This site concerns matters pertaining to a cervical disc surgery and recommendations before and after that surgery. On 10/16/98, a tri-level percutaneous surgery was performed by Dr. John C. Chiu of the California Spine Institute, Medical Center Inc., California Center for Minimally Invasive Spinal Surgery located in Thousand Oaks, CA. The full name of the surgery is Percutaneous Endoscopic (Arthroscopic) Cervical Discectomy, and it basically involves working through an endoscope with various instruments in an attempt to shrink cervical discs. In my case, the bulges were minor (2-4mm) and so were the symptoms. Although I had had occasional neck stiffness and minor neck pain for many years, neurological symptoms did not begin until August 6, 1998. I saw Dr. Chiu on September 28, 1998, and he recommended surgery. Surgery was also recommended earlier that month by Dr. Hae-Dong Jho formerly of the Center for Minimally Invasive Innovative Microneurosurgery (University of Pittsburgh Medical Center) involving an anterior microformainectomy, which was a more drastic operation involving the removal of pie-shaped sections consisting of 1/3 of discs at both the C4-5 and C6-7 levels. I decided not to have this operation. All the other doctors I saw (3) did not recommend surgery.
Although the Chiu surgery looked good the first few days, I rapidly deteriorated. The pain in the back of my neck, which developed on the day of my surgery, increased and spread to my left shoulder. I was too ill to keep my 2nd follow-up appointment on 11/2/98. When I explained my condition in detail over the phone to Dr. Chiu's receptionist (Trish) and physical therapist (Tammy), they assured me everything was probably alright. When I asked to talk to a doctor, they did not feel this was necessary. However, the pain became so excruciating I could not sleep, work, or function. Then, my left shoulder became almost completely paralyzed, and it was time to go to the ER (St. Joseph Medical Center, Burbank, CA). This was on 11/6/98. I and my doctors at the ER called Dr. Chiu's office, but again Trish did not feel my condition warranted notifying Dr. Chiu or one of his associate doctors. From the ER, Dr. Stanford C. Lee reports, "The patient has difficulty moving his left arm. He has obvious C5 palsy. We got approval for MRI of his C-spine."
An MRI was done that day, and it showed a large herniation of the C4-5 disc, which Dr. Chiu had operated on, consistent with my symptoms. The C5-6 and C6-7 discs, which Dr. Chiu also operated on, were intact. The C4-5 disc appeared (in the MRI) ruptured laterally on the posterior side. Prior to the 10/16/98 operation, this disc was intact and only bulging (about 3-4mm). See below.
An X-ray from the actual surgery of the C4-5 disc is shown below. Note the proximity of the endoscope to the spinal canal and the size of the endoscope. Also shown below is a side-view cut (from the MRI taken in the ER) of the spinal canal after surgery. Note the herniation at C4-5.
The descriptions given by the doctors who reviewed the MRIs above are as follows. Pre-operative (Dr. Kay Yan, Del Amo Diagnostic Center, Torrance, CA): "C4-5: There is a central disc protrusion present, measuring 3-4 mm in its anterior-posterior dimension. This results in mild impression upon the central and ventral aspect of the spinal cord. No evidence of entrance zone stenosis is seen. No foraminal stenosis in demonstrated." Post-operative (Dr. Mark Chen, St. Joseph Medical Center, Burbank, CA): "At C4-5, there is a large lateral disc herniation to the left which appears to impinge upon the spinal cord and exiting nerve root."
I saw 4 neurosurgeons that week in the Los Angeles, CA area (Dr. Charles L. Schnee, Dr. Fredric L. Edelman, Dr. Haig V. Minassian, and Dr. Rajendra K. Tiwari), and 3 wanted to operate soon with the classic ACDF. One scheduled a fusion late that week, but I was able to talk the other 2 out of a fusion and into a posterior approach. Nevertheless, due to administrative issues one of the "posterior" doctors backed out. The other "posterior" doctor scheduled an operation in a few weeks, after a planned vacation of his. (Some events unfolded in days beyond the initial week.)
