C3/4 Fusion Vs Synthetic Disc Replacement

Outcast (Carlton) · #1 19-11-2019, 04:17 AM

I am faced with this decision this Thursday when I see my surgeon.

Been doing a lot of research these past 6 months & have managed to chat with someone who has had a fusion done at this level 3 years ago.

There are pros & cons to both procedures & ultimately, the decision rests with me. However, has anyone here had a synthetic disc replacement at C3/4 level?

Be I interested to know of anyone's experience & if you'd opt for replacement or fusion if you had a do over...

Thanks in advance

ngcles · #2 21-11-2019, 09:59 AM

Hi Carlton,

I had a C3/C4 discectomy (removal of the disc between vertebrae) and laninectomy (removal of bone over-growth surrounding the sciatic nerve root), installation of a dynamic stabilisation device (big rubber band around C3 & C4 that restricts movement bone-on-bone), but no replacement "artificial disc" way back in 2006. What remained of that disc was in five fragments before the procedure.

20 years of on-off pain then 3 years of near constant high level pain before the procedure.

Haven't looked back and have been 99.999% pain free ever since. I was in less pain an hour after the operation than the hour before the operation and haven't looked back. My surgeon was a neurosurgeon, Dr Mark Davies Kogarah Hospital in Sydney -- one of Australia's most accomplished neuro-surgeons.

My next-door (next farm-gate) neighbour had the same procedure around the same time in QLD -- different surgeon, but included the installation of a carbon-fibre replacement disc. The procedure was carried out by an orthopaedic surgeon. He has less pain nowadays but still in significant pain and on high-levels of pain relief.

One major piece of advice (backed by the opinions of three physiotherapists I know): if you are going to have that op, get it done by a neuro-surgeon, not an orthopaedic surgeon. They use much more refined tools whereas Orthopaedic surgeons use the basic tools of carpentry. Higher chances of success + swifter recovery.

When I had mine done, a guy in the next room had his done by an orthopaedic surgeon three days before me. I went in on Monday and was out Friday afternoon. On the day I left, he was still using a walking-frame doing rehab. I walked out the door with my suitcase in my hand.

Lots of people see varying results. Mine was fantastic, your mileage may vary.

Best,

L.

Outcast (Carlton) · #3 21-11-2019, 11:11 AM

Quote:

Originally Posted by ngcles

Hi Carlton,

I had a C3/C4 discectomy (removal of the disc between vertebrae) and laninectomy (removal of bone over-growth surrounding the sciatic nerve root), installation of a dynamic stabilisation device (big rubber band around C3 & C4 that restricts movement bone-on-bone), but no replacement "artificial disc" way back in 2006. What remained of that disc was in five fragments before the procedure.

20 years of on-off pain then 3 years of near constant high level pain before the procedure.

Haven't looked back and have been 99.999% pain free ever since. I was in less pain an hour after the operation than the hour before the operation and haven't looked back. My surgeon was a neurosurgeon, Dr Mark Davies Kogarah Hospital in Sydney -- one of Australia's most accomplished neuro-surgeons.

My next-door (next farm-gate) neighbour had the same procedure around the same time in QLD -- different surgeon, but included the installation of a carbon-fibre replacement disc. The procedure was carried out by an orthopaedic surgeon. He has less pain nowadays but still in significant pain and on high-levels of pain relief.

One major piece of advice (backed by the opinions of three physiotherapists I know): if you are going to have that op, get it done by a neuro-surgeon, not an orthopaedic surgeon. They use much more refined tools whereas Orthopaedic surgeons use the basic tools of carpentry. Higher chances of success + swifter recovery.

When I had mine done, a guy in the next room had his done by an orthopaedic surgeon three days before me. I went in on Monday and was out Friday afternoon. On the day I left, he was still using a walking-frame doing rehab. I walked out the door with my suitcase in my hand.

Lots of people see varying results. Mine was fantastic, your mileage may vary.

Best,

L.

Thanks for that, all good information.

Yup, mine is being done by a Neuro-surgeon, Dr Eric Guazzo (based in Townsville). He has come highly recommended by a few folk I know who have been under his knife for other spine related issues.

I'm pretty much where you were... 18 years since first diagnosis, 15 years of moderate pain & discomfort with associated muscle spasms from mild nerve compression.. last two years increasing pain levels & horrendous pins & needles in arms & hands... last 12 months, near agony... kept tolerable with 400mg of Tramadol per day..

Nerves exiting c3/4 on both sides are essentially being crushed every time I move... Last cortizone shot they tried, the Dr showed me how he barely had room to get the needle in....

