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  • BPat
    Participant
    Post count: 9

    Thanks in advance. Three questions relating to my C6/C7.
    3weeks ago I woke up to a “large” herniation. Verified per MRI with pain in shoulder, triceps, elbow and forearm … and meaningful triceps weakness to further clinically triangulate on C6/C7.

    Background – I had a C5/C6 Foramenotomy 2yrs ago for pain – largely successful after some bumpiness the 1st 6mo. My C4/C5 isn’t pretty either per the MRI (disc bulge and foramenal stenosis but asymptomatic). I’m 42 and active (golf, ski, kids)

    I have seen 3 surgeons and gotten 3 recommendations all agreeing its C6/C7 and all saying act to decompress soonish to maximize chance of Triceps recovery. But the specific recommendations differ : 1) Vanilla ACDF (cadaver and external plate), 2) Zero-p ACDF and 3) ADR.

    So as I try to decide the approach – I’m trying to understand these 3 things (thanks again)
    A) Two of my surgeons have indicated ADR won’t help with adjacent levels. This seems to disagree with this 2013 study I found “ProDisc-C and Anterior Cervical Discectomy and Fusion as Surgical Treatment for Single-Level Cervical Symptomatic Degenerative Disc Disease.” Are they dated? Or is this study an outlier or not well regarded?
    B) IF that is right, and there is no adjacent level improvement from going with ADR, why ever get an ADR? What is the logic if not that?
    C) Any thoughts on the Zero-P? Internal fixation that sits in disc space and screws up and down (at angles) into vertebrae above and below. With integrated cage. No external plate to upset esophagus. The one study I found made it seem great (high fusion rates, lower complication re esophagus). But seems new and at a min lacking long term data. Also doesn’t seem like many are using it – curious? Is this something you use or would vs “gold standard” external plate?

    Thanks … 3 dissenting approaches (all from credible guys) has my head spinning

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I would agree that with significant pain and weakness associated with a large herniation at C6-7, a surgical procedure would be indicated.

    The three choices are not bad but there is a ranking order in my opinion. The cervical ADR will help maintain range of motion but will not help with adjacent segment disease (ASD-the wearing out of the level above or below). This adjacent segment disease is most likely from the genetics of the discs and not from the surgery. Also, ADRs will eventually wear out and have to be replaceD by an ACDF somewhere in the future. It might be 10 or 20 years (or possibly never).

    The standard ACDF with allograft (donor bone) is probably the most successful of the three surgeries. The fusion rate is pretty good and the “external plate” has almost never been a problem in my hands.

    The Zero-P is a spacer made of plastic (PEEK) and metal. As such, this reduces the biologically active fusion surface area and makes this device less likely to fuse successfully. This would be the last on the list if I were considering this surgery.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    BPat
    Participant
    Post count: 9

    Thanks so much. This is very helpful to narrowing a decision. One last question – are all 1 level ACDF “external plates” more or less the same. One surgeon highlighted his success with a low profile TWO screw external plate (I may have misunderstood) – while another surgeon suggested two screw external plates were not common or best practice (vs a 4 screw external plate). Is this an important decision point?

    BPat
    Participant
    Post count: 9

    … Or should I care if a single hole per level playing system is used (e.g., Vertical In-Line Plate or SlimFuse)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Almost all anterior cervical plates are of the four screw variety. If you eliminate two of the screws, the plate can toggle which makes for lessened stability. Having two extra screws makes the plate a parallelogram which significantly increases strength. The “extra” two screws are of enough consequence that they should not be eliminated by a two hole plate.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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