I regularly see patients who have been told by another doctor that they need a neck surgery to prevent the further degeneration of their cervical spine. Some of these patients are very frightened by what their doctor told them. Some were told that if their symptoms progress they could risk permanent damage to their ability to function maybe to the point of paralysis.

“I am worried if I do not get surgery my neck will get worse”

Research has strongly suggested that many patients decide on cervical fusion surgery because they fear a progression of their problem that will lead to permanent disability. However, follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time. In 2013, doctors published findings that suggested that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.

The researchers identified 27 patients with cervical degenerative spondylolisthesis (a slipped disc causing nerve pressure) for inclusion in their study.(1)

Here is what they found. For many of you, this terminology may sound familiar and you may recognize that your MRI included many of these terms.

• Eleven patients had cervical spondylolisthesis at C4-C5,
• Nine at C3-C4,
• Six at C5-C6,
• and one at C2-C3.
• Initially, 6 had anterolisthesis (disc forward displacement) and 21 had retrolisthesis (disc backward displacement)
• At baseline, 3 of 6 patients with anterolisthesis and 7 of 21 patients with retrolisthesis had translation of more than 2 mm on dynamic views.
• At baseline, 11 had no cervical symptoms, (This is a scenario I talk about often, MRI shows disc displacement, but the person shows no sign of pain or loss of motion. Should this person be scared into an unnecessary surgery?)
• 8 had cervicalgia (sharp neck pain that is felt in back and shoulders)
• 7 had radiculopathy (radiating pain into the elbows and hands)
• and 1 had myelopathy. Myelopathy needs a surgical consultation as paralysis and incontinence are at risk.

Same patients, on average, seen more than three years later show limited or no progression of cervical spine disease

• At the final visit, none of the anterolistheses or retrolistheses had progressed.
• At the final visit, 7 of 10 patients with initial translation of more than 2 mm on dynamic views had no change.
• Of 17 patients with less than 2 mm of initial dynamic motion, 3 patients progressed to have more than 2 mm of dynamic translation. All 3 of these had retrolisthesis initially. None had clinical worsening of symptoms at the final visit.

CONCLUSION:
The natural history of cervical degenerative anterolisthesis and retrolisthesis seems to be stable during 2 years to nearly 8 years. Although those with retrolisthesis seem to have a higher propensity to increase their subluxation, none experienced dislocation or neurological injury.

In 2019, the same researchers followed up six years later

In their 2019 follow up paper published in the prestigious medical journal Spine (2)  the researchers continued looking for progression for cervical spine slippage. They noted that in their previous study described above that 2- to 7-year follow-up showed that degenerative spondylolisthesis of the cervical spine did not progress. The purpose then of this study was to see if longer-term follow-up would reveal that these patients neck slippage actually do progress over time.

• 218 patients with greater than 5-year follow-up without surgery were examined.
• They were categorized as either having or not having cervical spondylolisthesis.
• The average follow-up duration was six and one-half years. Progression of translation (slippage) was found in 20 patients (9.2%), including 4 patients in the spondylolisthesis group and 16 patients in the control group. Progression of translation was not related to the presence of spondylolisthesis or the severity of translation at the initial evaluation, but was more common in the elderly and in the patients with anterior translation than those with posterior translation at the initial evaluation. In addition, progression of spondylolisthesis was not correlated with any change of symptoms.
• Conclusion: Progression of cervical spondylolisthesis is not related to the presence of spondylolisthesis at baseline. 

Observation, rush to surgery NOT endorsed by researchers

Doctors at the Rothman Institute, Thomas Jefferson University and Hospitals found: “With many surgeons expanding their indications for cervical spine surgery, the number of patients being treated operatively has increased. Unfortunately, the number of patients requiring revision procedures is also increasing, but very little literature exists reviewing changes in the indications or operative planning for revision reconstruction.” (3)

What these researchers are saying in their study is that doctors have broadened the criteria for neck surgery so more can be justified. However, the literature is not keeping up with ways to help the increasing new group of failed neck surgery patients.

A majority of patients with clearly defined MRI abnormalities who were not at all bothered by neck pain

Compounding this is the always present rush to surgery spurred on by MRI. Doctors at Yale University suggested to doctors not to solely rely on MRI readings when evaluating patients for neck pain treatment: “Physicians should be aware of inconsistencies inherent in the interpretation of cervical MRI findings and should be aware that some findings demonstrate lower agreement than others (in recommending surgery).” (4) This agrees with the first study showing a majority of patients with clearly defined MRI abnormalities who were not at all bothered by neck pain.

