The risks of waiting too long for Cervical Disk Surgery

The risks of waiting too long for Cervical Disk Surgery

The risks of waiting too long for Cervical Disk Surgery

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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.

Citations

  • 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

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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