There is no way to restore a disk that is no longer there."
This final stage is when I'll have any kind of back or neck surgery, and not a minute sooner. God willing, it won't come to that because I'll be reading Dean's books and doing what they say and reversing the disc degeneration in my spine.
A few final notes from the Rebuilder's Forum:
- Surgery is the common recommendation that a surgeon is going to make...
- Lots of research indicates that in the long run, PT is as effective as surgery, without the risks/costs that come from surgery.
- In a perfect world, the information you need would not be so difficult to find and there wouldn't be anybody trying to take advantage of you during this difficult time in your life ... but for now ... not so. Lots of smiling, well-meaning sharks out there!!
"Overview: More than just a joint rebuilding program... this book is for anyone struggling with stubborn joint or muscle pain. Covers virtually every form of joint pain from arthritis to fibromyalgia and everything in between.
"Note: This book was specifically designed for people who were unable to begin the above back or neck rebuilding programs due to debilitating nerve or joint pain. It may be the first book you want to get."