Is surgery necessary for my cervical spondylosis?

Question

Hello doctor,

I truly appreciate the opportunity to receive your opinion regarding my cervical spine condition. I am a 54-year-old woman diagnosed with cervical spondylosis and spinal canal stenosis at the C5/C6 level, with abutment of the bilateral C6 exiting nerve roots.

Approximately two months ago, I experienced severe pain in my right shoulder and neck. Fortunately, that pain has since subsided. However, I continue to experience numbness and weakness in my left hand.

My surgeon has recommended a total disc replacement at C5/C6. Given my history of unprovoked DVT, I understand there are certain risks associated with the procedure. I would be very grateful to hear your perspective.

Should I proceed with the surgery?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I completely understand your concerns.

Cervical spondylosis with canal stenosis and nerve root abutment (age-related wear and tear in the neck (cervical spine) that causes narrowing of the spinal canal (stenosis) and pressure or contact with nearby spinal nerves (nerve root abutment)). It can contribute to the symptoms you are experiencing. It is a positive sign that your severe pain has improved, but the ongoing numbness and weakness in your left hand indicate that there may still be nerve compression, which does not always resolve on its own.

Total disc replacement (a surgical procedure where a damaged or degenerated spinal disc is removed and replaced with an artificial disc) at the C5/C6 level is typically considered when conservative treatments have not been effective and there are signs of neurological involvement, such as the weakness you are reporting. However, your history of unprovoked deep vein thrombosis (DVT) (a condition where a blood clot forms in a deep vein, usually in the legs) does raise important considerations, particularly regarding the risks associated with anesthesia and the postoperative period of reduced mobility.

Given these factors, I strongly recommend a thorough discussion with both your orthopedic surgeon and a hematologist. This will help assess your clotting risk and develop a clear plan for managing anticoagulation around the time of surgery, if it is pursued.

If your current symptoms are stable and not progressing, and you are functioning reasonably well, it may be appropriate to continue with a conservative approach. This could include physiotherapy, close monitoring of nerve function, and possibly nerve conduction studies. However, if the weakness worsens, surgical intervention may become necessary, despite the associated risks. In that case, balancing the goal of nerve preservation with careful clotting risk management will be crucial.

I hope this helps.

Kindly revert if there is any query.