Cervical spine fusion

Hi, I have had RA now for 40+ years and have had several operations in that time. I have both wrists fused, a total elbow replacement and are having Infliximab infusions every 6 weeks. I take Mtx and other anti-Inflammatories and pain relief drugs. I had a MRI recently on my spine due to excessive pain in my neck which I have had for a couple of years and although I kept telling my Rheumy nurse of this pain she seemed to be reluctant to do anything about it until more recently. They have found that I have excessive wear in the cervical area and the discs are almost non existent. So the cervical vertebrae are bone on bone with spur extensions that are putting pressure on the spinal cord. I have been offered a full cervical fusion or a series of injections first to see if this will relieve some of the pain. I have accepted the injections as I am hoping that this will give me the relief I need without having to have this dramatic operation which will make my neck rigid. I guess that in time I will have to have this op' as I believe the injections will only be a temporary measure and will not last indefinitely. Has anyone else been faced with this decision and what was the outcome. I would love to hear your experiences. Thank you, Brian

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14 Replies

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  • Hi Brian,

    sorry to hear about your spinal problems. I hope you manage to get things sorted. Hopefully there are other people on here who can share experiences. Take care of yourself,

    Beverley (NRAS helpline)

  • Thank you very much Beverley. I am sure it will get sorted in time.

  • Hi Brian

    I have DDD, which is unrelated to RA (apparently), but had to have surgery on my cervical spine. I had what's called a laminectomy which is where they remove some of the bone from the back of the vertebra to relieve the pressure that was being exerted on to my spinal cord by a massively prolapsed disc.

    As part of this surgery they usually do a fusion to help provide extra support to compensate for the missing bone, however I escaped this particular aspect of the procedure as my vertebrae had auto-fused. It was totally news to me, I don't even get any pain in my neck!

    I imagine this would 'feel' quite different from a surgical fusion, but don't know for sure.

    I have also had 5 nerve ganglion root block injections. There are different types of injection (which is why I'm being specific). I've had them mainly in my lumbar spine, and for me they have been very effective.

    Observations: they aren't effective for everyone, it depends on a few things such as what the cause of the pain is, how well they are performed (under general and guided by X-ray = good) and pure Lady Luck it seems.

    With regards fusions, there are lots of horror stories about spinal fusions, sometimes they don't work, sometimes they make things worse, sometimes they work for a bit and then fail (broken screws etc), etc, etc.

    I was possibly going to need a third surgery on my spine which would have involved a fusion, and even my surgeon said we are desperately trying to avoid it.

    On the other hand, they can be effective and sometimes there is no option.

    If I was you I would definitely go with injections first (I was told they get more effective the more you have), and if you get an opportunity in between see if there's any physical therapy you can do (improves outcomes).

    And knowing what I know now about spine surgery and outcomes I would be asking the surgeon lots of questions about risk, options, need, their own record with this surgery etc.

    There are also some rare and very serious risks which I'm sure you can imagine.

    Not trying to scare you, but it's not like a wrist fusion (for example), the risks are far higher, but then the 'not doing anything' option may not be a realistic one.

    Good luck.

    Ade

  • Thank you very much Ade for your very descriptive reply. It is very useful to know other experiences. You are right that there are a great number of risks attached to any procedures to the spine and I was told a few of these at my consultation with the specialist. I suppose one has to weigh up the pros and the cons and decide if the options will do the job and stop the pain. Thank you once again, I am very grateful for your reply and wish you well. Brian

  • You're most welcome, have to put all this new-found experience to good use. 😀

    For what it's worth I didn't have much choice regarding surgery, I literally couldn't move my feet. But, I am as pleased as I can be under the circumstances. I was careful to pick a good surgeon too.

    All the best.

    Ade

  • Hi Kai, thank you very much for the two links to cervical spine infusion.

  • In 2002 I had my cervical spine fused from C3-C6. My neck vertebrae had subluxed, i.e. staircase effect, and were chaffing my spinal cord giving me all sorts of symptoms I thought I had MS. I was told I had no choice but to have my neck fused as I could trip and fall and either end up paralysed from C3 down or dead. Obviously I took their advice and had the surgery. Not had any problems with my neck since.

  • Hi BoneyC thank you very much for your reply. You were certainly very brave when faced with this scenario but obviously one you couldn't ignore. How restricted are you regarding the fusion of your neck? I understand from seeing the MRI scan of my neck that from C2 to C6 have extended spurs and the discs are virtually non-existent which is causing pressure on the cord. Thank you again Brian

  • My neck is pretty much rigid, but slight left to right movement and slight up and down, i.e. I cannot give a nod to driver's who give way, I have to wave instead.

