“Four years ago, I experienced a back injury,” recalls Sam Aycoth. “I was lifting weights when I heard something pop.
“A month later, I wound up in the hospital for a week with severe pain. When I checked out, I had numbness running down my right arm into my hand. I had herniated the C5/C6 disc, between the C5/C6 vertebrae, and that was putting pressure on a nerve running down my right arm.”
Sam went to the doctor, but he felt he was being hustled into a surgical suite, and balked at the idea. “I had some unpleasant experiences with neurosurgeons who wanted to cut, cut, cut,” he says.
He tried to tough it out, but eventually had to take action to relieve his pain.
“I ignored the issue for a while, but it got to where the pain was untenable,” Sam says. “I was losing the feeling in my left hand, I already had numbness in my right hand, and I knew I needed to do something about it.”
The pain from Sam’s injury was excruciating at times, he adds.
“I had a feeling like a pulled muscle in my back, a constant painful knot. There were times when I would have rated my pain as an eight on a scale of one to ten. I was unable to jog for probably about two years; riding in a car was painful; and I ride a motorcycle, and right before the surgery I was riding down the road and my entire left arm went completely numb.”
Ultimately, Sam decided he ought to consider surgery, and he consulted Stephane Lavoie, MD, who specializes in spinal disorders and is fellowship-trained in spine surgery.
“My first visit to Dr. Lavoie was in March 2009,” recounts Sam. “I remember I was ready for surgery at that point because I’d gotten to where I was hurting so bad. I was actually a little upset that Dr. Lavoie didn’t want to perform surgery immediately! But he wanted to make sure that surgery was my last option, not my first.
“After going through some physical therapy and a pharmaceutical prescription regimen, we decided that surgery was the correct choice. I had two options at that point: I could have gone through the traditional disc fusion – which I ended up deciding not to do – or I could get an artificial disc.”
Cervical disc replacement
Although surgical fusion may be necessary for some patients, Dr. Lavoie notes that it should be considered only in cases where other options have been ruled out. For Sam, Dr. Lavoie recommended a leading-edge alternative to spinal fusion, cervical disc replacement.
“The advantage of the cervical disc replacement procedure, as opposed to a spinal fusion, is that with this particular operation there is no need to wait for a fusion after the surgery is done,” explains Dr. Lavoie. “Whereas normally we place the bone graft and a plate, with the disc replacement, the soft tissues from the surgery are better after a week or two, allowing for a better early range of motion.”
He adds that, for patients like Sam, there are other compelling reasons to opt for this procedure over a spinal fusion.
“Even though Sam only had one disc that was symptomatic in causing his pain, the discs above and below the surgical site were beginning to show signs of deterioration. If we had performed a fusion, it might have caused increased stresses across the discs above and below, which might have then accelerated that deterioration and down the road caused more problems which would require more surgery. We believe that by preserving the motion at C5/C6, we will at least slow the deterioration of the discs above and below it. So this was a great indication for this particular patient.”
Dr. Lavoie observes that for select patients who have failed conservative treatments, the disc replacement is an appropriate option.
“If you have one disc that is herniated, and the patient does not get better with conservative care – for instance, Sam had physical therapy, multiple spinal injections, and then all the testing with MRI that narrowed it down to that one disc – then we are able to proceed with this procedure. The idea is to take the pressure off the nerve impingement. That’s the first priority.
“Secondly, when the decompression is adequate, the prosthesis is implanted much like a bone graft would be. It’s a little larger, and more accuracy is required in the placement of the prosthesis. With a disc replacement, there’s ongoing range of motion, unlike with a fusion procedure.
“I believe that in the long run we’re going to see fewer patients require another procedure after disc replacement because of the deterioration of discs above and below the surgery,” concludes Dr. Lavoie. “This is something only appropriate for select patients, but for those for whom it is indicated, such as Sam, it’s an excellent choice. We do know that it allows a quicker return to activities: Sam was back in the gym three weeks later, so his return to activities was particularly fast.”
“No limits”
Sam certainly wishes he had undergone the procedure sooner, but he’s glad it worked out so well.
“For me, the surgery was simple,” he says. “I checked in on a Tuesday, and Wednesday morning I walked out the door of the hospital. I was actually able to walk two miles that Friday without stopping.
“I was back at work in nine days, so the recovery was very quick, very painless, and I felt little, if any, pain related to the disc. I had an immediate relief in my back that has actually continued to improve over time.”
Sam’s return to activities of daily living has been a marvel in itself.
“I’ve played tennis since the surgery, I’m back to riding my bike, and I’m even jogging a little,” he lists. “I don’t feel I have any limitations now. I’m able to drive long distances without stopping, so I feel I’m back to about ninety percent of where I was before I injured my back. Most days, I forget I even had an issue.”
Sam is especially appreciative to Dr. Lavoie for the care he put into finding just the right solution for him.
“The thing that impressed me the most is that Dr. Lavoie is an orthopaedic surgeon, but the last thing he wanted to do was operate, which I found very reassuring. With most surgeons, that’s the first thing they want to do. I really felt like he was concerned about the best solution for me. That was a good feeling, a very comfortable feeling.
“This option of using an artificial disc instead of a fusion is certainly something people should consider,” adds Sam. “Your recovery time is very rapid, so it allows you to get back to a more normal lifestyle much faster than with fusion surgery. It was a very good experience overall.”
FHCN – Michael J. Sahno