[JonM]

#28655

Dr Corenman

Hello – I am a 63 year old male in generally good health
One year ago- onset of cervical pain and radiculopathy issues. Now primarily just pain
Recent MRI
c3-4 there is a disk bulge with posterior osteophyte causing thecal effacement with spinal cord indentation. Mild to moderate canal narrowing present. Mild to moderate bilateral stenosis
c4-5 1.5mm posterior disk protrusion. Moderate canal stenosis. Moderate to severe bilateral foraminal narrowing
c5-6 a small left foraminal disk protrusion may be present. Mild canal narrowing. Moderate to severe left foraminal stenosis
Dr suggests ACDF surgery
FYI – I am very unluckly with surgery outcomes with probabilities and frankly scared. I have tried PT and 2 cervical shots. Basically pain remains- primarily shoulder – a little in the arm. Function and strength are OK. Other treatment options?
Other than stats quo (and is this a good idea – or potentially could it cause serious damage?) – is ACDF surgery the only real option? Given the above – probably multi level – so worried about adjacent disk disease? Does this happen a lot? Internet is confusing regarding probability of success of ACDF at 1 and 5 years post op. Your views?
Hoping to have a few good years left without continuously chasing chronic back issues and pain if possible

Thanks so much

Jon

[Donald Corenman, MD, DC]

#28660

If the disc has lost less than 50% of its height, you could consider an artificial disc replacement (ADR) however these only slightly reduce adjacent segment wear as most of the wear is genetic in nature. If you have no motor weakness (as demonstrated by a thorough physical examination), then you don’t have to have surgery. However, if you already have had two epidural injections and undergone physical therapy without relief, it is unlikely that you will note significant improvement in your symptoms over time. It still is possible but unlikely

The two nerve blocks hopefully gave you great temporary relief which would diagnose the level of injury (see https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/).

Success of a well planned and performed ACDF should be in the 90-95% range. The flexion/extension X-rays will allow your surgeon to determine if the level that is most involved has any range of motion. If minimal, an ACDF would not pose any additional wear on the other levels.

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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