    I was told my atlanto-axial joint at the top was virtually fused by RA anyway. My MRI images showed virtually no spinal fluid down the sides of my cord and my cord looked like badly made sausages, bulging everywhere. It was where the vertebrae had subluxed that the chaffing of my cord occurred, giving me numerous symptoms, i.e. extreme fatigure (not just RA fatigue), I was sleeping on and off throughout the day; my legs shook as if I had MS or Parkinsons etc. The first symptom was very intermittent tingling down my arms which I ignored at first, but it gradually increased and more symptoms began.

    I've had RA 45 years since childhood and all my adult life so DVLA had already noted on my licence "requires suitably adjusted mirrors" from when I had my provisional. Neck fusion didn't make any difference to that, so you ought to be able to continue driving.

    My surgeon told me not to stretch up with both arms in the air and not to bend down and lift heavy items which I can't do anyway because of other joints. I have to say my neurosurgery was probably the most successful I've had to date. I would have thought if your neck is really bad they would offer you surgery asap and not bother with injections, but they know best. Good luck with yours.

  • Thank you so much for your very descriptive answer. Yes they did offer surgery but also the option to try injections first to relieve pain. I have had injections in fingers before which has relieved pain for a time but it returns. Your situation must have been far more critical than mine. You have obviously been through really tough times. I do hope you get relief soon. Thank you once again.

  • Hi Brian,

    You have certainly had your fair share of things on your RA journey. I was told last year that I need a cervical decompression operation I think from C3 to C7 but unfortunately at that time my legs and feet were badly swollen and I was awaiting tests a cardiology so decided to leave things until I got results etc.I have been getting one thing after another since July 2015 and had my RA meds stopped and started several times since then. I had been on Methotrexate since 2001but it affected the liver eventually, I had also been on once a month injections of Simponi(Golimumab) but was not working without Methotrexate.

    I had an ultrasound done on my liver and end of March 2015 they removed Gallbladder thinking that was the cause as I had gallstones. I was to try a new biologic injection but after two injections either got an infection or other problem so it had to be stopped. I have had nothing for the pain apart from co-codamol since March last year. It had taken a while but they now suspect PBC and I am awaiting a liver biopsy to confirm. Once again they stopped the injection (etanercept/Benepali) about three weeks ago and I was given a short course of prednisolone, which has helped take down swelling in legs and feet, only problem is once I start going down on prednisolone and get past 15mg it all starts to swell again.

    I thought I might be offered the injections for my neck but he said no I needed the operation and only had 3 years before it became dangerous. I didn't question him at that time. Hopefully you will do ok on the injections. I am guessing they were cortisone; which I just had in my wrists to no avail as a week later pains just as bad but then I have Ulnar drift which is gradually getting worse with no treatment.

    Its sometimes a case of having to wait for one thing before they can do another. Sorry for long drawn out explanation.

    I wish you all the best and hope things go ok for you

    Dee

  • Hi Dee you have certainly come to the right place by joining NRAS. There are lots of lovely people on here from all over the world. Together we have a wealth of experience in RA. It seems you have really gone through it and I really feel for you. It is an awful disease and one I would not wish on my worse enemy. I have just had an injection just over a week ago now and I guess I am beginning to feel the benefit of it. I am due to have my Infliximab fusion again in a couple of weeks and that I really look forward to as it keeps me going. Thank you for your kind words and do hope you get a lot of relief after your surgery. Do let us all know how you get on and I wish you a speedy relief and recovery. Regards Brian

  • Hi Brian

    Thank you very much for your reply and yes from what I have read and your kind words, I feel that this site is one of mutual support and as we all have our own journeys with this disease; support is a very important requirement to enable us to get through.

    As I said I am waiting for the liver biopsy first, once I have a result maybe they can sort out some medication, which I am really desperately in need of, the pain and fatigue is at an all time high! Then the rheumatologist has promised he will refer me back to get my neck done. This past two years has been both an emotional and physical roller coaster that I dearly wish to see an end to.

    I will keep you informed and I am hoping I won't be waiting too long for the biopsy. Thank you again for your kind words. Take care yourself.

    Kind regards

    Dee x

  • Brian I had a neck fusion back in 2000 thinking that was the problem for my pain and it was not a good

    Operation. Then 2 months later I was diagnosed with RA. During all this time I went to pain management and used every procedure medication etc to relieve the horrible headaches nausea etc. then I discovered a chiropractic specialist who only workspace The first two vertebrae in my neck. It is amazing. He actually thru this procedure straightened my back at the time. I don't know where you live but there is only two of these specialists in NC and I was driving to Atlanta GA which was 4 hours away just to get relief. I am on no more mess for my neck and the headaches are gone. I could not go to a regular chiropractor since they really don't work with the c1 and c2

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