Back Pain Forum - Cervical Spine At C4-5 & C5-6

Conditions and Diseases > Back Pain Forum > Cervical Spine At C4-5 & C5-6

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Q: Cervical Spine At C4-5 & C5-6

asked by: larry0 on September 19th, 2007

New User

Need your advise!
I have been doing physical therapy, etc. for the few months as well as going into water. Had a cervical myelogram. Shows at the C4-C5 demonstrates posterior osteophyte disc comple with moderate degeree ofr central canal stenosis. At C5-C6 demonstrates posterior osteophyte disc complex with moderate to severe central canal stenosis.

In the last month, I feel that I am getting worse, with my NECK with tingling burning (from the back of my neck to the top of my forehead). In addition, muscles around the breastbone is tightening and burning as well well as my back muscles. In addition, I will be trying acupuncture.

In addition, I have been taking pain medication (flexirle, lyrica, vicodin, ambien etc.). How severe does this have to get before a neurosurgeon will do surgery (fusion). Please note, I am trying to do everything possible to prevent surgery, but the pain is almost 24-7 except when I sleep or when I wake up for a few hours. I only take the meds when I am in extreme pain. Does the MRI or myelogram have to show only severe to be a candidate for surgery?

Your insights will be greatly appreciated. In addition, I do have bone spurs as well. Truthfully, I am really trying to do everything from the last step (fusion), but in all honestly, I'm not sure why they (the doctors) are not suggesting this at this time. I don't have any physical (including heart) problems? I just the want the pain/discomfort to disapate. Your insights would be greatly appreciated.

Replies(8)

Tyton

replied on September 25th, 2007

New User

When Are You a Surgical Candidate?

LarryO,

Through the years (yes, I said years) I have walked more then a couple of miles in your shoes and feel your frustration. It so often seems that our complaints fall of deaf ears and the medical professionals never move as fast as our desires for recovery. And sometimes it's not even recovery that we're looking for as much as relief sufficient enough to restore the quality of our lives.

From my personal experience, I can tell you that it's unlikely that you will be considered a good surgical candidate until after you have failed to improve with conservative treatment options. Regardless of how bad things may look radiologically, it's amazing how often patients realize significant improvement and pain reduction or elimination altogether with physical therapy and exercise. Since it doesn't sound as though you've acheived many benefits from your course of physical therapy you might be to a point that your doctor might consider it reasonable to start discussing any surgical options you might have.

Tyton

larry0

replied on September 25th, 2007

New User

When Are You a Surgical Candidate?

Tyton...
thank you very much for your answer. It does help. Not trying to be redundent, Just one other point of clarification -- even if mri and mylograms show moderate or moderate to serve, doctors usually will not consider you as a candidate unless you try all conservative treatments first? So the only time they will bypass the conservative if it (mylegram/mri) show severe???

Again not looking to do a fusion? Just trying to make some sense out of this. And I know that even having a fusion is no gurantee, but will it help reduce the pressure (8-9mm) that I am feeling (tingling/buring head/neck, breasbone spasm-tightens, C4-C7, etc. Does a double fusion cut your range of motion in half (just curious)

Again thank you Surprised

Tyton

replied on September 26th, 2007

New User

LarryO,

I am more than happy to help any way that I can.

Here’s the pisser, even when radiological findings are severe most patients are not considered surgical candidates until they complete a course of physical therapy first. There are actually some extremely important and beneficial reasons behind this normal and standard requirement, too many to expound upon and not really the topic of this conversation, but I tend to be a little conservative in my approach to my own health care and am always seeking non-surgical options even if it only delays what I know will be inevitable.

Despite the severity of any radiological findings or the appearance of the actual structures, doctors are actually looking for a variety of things prior to considering you as a surgical candidate and your radiological findings are really only a fairly small piece of the bigger picture that surgeons actually take into consideration. So does it have to be severe before you’re considered a surgical candidate? No

With a fusion of the C4/5 through the C5/6 levels you will lose 30-40% of your normal range of motion. And while I know that that sounds like a lot, the truth of the matter is it’s not as restrictive as I know you’re afraid it might be. If you’re fortunate enough to achieve optimal recovery standards, I promise that nobody you meet will guess that you have had two levels of your neck fused.

Best Wishes,
Tyton

sillyakchick

replied on September 27th, 2007

Extremely eHealthy

Hi Larry;

I am wondering if your docotr has suggested a trial of epidural steroid injections. I work in a medical office and our specialty is non-operative spine. I would imagine our approach with you would be an injection at those two levels followed by PT. I agree with you trying to avoid surgery. As far as when do you become a surgical candidate? Well, with the symptoms you have demonstrated and your MRI findings, you are most likely a candidate now. However, the choice always remains up to you. Yes, surgery COULD help you with your problem, but that does not mean it is the best choice. Surgery COULD correct the problem in your neck, however, you may be much better off trying to rehab this yourself with the help of a really good physical therapist. Let me know if you have any more questions or if i have rambled on so much that what I have said is no longer clear.

Tyton

replied on September 27th, 2007

New User

Sillyakchick brings up an awsome point for consideration. It's my understanding that the only conservative treatment that you have received thus far has entailed a course of physical therapy and meds to manage the symptoms. I agree that fusion should always be your last option, and although the road isn't necessarily pleasant to travel you have many many other courses of treatment available that I would encourage you to consider.

Tyton

bptilk451

replied on August 13th, 2008

New User

Fusion 4-5,5-6,6-7

Am about to undergo the fusion route after trying for 18 months to get resolution.
Really can't tolerate the constant pins and needles and numbness in my hand and
it is now starting to move up the top side of my arm. MRI after a year shows
further damage to 4 from when my original one was done. Did this happen because I delayed and tried other options first? I took two falls in the last six months and worry they helped make things worse. What do I have to look forward to as far as after the surgery. My surgeon says I'll be able to return to work in
two weeks (at an office doing lots of computer work - which could also be a con-
tributing factor). Other people I know are off for 2-3 months?
Any thoughts

lagurly

replied on August 31st, 2008

New User

c4-c5 acdf

I am 35 and was just told on Fri to have surgery Tues due to an unstable c4-c5 disc. ACDF will be done and I have read nothing but horror stories online. I have never had a pain in my life, but if I dont do surgery, the top neuro guy at UCLA says I risk paralysis if something was to happen and my spinal cord is damaged.

I am scared out of my wits. It seems that NO ONE has ever had this done with success or the ones that do, dont bother complaining and just the ones that have problems are online.

Plate, screws, no voice, lump in throat, cadever bone -- can it be possible to live a normal life?

81Keith

replied on December 21st, 2008

New User

I'm 27 with a hernaited C5, I have all the tell-tale symptoms. Left arm weakness, fingers tingling, pressure on the back of my neck and chest pain. 11/2006 is when I was injured. I do also have T3 hernaited, as of the past three weeks or so my pain is gettin almost non-tolerable. Surgery is an option for me but I'm trying to avoid it at all costs. I'm in deep fear that its my T3 causing the pain and not my C5, they've done everything you can think of for my C5 and havent once mentioned the T3..

Cervical anterior fusion is what they want to do to me, take out the c5, put in a cage with a polymere donut with donor bone chips and cement inside the cage, and to reinforce my neurosurgeon wants to add a metal plate in the front and back of the cage... Is this normal for a level 1 fusion ?

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