surgical precision indecision

I am the strangest type of extrovert. While it's true I prefer to talk things out...and talk...and talk...and talk, I also tend to curl up like a pill bug when something is bothering me all deep down or maybe like a cat behind the couch. I actually don't like either of those comparisons but I'm too lazy to do anything about it.

I'm headed into surgery next week for an anterior cervical disc replacement, which is different from an anterior cervical fusion, which is what Peyton Manning received. Twice.

Show off.

I have been chewing on this for weeks. I suppose, if you're struggling with pain and/or tingling and/or numbness in your arms and hands and you're diagnosed with a bulging or herniated disc in the C-section of your spine, this might help you a little.

First, I had to decide. Do I get the surgery or not? This, I handled through a series of questions:

Did physical therapy help? No.
Did two treatments with oral steroids help? No.
Did an epidural shot help? Hell no.
Am I able to work at 100% capacity with this injury? No.
Is the pain unbearable? No.

Ay. And there's the rub. I can totally live with the level of pain I'm experiencing. I mean, when I went in for my surgical consult, I saw people crying in the parking lot because they couldn't stand their pain. There were people who couldn't stand up straight and people who were begging for relief. I am not one of those people. My left hand is numb and I have trouble holding a pen or a fork. But, I can type and, honestly, I could stand to hold a fork a little less. And, I'm fine with chopsticks for some reason. Which isn't the point. I know.

I realized, the sooner I have this fixed, the sooner I can get back to my life. So, there it is. Surgery decision made.

Second, I had to decide whether I would get a fusion or a disc replacement. This wasn't as black and white as the decision to have surgery. I consulted with my surgeon again. I went online and read about the differences between the two procedures. I talked with an orthopedic doctor. I talked to the guy who cut my hair into a mullet. I read insurance reports and clinical trial data. I talked to people who have had similar operations. I watched YouTube videos (no, I'm not linking anything here...too graphic and as my operation date approaches I'm starting to freak out so I don't even want to see them).

What I learned about fusion vs disc replacement is that they are super similar procedures. For both, the surgeon will make a horizontal incision across my throat (which is so badass I almost can't wait for that scar); he will perform a discectomy (which is a fancy way of saying he'll scrape out the schmootz between my vertebrae); he will insert something between the two vertebrae; he will drill a plate to my vertebrae. And that's where the similarities sort of stop. So I made a pros and cons list.

Fusion

• The surgeon inserts a piece of cadaver bone between the vertebrae. (PRO!)
• The bone fuses everything together. (CON!)
• I could be susceptible to adjacent segment disease because of the pressure on the discs within the vertebrae surrounding the fusion. (CON!)
• Recovery might be a little longer. (CON!)
• Insurance will pay for the entire procedure. (PRO!)

Disc Replacement

• The surgeon places a sort of mechanism between the vertebrae and drills it in place to the outside of the vertebrae...what? (ProooConnnn? I don't care.)
• Preliminary studies show that maybe there might be some better range of motion after surgery. (Pro)
• Preliminary studies indicate recovery may be faster. (Pro)
• Preliminary studies and the marketing department at the places that manufacture artificial discs indicate and promote that disc replacement can help prevent adjacent segment disease. (Though the information gets a pro, the fact that they're shoving it down my throat while it's entirely unproven makes me want to give it a con on principle.)
• This is so new that I might have complications later, like how all those artificial hips were recalled because people jumped the gun on new technology. And, ew. (CON!)
• In some of the clinical studies and insurance information, I noticed that Cigna (which is not my insurance carrier) will pay for disc replacement but will not pay for disc replacement if a patient has already had a fusion in another section of the spine. This makes me think insurance companies might start writing policy like that. (Pro)
• My insurance will not cover the entire procedure. (CON!)

So. My gut tells me, disc replacement it is. And it's scheduled for Tuesday. I go under the knife next Tuesday. I'll spend one night in the hospital and then head home for hours and hours of Dexter reruns on Netflix.

If you're reading this because you googled disc replacement vs fusion and you ended up here, I hope this information helps you. But, don't beat yourself up over it. If my surgeon called tomorrow and said, "Don't get a disc replacement," I'd be like mkay. I don't know that it makes that big of a difference right now, and the one thing that red-flagged it for me was the Cigna information (bullet #6 above). I'm basing all of this on a feeling that things might trend this way. But, I also wore a poncho in the 8th grade because I thought people would start wearing ponchos, so....grain of salt and all that.

I kind of want to mention one final thing that makes me look like a complete idiot. I knew I had chosen a good surgeon when I called his office to find out more about disc replacements. First of all, he looked up my insurance and contacted the people who make the artificial discs to see if I could get coverage for the procedure. Not his medical associate. Him. Second, he called me himself to talk more about it. He didn't have his medical associate or his nurse call. He called me from his office phone. I've never had that happen before. So, I totally went all Maeby Funke on his ass.