Seeing the surgeon this afternoon, a few more questions to ask but, leaning heavily towards the disc replacement. Whilst it's only been around now about 10 - 12 years, there seems to be some significant advantages in having the disc replacement vs fusion such as less invasive, greater mobility & less stress on surrounding joints as well as faster recovery time. Discs now are surgical steel, kinda like articulated joints.. can't think of another way to describe them..

Main issue is whether or not the foundations for the disc replacement are solid enough to ensure a good result... this is what I will be discussing today... I know my surgeon has some minor reservations based on it being the upper limit of where it can be done.. again, that's what we'll be discussing today.. final pro's & con's analysis.. decision & then booked in for 3 days in Townsville hospital...

Ultimately, I just want the pain to go, I can handle some movement limits (can't be any worse than my current limited range of movement I suspect) just to be pain free would be good..

Cheers

Carlton

casstony · #4 21-11-2019, 12:36 PM

The most important aspect of spinal surgeries is the past success rate of the surgeon. If your GP has sent a number of patients to the surgeon and they are reporting a high degree of success post-op then you can be fairly confident of getting a good outcome.

Outcast (Carlton) · #5 21-11-2019, 01:03 PM

Quote:

Originally Posted by casstony

The most important aspect of spinal surgeries is the past success rate of the surgeon. If your GP has sent a number of patients to the surgeon and they are reporting a high degree of success post-op then you can be fairly confident of getting a good outcome.

Thanks Tony

Agree, & my GP fortunately is someone I have come to place a lot of faith & trust in...

As such, whilst our options for specialists/surgeons are somewhat limited due to our somewhat remote location, I'm confident that my GP has referred me to someone extremely competent.

As regards to the Surgeon himself, first consult I was a little 'meh' in my feelings toward him.. typical Surgeon, not much of a talker & not a lot to say about my condition other than to order an MRI. Second consult, completely different man, very talkative, a lot of discussion about options & outcomes, what he could confidently achieve, what he couldn't & potential complications...

That was 6 months ago as I had to get my seasonal employment done, that finished (well almost) I can now get the surgical fix done. I've spent a lot of time researching the options presented.... a couple of questions of my surgeon today & I believe I have everything I need to make that decision although, of course, I'd rather not have to...

I'm confident he knows what he is doing & that he has a high success rate... it's more just trying to decide what option to go with, there is risk associated with all the options, there are pro's and cons for each procedure.. I think I just need to be as confident as I can be that I understand those risks, weigh up the pro's & cons, make a decision.. sounds simple eh...

I'll let you all know in a few months how it all works out I guess coz after today, I'm looking at first week of December to have my throat cut.. literally...

ngcles · #6 21-11-2019, 02:13 PM

Hi Carlton,

Quote:

Originally Posted by Outcast

... I'm pretty much where you were... 18 years since first diagnosis, 15 years of moderate pain & discomfort with associated muscle spasms from mild nerve compression.. last two years increasing pain levels & horrendous pins & needles in arms & hands... last 12 months, near agony... kept tolerable with 400mg of Tramadol per day ...

... Ultimately, I just want the pain to go, I can handle some movement limits (can't be any worse than my current limited range of movement I suspect) just to be pain free would be good ...

Know the feeling. At the end I was on four Panadine Forte per day + 200mg Voltaren tabs + the odd "top-up" regular Panadine. Unfortunately I am allergic to morphine-based analgesia so that's out for me. I have (been told) a relatively high pain threshold (so-said two physios) and that medication load was just enough to get me on my feet and to work and back. Not pain-free by quite a way but, reduced it to a tolerable level. When I woke up in the morning it was agonising before I could medicate-up (took about 90 mins before the first dose of the day kicked-in).

People who have never had severe back pain have no idea how bad it can be for some. I used to look at people with some degree of scorn who were "on compo with a bad back". While some of them were in fact probably just bludgers, genuine back problems are incredibly debilitating -- I know that now. I feel fortunate that I've been very nearly pain-free for 13 years after the op.

Re the level/severity of pain: I know about 5 years after I had my op, my former wife developed back problems and confided in me (perhaps grudgingly) "this is as bad as giving birth". I have no doubts giving birth is extremely painful, but labour pain is normally over in 4-48hrs. Back pain is almost endless.

Best of luck with the consult and the procedure. Hope for you it gives mighty relief.

Best,

L.

Outcast (Carlton) · #7 21-11-2019, 03:09 PM

Well, questions asked & answered at the Surgeons consult today....

Final CT scan tomorrow & MRI Sunday just to ensure no significant changes since my last MRI..