However, the 4th neurosurgeon (Dr. Rajendra K. Tiwari, Glendale, CA) looked very carefully at my MRI and said the large herniation, while a rupture and leaking disc material, may be composed mostly of blood. This condition could heal without surgery. I canceled 2 surgeries, and put myself under Dr. Tiwari's care. On his referral, an electromyogram was performed by Dr. Aye Aye Cho (11/23/98), who reports, "EMG of the left upper extremity was consistent with C5 radiculitis." But over the weeks, I began to improve, and by Christmas I had regained almost 100% function of my shoulder. Also, I was in only minor pain, with some moderate pain. Other neurological symptoms were minor--as they had been before surgery--but improved over my pre-operative condition. Still, it took about a year or two for my neck to really start "loosening up." To this day, I continue to improve and have learned (and am applying) much from further study, particularly the Internet. I have made a truly remarkable recovery and have 100% function of my left shoulder, over 3/4 flexibility of my neck, and almost no pain or other neurological symptoms. I have essentially made a complete recovery.
In my opinion, a few changes in behavior, patience, plus the body's own remarkable ability to heal itself, have made a world of difference -- for both the herniation and bulges. For example, I have corrected bad habits which put undue stress on my neck, such as tipping my head for long periods over desks and in cars. (For completeness, it should be stated that I was rear-ended in a 1978 auto crash, but medical examination of my neck showed no injury.) I now also further reduce stress by often laying down for an hour mid-day and staying in bed longer overnight. In addition, I lay on my back or side with pillows holding my neck and back "just right." At the same time, movement and range-of-motion exercises are important. Mild traction, initially, using a stiff collar was very helpful, but I needed to be careful not to put undue stress on my neck. Traction continues to be important. I now use "active traction," by placing my fist below my chin and pushing down with my chin while moving my head with various motions. "Active traction" for only 5 to 10 minutes right before bedtime particularly helps me. Also, the popular nutrients glucosamine, chondroitin, and collagen have been very beneficial. Additionally, for general health, I take fish oil, calcium/magnesium, lysine, and other supplements.
An Internet site I have found helpful (in understanding the course of treatment for disc problems) is the Florida Spine Institute http://www.spinepain.com (see also http://www.lowbackpain.com). Good spine forums are at http://neuro-www.mgh.harvard.edu/forum/SpinalDisordersMenu.html and http://www.healthboards.com/cgi/forumdisplay.cgi?action=topics&number=14. And I wish to express my deep appreciation and thanks to Dr. Tiwari for the care he gave me in late 1998.
As mentioned above, in addition to the C4-5 disc, the C5-6 and C6-7 discs were also operated on. However, these discs remained intacted before and after the surgery as shown below.
Below are given brief excerpts from concurrent opinions of my condition (before surgery) by Dr. Stanley Goodman (8/13,16/98) and Dr. Srinath Samudrala (8/31/98). I also saw Dr. Schenley L. Co (8/12,17/98), but his notes are not typed and illegible to me. None of these doctors recommended surgery.
"Since his neurologic exam was normal, and since the spinal cord does not show any tissue change indicative of any damage, I told him I do not recommend the surgery at this time for his low level symptoms."
"There is no definite signal change in the cord in my opinion."
"I do not see a clear history for a myelopathy nor do I find clear evidence of a myelopathy in his physical examination."
So this is my experience with spine surgery. I make no conclusions as to the success rate or value of Dr. Chiu's procedures (other than to say I like minimally invasive approaches and the surgery may have reduced my bulges). I have only factually given my experience--with a minimum of opinion, and the decision to have the operation was ultimately my own. One reason for this decision (and perhaps my over reaction) was that my father had recently suffered a disastrous cervical myelopathy, spinal cord damage, and three surgeries. Please refer to the Internet sites given above and below. And, again, I wish to express my deep appreciation and thanks to Dr. Tiwari for the care he gave me in late 1998.
The experiences of other people:
http://dem0nmac.mgh.harvard.edu/neurowebforum/SpinalDisordersArticles/YourOnTheRightTrack.html
http://dem0nmac.mgh.harvard.edu/neurowebforum/GeneralFeedbackArticles/idsaywait.html
http://neuro-www.mgh.harvard.edu/forum/SpinalDisordersF/IGotBetterWithout.html
http://dem0nmac.mgh.harvard.edu/neurowebforum/GeneralFeedbackArticles/C6-7DiscHerniation.html
http://dem0nmac.mgh.harvard.edu/neurowebforum/GeneralFeedbackArticles/Toughitoutawhile.html
http://dem0nmac.mgh.harvard.edu/neurowebforum/GeneralFeedbackArticles/herniateddisk.html