Double Disc Trouble

A pain in the neck. For Ken Levine, that’s no mere figure of speech. Levine knows all about neck pain. His painful odyssey began in 2004, when he was only 46.

Levine moved to Sarasota from St. Petersburg in 1974 after accepting the position of service manager at Sarasota Chrysler—a job he still holds today. At 6'1" and 215 pounds, he describes himself as being in “pretty good shape.” In his free time, Levine is almost always near the water—or under it. His passion is scuba diving; for him, it’s both exercise and a plunge into a different world. Living his healthy lifestyle, he never expected to enter a world of pain.

And then it started. At first, it was only a mild spasm in his neck. “It seemed to come out of nowhere,” he relates. A few weeks later, Levine’s left arm started to feel numb. He found it harder and harder to hold his head up without pain.

Within a few months, the pain and numbness were constant. “I don’t even have the words to describe it,” he says. “The pain was there all the time—standing, sitting or sleeping. It was constant.”

Levine knew one thing for certain. He had to do something about the pain.

A colleague recommended Dr. Ryan Glasser, a board-certified neurosurgeon known for helping people with cervical (neck) disc problems.

Glasser felt that the likely cause of Levine’s pain was a herniated disc in his lower neck. A battery of diagnostic tests, including X-rays and magnetic resonance imaging (MRI), eventually confirmed Glasser’s suspicions. A herniated lower neck disc was exactly what he found.

And now, a few words about the spine.

In layman’s terms, spinal discs function as natural shock absorbers separating the sharp bones of the vertebrae. As a disc degenerates, it compresses and loses its effectiveness as a shock absorber. The bones on either side move closer together, sometimes leading to bone spurs and pinched nerves. A “herniated” disc occurs when a disc’s spongy inner material bulges out through the gap. If that material presses on a nerve, it can cause pain, loss of feeling and weakness. Bottom line? If you’re feeling severe neck pain, a herniated cervical disc is often the cause. In Levine’s case, it was.

What caused the herniation in the first place?

“The truth is, we don’t always know,” says Glasser. “The cause can stem from disease, injury or from the aging process.” He adds that the condition can arise spontaneously. “Some people turn the wrong way in their sleep and wake up with a problem.”

To fix the problem, Glasser began with a non-invasive approach involving physical therapy and medication. “Generally, I’ll start conservatively and then wait and watch. Unfortunately, in Ken’s case, these methods didn’t really help.”

Levine agrees. “The pain medication and therapy only dulled the pain. I just couldn’t get any real relief.”

Next, Glasser performed a nerve block, a procedure during which a tube is inserted into the painful region and anti-inflammatory steroids are injected into the tube. Nerve blocks can relieve pain, but they do nothing to treat the root cause.

That didn’t work, either. Levine felt a few days of temporary relief. Then his pain level climbed back to high. Glasser decided it was time for more aggressive action.

The standard approach to fix a herniated disc is an anterior cervical discectomy with fusion (ACDF). The surgeon solves the problem of a deteriorated disc by removing it and replacing it with a small piece of bone from a bone bank. Once the disc is gone, the two vertebrae on either side no longer rub together because they fuse together after surgery. Sometimes, only the bone graft is needed to make that happen. At other times, the surgeon will lock the discs together with screws and metal plates.

 The upside of spinal fusion is loss of pain for many patients. The downside? Depending on where the disc is located, a loss of flexibility and range of motion. In Levine’s case, since the damaged disc was located at the bottom of his neck, where movement is minimal, an ACDF procedure made sense.

A few days later, Glasser performed the hour-long fusion surgery. Glasser’s only concern was that, during surgery, he had noticed that Levine had a bone spur in a nearby disc. He knew it could cause problems down the line.

When Levine woke up from the surgery, he realized that for the first time in months, he was pain free. “I’ll never forget how that felt. Suddenly, all the pain was…just gone. It was liberating.” Within two days, he was back at work. The procedure had been a total success. Levine didn’t even experience a loss in his range of motion. “I was completely cured,” he says. “Dr. Glasser told me he hoped he’d never have to see me again.”

And that’s how it stayed for four years.

Then, in 2008, Levine began to feel pain in his right shoulder and upper back. Within weeks, the pain became intolerable. “It felt like there was a flaming harpoon in my back,” he says. “It finally got to the point where I had to hold one arm over my head just to relieve the pain—and I had to do it all the time!” And he means that literally: Levine drove, slept and worked with one arm propped awkwardly over his head. Once again, he found himself popping pain pills 24 hours a day. “I was a mess,” he says.

