The risks of waiting too long for Cervical Disk Surgery
While it is prudent to wait at least 6 weeks for elective cervical disk surgery, waiting more than 6 months can lesser your chances of a more acceptable outcome.
Unless you have a severe loss of muscle control, or inability to control your bowel and bladder control, most patients should wait at least 6 weeks before considering neck discectomy operations.
Of the patients who have symptomatic disk herniations to the neck, they often progress to one of three scenarios:
1. Within six weeks, the pain improves, and any minor weakness starts to go away. The initial few weeks are very painful. With proper guidance, and judicious use of medications, injections, and therapy, greater than 90% of patients do get better without the need for long term management. The key is having confidence in their Physician, and accepting that the pain will likely improve, even though it can be quite severe in the future.
2. The pain does improve, but only slightly. There is some associated weakness, and any sudden movement, or change of direction causes a significant flare up of pain. Most of these patients fail to improve despite medications, therapy, and steroid medications or injections. If the pain pattern follows a certain distribution, and the tests show a corresponding disk that can explain the pain pattern, there is a high likelihood of improvement. Most patients choose to pursue surgery after 6-8 weeks of non surgical care.
3. The pain improves enough that the patient can perform most activities, but it is a struggle. There is a concern of dependency on narcotic medications, or muscle relaxers. Any change in physical demand causes increased pain. The pain prevents proper sleep, exercise, and intimacy. Despite the pain, however, the patient would like to avoid surgery, and is now more than 6 months from the initial onset of the pain.
In the first two scenario’s, the proper path is relatively easy. In Scenario #1, no surgery. The patient is likely to fully recover. While there is still a 5-10% change of a recurrent disk episode, each future episode can be treated the same as long as the pain improves.
In Scenario #2, the pain is significant enough that the choice of surgery is a reasonable next step. In the properly selected patient, there is greater than 90% chance of a significant improvement of pain and function after surgery.
The third scenario is difficult. Traditionally, surgeons have thought that this population of patient is at risk of poorer outcomes, by waiting too long. Another recent study, published in the Spine Journal again supports that conclusion.
The bottomline is the decision for surgery is still the perogative of the patient. The patient, however, must understand that there are potential risks to delaying surgery after 6 months. If you are at a loss to what to do, please get opinions by Surgeons that will take the time to discuss the pro’s and con’s of surgery in your individual situation.
- Tetreault LA, Kopjar B, Vaccaro A, Yoon ST, Arnold PM, Massicotte EM, Fehlings MG. A clinical prediction model to determine outcomes in patients with cervical spondylotic myelopathy undergoing surgical treatment: data from the prospective, multi-center AOSpine North America study. J Bone Joint Surg Am. 2013 Sep 18;95(18):1659-66. PubMed PMID: 24048553