Revision cervical fusion surgery – Should adjacent asymptomatic levels be included in revision fusion surgery if they show severe radiographic degeneration? Researchers say NO even if MRI shows abnormalities at adjacent levels

An August 2021 study (5) added to the question as to should surgeons fuse adjacent segments that remain asymptomatic. The researchers suggested that Anterior cervical discectomy and fusions (ACDFs) are generally limited to the levels causing neurological symptoms, but whether adjacent asymptomatic levels should be included if they demonstrate severe radiographic degeneration is a matter of controversy. In evaluating whether asymptomatic preoperative magnetic resonance imaging (MRI) abnormalities at adjacent levels were predictive of reoperation (if they were not dealt with in the first surgery would they cause the need for a second further fusion) for symptomatic adjacent-segment degeneration (ASD) after the initial Anterior cervical discectomy and fusion. Their findings do not support including asymptomatic levels in an anterior fusion construct, even if severe MRI abnormalities are present preoperatively.

The failure of Cervical Total Disc Replacement

A March 2021 study (9) presented the experiences of doctors at the Department of Neurosurgery, at International St. Mary’s Hospital  with failures in Cervical-Total Disc Replacement and revision surgery outcomes.

The doctors “retrospectively examined patients who underwent revision surgery due to the failure of Cervical-Total Disc Replacement between May 2005 to March 2019. Thirteen patients (8 males and 5 females) were included in this study. The mean age was 46.1 years (range: 22-61 years), and the average follow-up period was 19.5 months (range: 12-64 months).

Results: The main complaints of patients were posterior neck pain (77%), radiculopathy (62%), and/or myelopathy (62%). The causes of failure of C-TDR were improper indications for the procedure, osteolysis and mobile implant use, inappropriate techniques, and postoperative infection. The most common surgical level was C5-6, followed by C4-5.

This is an audio clip from Dr. Darrow’s weekly radio show.

Dr. Darrow is responding to a person’s email asking about her husband.

He is now in so much pain. The the worst is waking up. The pain is horrible but he gets up and goes to work. He gets no help with his pain. Please is there anything that can be done to assist him, he has been living with this for years and is getting worse since the surgery can you please help? So this is a cry for help because of a failed surgery.

I think the key points here are that number one:

• This gentleman had cervical degenerative disc disease and this poor guy had a neck surgery for it and had a disc removed from his neck. I’m not sure what good that did because he’s in worse pain now. I see this all the time where people come in and have discectomy is and they’re worse. Sometimes the surgeon will put in what’s called a spacer or some type of plastic or metal device between the vertebrae to take the place of the disc they removed. Now some of these surgeries must work very well or they couldn’t keep doing them but I get cases where the surgery didn’t work. Should there ever be a surgery done for degenerative disc disease. In my position, here in the patients I see and the work that I do of regenerating the body, regrowing tissue by doing injections of platelets or stem cells or mixed together that we seem to get people better who have degenerative disc disease.

Not relying on MRI

• I see many people with degenerative disc disease that don’t have any pain. So I’m not going to trust an x-ray or MRI to decide for me if the person has pain. I know this is a mind-bender for a lot of people because we grew up thinking that if we see something on an MRI or an x-ray that must be the truth of who we are and it just is not the case. It is difficult sometimes to  explain to new patients who come in that what they see on MRI and what they really have can be two different things. Studies show that people that have no pain at all can have terrible things in their MRIs and X-rays and vice versa, they can have terrible pain and their MRI or x-ray shows nothing. We have to be very careful, as doctors to remember to use our hands so as doctors we need to touch the area, move the person around, find out where the pain is being generated from.

The failed surgery

• It is possible in this case that we discectomy in this man’s neck which was a surgery that in my book should never have been done.
• Discectomy is a drastic surgery. It removes a disc to get rid of neck pain or back pain and in this case it didn’t work. I get patients like this all the time. They come in after these failed surgeries, failed meaning surgery was done and it didn’t work, now with a diagnosis of failed shoulder surgery, failed hip surgery, failed neck or back surgery. What do these recognized diagnosis tags tell you? That way too many of these surgeries are being done and they are failing people. These failed surgeries should have never been done in the first place.

How can this person be helped?

• Regenerative medicine using platelets and stem cells are typically the answer for how to heal these areas. These treatments do not work all the time, but I am saying is that the landscape of medicine in musculoskeletal and orthopedics is totally changing from doing surgery to regenerating the body. The easy part about doing regenerative medicine is it’s a very simple injection process we don’t have to open up the body with a scalpel of the side effects are very minimal if any very rare to have side effects if possible that’s very rare wear a surgery there are many side effects.