Within a few weeks, Levine was back in Dr. Glasser’s office.

“I knew the moment he walked in what was wrong with him,” says Glasser. “He had one arm over his head—very typical posture for someone suffering from a bone spur that’s rubbing on the nerve root and irritating it.” Glasser notes that bone spurs are collections of calcium that can eventually interfere with the vertebral openings and create pinched nerves in the spinal cord. When a spinal bone spur irritates a nerve root, the symptoms resemble those of a herniated neck disc: numbness, shoulder and neck pain and weakness in the arms.

Once again, Glasser prescribed physical therapy and a wait-and-watch approach. It didn’t help. He called Levine in for another conference. It was time to make a critical decision.

First, Glasser explained why an ACDF wasn’t the answer for Levine’s latest problems. Because the damaged disc was located near the fusion site, it would put more stress on the normal disc between the fused disc and the damaged disc, and result in a severely limited range of motion. But there was a better option.

Glasser told Levine about a relatively new procedure in which the surgeon replaces the damaged spinal disc with a high-tech artificial disc designed for flexibility. This procedure eliminates loss of mobility without putting any stress on nearby discs.

“Cervical artificial disc surgery is an exciting alternative to standard cervical fusion,” says Glasser. “It doesn’t require bone grafting and allows for normal neck motion. The patient can move the neck without limitations immediately after surgery, shortening the recovery process.”

Although this procedure had been performed in Europe for the past decade, it wasn’t approved for use in the United States until 2007. Still, its success rates were excellent. It’s an effective treatment for a range of disc problems, including degenerative disc disease, unresponsive osteophyte formation and disc herniation. To Glasser, Levine was the ideal candidate.

“This technique was perfect for Ken,” he says. “His age and good state of health were also factors.”

Levine’s artificial disc surgery took place at the Spine Care Center at Doctors Hospital of Sarasota a few weeks later. First, Glasser removed the damaged disc. Next, he replaced it with a two-piece, ball-and-groove device resembling something out of the Bionic Man—the Prestige Cervical Disk, designed to flex and move with the rest of the spine. Glasser secured the shining steel device in place with a locking screw mechanism. The operation took an hour and a half.

When Levine woke up in the recovery room, he was—again—pain free. “It’s like someone turned the switch off,” he says. “I was back to normal.” The next day, he went home. The following day, he returned to work.

He did, however, suffer from the effects of withdrawing from the heavy-duty pain pills he had been on. “I had the jitters for a month,” he says. “Now everything’s back to normal.”

Levine has gone back to thoroughly enjoying his work and his time away from work. Throughout his two ordeals, he had never stopped scuba diving, but the pain interfered with the sense of pure freedom he loved about diving. Today, Levine remains pain-free—and diving is the only thing he’s hooked on. The free-floating undersea tranquility is back, all thanks to a shiny metal device that resembles a prop from The Terminator.

“I’m glad I took the plunge,” Levine says. “There’s nothing like losing your well-being to make you appreciate it when you get it back.”

 

Resources:

Prestige Cervical Disc: www.prestigedisc.com

Dr. Ryan Glasser: Neurosurgery & Spine Specialists, 5831 Bee Ridge Road, Ste. 100; (941) 308-5700

Spine Care Center at Doctors Hospital of Sarasota, 5731 Bee Ridge Road, Sarasota; (941) 342-3375; www.doctorsofsarasota.com

 

About Cervical Herniated Discs

Causes

As we age, the discs in our spines can lose their flexibility and elasticity. The ligaments surrounding the discs become brittle and are more easily torn. When a herniated disc occurs, it can put pressure on nearby spinal nerves (radiculopathy) or the spinal cord (myelopathy), causing painful symptoms.

Symptoms

A herniated disc in the neck can cause neck pain, radiating arm pain, shoulder pain, and numbness or tingling in the arm or hand. The quality and type of pain can vary from dull, aching, and difficult to localize to sharp, burning, and easy to pinpoint. Pain in your arms as well as in your neck is usually the first sign that your nerve roots are irritated by a problem in your neck. Symptoms such as numbness, tingling, and especially weakness in the muscles of your arms are warning signs that your problem may be more serious. Weakness in your arms is a definite sign that you should see a doctor about your neck pain.

Risk Factors

The aging process and wear and tear on your spine can cause a herniated disc in the neck. A herniated disc can also be caused by repetitive activities or an injury to the spine.

Source: www.medtronic.com