Choosing Surgery for Cervical Disc Herniation: Risks and Alternatives

Options for Cervical Disc Rupture Surgery

My mother is 56 years old and has been experiencing severe pain in her neck and arms, requiring steroid injections for pain relief.
After an MRI, the doctor diagnosed her with a herniated disc at the C3-C4 level and a slipped disc at the C4-C5 level, which is compressing the nerves.
The doctor recommended a microsurgery to stabilize the C3-C4-C5 levels using PEEK implants covered by health insurance.
However, my mother prefers to avoid surgery and has been undergoing intensive acupuncture and resting.
Currently, she is not using pain medication and her pain has significantly decreased; she has no issues with daily activities and does not experience weakness.
Nevertheless, the doctor still believes that prolonged nerve compression may pose risks, including the possibility of paralysis from a fall, and continues to recommend surgery.
I have several questions:
1.
Will stabilizing the C3-C4-C5 levels increase wear on the other cervical vertebrae?
2.
Are there alternative options, or can we wait until the pain returns to consider surgery? What risks are associated with this approach?
3.
Is high-frequency thermal coagulation or nerve block therapy an option? Are there any potential side effects?
4.
Since my mother is still relatively young, she is concerned about the possibility of severe degeneration of other cervical vertebrae due to surgery.
Thank you for taking the time to respond!

Xiao Ke Ai, 30~39 year old female. Ask Date: 2016/01/04

Dr. Lai Zhaokang reply Neurosurgery

Hello, based on your description, I infer that 1.
it may increase wear on adjacent segments, referred to as adjacent segment disease.
To overcome this, it would be necessary to replace the fixed PEEK cage with a mobile artificial disc, although this option is more expensive.
2.
Generally, the main treatments include medication (including B vitamins), rehabilitation, and surgery.
If your mother is currently not undergoing surgery, in the short term, she is not experiencing pain or weakness, so there is no immediate urgency for surgery.
However, in the long term, the compression will not completely resolve on its own, and prolonged nerve compression is certainly detrimental, although your mother feels relatively well.
3.
Radiofrequency ablation or nerve block procedures are aimed at controlling pain symptoms and will not alleviate nerve compression.
Wishing you a speedy recovery.
Director of the Spine Neurosurgery Department, Changhua Hospital, Dr.
Lai Chao-Kang.

Reply Date: 2016/01/04

More Info

When considering surgery for cervical disc herniation, particularly in a case like your mother's, there are several important factors to weigh, including the risks associated with surgery, potential alternatives, and the long-term implications of any chosen treatment.

1. Risks of Surgery: Surgical intervention, such as the recommended microsurgery to address the herniated discs at C3-4 and C4-5, carries inherent risks. These can include infection, bleeding, nerve damage, and complications related to anesthesia. Additionally, there is a possibility of developing adjacent segment disease, where the discs above or below the surgical site may experience increased wear and tear due to altered biomechanics. This could potentially lead to further issues in the future.

2. Impact on Adjacent Discs: Fixing the C3-4 and C4-5 discs could indeed place additional stress on the adjacent cervical discs (C2-3 and C5-6). The mechanics of the spine are complex, and any alteration can lead to compensatory changes in the way the spine functions. However, this does not necessarily mean that adjacent discs will definitely deteriorate; it varies from person to person based on factors such as overall spinal health, activity level, and adherence to post-operative care.

3. Alternatives to Surgery: If your mother is currently experiencing significant relief from pain through conservative treatments like acupuncture and rest, it may be reasonable to continue these approaches. Physical therapy, chiropractic care, and pain management strategies, including steroid injections, can also be effective in managing symptoms. However, if there is persistent nerve compression, it is crucial to monitor for signs of neurological deficits, such as weakness or loss of sensation, as these could indicate a need for surgical intervention.

4. Waiting for Surgery: Delaying surgery until pain becomes unbearable can be a double-edged sword. While it may allow for a more conservative approach, prolonged nerve compression can lead to irreversible damage. If your mother experiences any new symptoms, such as weakness, numbness, or changes in bowel or bladder function, it would be critical to seek immediate medical attention.

5. Other Procedures: High-frequency thermal coagulation and nerve block procedures are indeed options for managing pain. These methods can provide relief without the need for invasive surgery. However, they may not address the underlying structural issues of the herniated discs. Potential side effects can include temporary numbness, weakness, or, in rare cases, more severe complications depending on the technique used.

6. Long-term Considerations: Given your mother’s age and the desire to avoid complications from surgery, it is essential to have a thorough discussion with her healthcare provider about the risks and benefits of all available options. If surgery is ultimately deemed necessary, ensuring that she follows a comprehensive rehabilitation program post-surgery can help mitigate the risks of adjacent segment disease and promote overall spinal health.

In conclusion, while surgery may provide a definitive solution to the herniated discs and associated nerve compression, it is essential to weigh the risks against the benefits carefully. Continuing conservative management while closely monitoring her symptoms may be a viable option, but it is crucial to remain vigilant for any signs of worsening neurological function. Regular follow-ups with her healthcare provider will help ensure that any changes in her condition are addressed promptly.

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