In a person with failed neck surgery, we would have to examine the neck and as mentioned above, physically find the spots in the neck that is causing this person’s pain. Then we could develop a program to help alleviate the pain and restore function. Failure rate for neck surgery is considered low by some and more frequent by others. Secondary or revision surgery is usually considered as a last resort.

Do patients rush to neck surgery because they are tired of pain medications?

The use of opioids or painkillers among people who have been suffering with long-term neck pain sufferers is significant. We see patients all the time who come into the office with a gallon size baggie of current and past medications. What is worse is that many of these prescriptions are not helpful. This is when many patients decide on the surgery. Not because of fear of worsening condition, but rather, fear of opioid addiction and the side effects.

Use of painkillers after surgery is worse

Many people get a good benefit from a cervical spine surgical procedure. Some do not. For those who did not get benefit from the surgery and their physical conditioned worsened, the need and abuse of painkillers became that much worse. Doctors publishing in the medical journal Anesthesia & Analgesia (6) warn against theses abuses of prolonged pain-killer usage after surgery. They reported “Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.”

The investigators of the study suggested that the patients felt or knew that they would be in great pain during the surgical recovery period and that other factors including depression added to this fear. Opioid addiction came easily. The prolonged opioid use after surgery made healing at the least, difficult.

Especially among the older patients

Published in the Archives of Internal Medicine (7) researchers suggested that prescribing opioids to older patients shortly after surgery resulted in long-term analgesic use. The researchers suggested while opioids can be beneficial, they are associated with significant adverse effects such as sedation, constipation and respiratory depression, and their long-term use can lead to physiologic tolerance and addiction.

Chronic neck and back leads to problems of pain management including over-medication. If you have suffered from long-standing pain, chronic prolonged pain surgery and you want to explore ways of finding alternatives to opioid use, let’s explore the possibilities of regenerative medicine.

More research is given in my article:

Stem Cell Therapy for Cervical Spine and Neck Pain

Do you have questions? Ask Dr. Darrow

[embedded content]

[embedded content]

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

References

1 Park MS, Moon SH, Lee HM, Kim SW, Kim TH, Suh BK, Riew KD. The natural history of degenerative spondylolisthesis of the cervical spine with 2-to 7-year follow-up. Spine. 2013 Feb 15;38(4):E205-10.
2 Park MS, Moon SH, Oh JK, Lee HW, Riew KD. Natural history of cervical degenerative spondylolisthesis. Spine. 2019 Jan 1;44(1):E7-12.
3 Helgeson MD, Albert TJ. Surgery for Failed Cervical Spine Reconstruction. Spine (Phila Pa 1976). 2011 Nov 8. [Epub ahead of print]
4 Fu MC, Webb ML, Buerba RA, et al. Comparison of agreement of cervical spine degenerative pathology findings in magnetic resonance imaging studies. Spine J. 2016 Jan 1;16(1):42-8. doi: 10.1016/j.spinee.2015.08.026. Epub 2015 Aug 17.
5 Kundu B, Eli I, Dailey A, Shah LM, Mazur MD. Preoperative Magnetic Resonance Imaging Abnormalities Predict Symptomatic Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion. Cureus. 2021 Aug 18;13(8).
6 Carroll I, Barelka P, Wang CK, et al. A Pilot Cohort Study of the Determinants of Longitudinal Opioid Use After Surgery. Anesth Analg. 2012 Jun 22.
7 Wolf MS et al (2012). Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine; DOI: 10.1007/s11606-012-2096-3
8 Mauskop A, Rothaus KO. Stem Cells in the Treatment of Refractory Chronic Migraines. Case Rep Neurol. 2017 Jun 14;9(2):149-155. doi: 10.1159/000477393. PubMed PMID: 28690531; PubMed Central PMCID: PMC5498934.
9 Kim KR, Chin DK, Kim KS, Cho YE, Shin DA, Kim KN, Kuh SU. Revision Surgery for a Failed Artificial Disc. Yonsei Medical Journal. 2021 Mar 1;62(3):240.

• SEO Powered Content & PR Distribution. Get Amplified Today.
• PlatoData.Network Vertical Generative Ai. Empower Yourself. Access Here.
• PlatoAiStream. Web3 Intelligence. Knowledge Amplified. Access Here.
• PlatoESG. Automotive / EVs, Carbon, CleanTech, Energy, Environment, Solar, Waste Management. Access Here.
• BlockOffsets. Modernizing Environmental Offset Ownership. Access Here.
• Source: https://stemcellinstitute2.com/many-patients-get-neck-surgery/?utm_source=rss&utm_medium=rss&utm_campaign=many-patients-get-neck-surgery