Surgery booked for 03 Dec in Townsville Mater Hospital.. opted for the disc replacement... Surgeon was quite supportive of the decision, certainly didn't try to talk me out of it...

Guess we'll see how it all goes after they cut my throat & do what needs to be done...

Wish me luck..

Thanks to you both for your support & sage advice

Cheers

GrahamL · #8 24-11-2019, 07:19 PM

I was talking to a good friend today who had this done a couple months back,,check and confirm post surgery what you are able to do movement wise ,,
my friend was put into a position he shouldnt of been post surgery

he was also moved into a rehab program that was to much to soon .
The surgeons specific notes stated clearly what needed to be done but wasn't followed .
he now has some issues that need total rest for some months

Hes hopefull things will settle without more surgery .

Outcast (Carlton) · #9 24-11-2019, 08:48 PM

Quote:

Originally Posted by GrahamL

I was talking to a good friend today who had this done a couple months back,,check and confirm post surgery what you are able to do movement wise ,,
my friend was put into a position he shouldnt of been post surgery

he was also moved into a rehab program that was to much to soon .
The surgeons specific notes stated clearly what needed to be done but wasn't followed .
he now has some issues that need total rest for some months

Hes hopefull things will settle without more surgery .

Thanks Graham,

Very good tip & I will absolutely pay attention to what my surgeon has to say post op.

I have encountered this type of situation before where the odd health professional feels they know better or simply ignore instructions... whereas I used to he somewhat compliant & just do as I was told, these days I'm way more inclined to be more informed & to not be intimidated by anyone.

Thankyou for sharing your friends experience, you have no idea how useful that information is, I'd not particularly given that type of issue a great deal of thought until now.

Cheers

Carlton

GrahamL · #10 24-11-2019, 09:15 PM

Quote:

just do as I was told,

Was what any of us would do,,best wishes for a speedy recovery Carlton.

Outcast (Carlton) · #11 24-11-2019, 10:33 PM

Thanks Graham

Outcast (Carlton) · #12 28-11-2019, 05:12 PM

Well my oh my, how things can change in a short space of time...

Had the consult on Thursday last week & we discussed disc replacement... & booked for 03 Dec.

Final CT & MRI then, a phonecall... unfortunately, things have changed for the worst in the last 6 months since my original MRI so, nolonger a candidate for Disc replacement...

So, fusion it is then..

Nevermind... I'm assured that it won't result in a significant reduction in mobility due to the fact it's the first joint down from where your spine is actually solidly fixed to your skull...

Fingers crossed, all goes well next week... anyways, compared to the pain I currently experience I guess a small loss in mobility (if even noticeable) will be a small price to pay...

Thanks again to all that chipped in with advice & support

Cheers

Outcast (Carlton) · #13 03-12-2019, 06:54 PM

Surgery done, this morning. Back on the ward & all seems good thus far..

casstony · #14 03-12-2019, 10:10 PM

Sounds positive Carlton - no laying pavers for a while

Outcast (Carlton) · #15 03-12-2019, 10:18 PM

Quote:

Originally Posted by casstony

Sounds positive Carlton - no laying pavers for a while

Indeed...

Astronovice (Calvin) · #16 03-12-2019, 11:49 PM

Quote:

Originally Posted by Outcast

Surgery done, this morning. Back on the ward & all seems good thus far..

All the best and I hope all continues to go well.

Outcast (Carlton) · #17 04-12-2019, 08:42 AM

Quote:

Originally Posted by Astronovice

All the best and I hope all continues to go well.

Cheers

JA · #18 04-12-2019, 04:59 PM

Get well soon

Best
JA

Outcast (Carlton) · #19 04-12-2019, 07:53 PM

Quote:

Originally Posted by JA

Get well soon

Best
JA

Thankyou

Outcast (Carlton) · #20 07-12-2019, 03:57 PM

Well, I am home now after a week in Townsville for my C3/4 Fusion...

Whilst there is some localised pain around the base of my neck & top of my shoulders from the surgery, all the referred pain, pins & needles, etc.. that I used to suffer from has gone...

Surgeon says it should take another couple of weeks for the surgery pain to settle down but, he is very happy with how it all went & from how I feel (aside from feeliing a bit battered & bruised), I concur with his assessment.

I now look forward to 2 months of wearing a soft collar (in lovely Tropical FNQ) & being allowed to do pretty much... nothing...

So, with no malice intended to my fellow FNQ astronomers, let it rain, let it rain, let it rain so that we can have nice clear skies from Feb...

Thankyou once again to all that offered kind words, advice & support...