This was originally posted to spine-health.com in 2016. The spine-health.com forums no longer exist, so posting here for posterity.
I’m almost a year out from a C5/6 foraminotomy; in my decision-making leading up to surgery, I found this forum to be quite helpful, and more than anything I was seeking information about cases similar to mine, so I’m posting to pay back the Karma by sharing my story, which hopefully will be useful for the next person making the same decision.
Short version: I am extremely happy with my laminoforaminotomy for a posterior C5/6 herniation, with relatively easy recovery and almost complete resolution of symptoms, though my gut says it isn’t a lifetime fix and I haven’t had my last surgery.
Long version…
I’m male, now 39, 150 lbs, very active (except that I work at a computer all day).
In 2010 (I was 32 at the time), I started having shooting pain radiating into my right arm when I bent my neck in certain ways, particularly bending my neck backwards when I was otherwise bending forward, e.g. when bending over to tie my shoes, reach into the laundry machine, etc. I had no persistent pain and no weakness. MRI confirmed a significant C5/6 protrusion. There was no root cause I could point to; I built up some theories about a bike accident five years earlier, a fall I took when I was a kid, etc. But basically I think it was years of bad posture while working at a computer, and some genetic predisposition (a PT has called me “cartilage-challenged”).
I was treated with an injection, and was fortunate to respond well to the first injection. There were a couple weeks of crushing disappointment, even though everyone told me it can take a few weeks for the injection to work, then about two weeks later everything resolved. I did some PT, and made some lifestyle adjustments, in particular (1) standing instead of sitting at work, and (2) avoiding extensive periods on an exercise bike. I think these changes were hugely important, and the next five years were likely the most active of my life, and – silver lining – because I couldn’t ride the exercise bike any more, I discovered running for the first time, and in those five years I ran three marathons. Thanks, neck injury!
One thing that didn’t go away, or maybe even developed during this period, was a persistent tightness in my neck and upper back, and in particular a frequent desire to crack my neck. It’s hard to say whether this tightness caused the disc issue or vice versa, but they are certainly related. I knew enough to avoid getting my hands involved, but if you hung out with me, you would notice me moving my head around a lot. This was mild and not really a big deal, until ~late 2015, when it got really intense. Not painful, just an intense desire to crack my neck. In retrospect I wish I had been stronger about resisting it, because by early 2016 I was indulging it a little too much, and I believe this led to a regression in the disc situation.
In 2016, I started experiencing some aching in my right shoulder and arm. In particular, *sitting* was a disaster. I could still run (running was great therapy, in fact), and I could sleep fine, but I couldn’t sit in a chair for more than a few minutes. I had to take breaks on drives longer than 20 minutes, I could no longer play piano, and I couldn’t have my kids sit on my lap. The couple of flights I took during this period were absolute torture; I felt like someone was trying to pull my right arm off. PT didn’t help, and this time around injections didn’t help. MRI showed the protrusion had gotten a little worse, and in particular there was some spinal stenosis that was not causing any symptoms, but was utterly terrifying. I literally dreamed of the MRI slice that showed the stenosis most clearly. The surgeon who ordered the MRI this time around immediately recommended disc replacement, which of course freaked me out even more. While he wasn’t way off -base, and this was a legitimate option, I know now that on the spectrum from “conservative” to “cut now, ask questions later”, he definitely leans toward quick recommendations for surgery, and in particular toward disc replacement. I’m glad I continued to seek conservative treatment while talking to other surgeons as well. All the non-surgeons I spoke with recommended waiting, because as long as I wasn’t sitting, I was pain-free, and it’s hard to recommend surgery for someone who walks into your office active and pain-free. Even the other surgeons I spoke with said that surgery was not urgent.
Conservative treatment included PT, two injections, and dry needling, none of which helped at all this time around. The pain continued to progress, though there was still no weakness or issues with sensation. My decision to have surgery came when the pain started occurring when I was lying down, and sleeping became difficult. Right up until the day of my surgery, I was still pain-free when standing and even running, but I could see things were headed downhill, the functional limitations around sitting were adding up, and as many of us on this forum know, poor sleep has a profound impact on quality of life and on the injury itself.
I spoke to several surgeons, and opinions were split among disc replacement, fusion, and foraminotomy/microdiscectomy. Mostly on the grounds that (1) I really trusted the surgeon who recommended foraminotomy, and (2) foraminotomy was the least invasive option available, and had little or no bearing on the eventual success of fusion/replacement if I ended up there, I decided on the foraminotomy.
I’m fortunate to have a surgeon in the area who does minimally-invasive foraminotomies (I’m not sure I would have chosen this option otherwise), so the surgery was very mild in terms of amount of tissue torn up. You wouldn’t notice the incision if I didn’t point it out. The only disappointment wrt the procedure itself was that he was hoping he might get some access to the disc; in fact, there was no way to safely remove any portion of the disc via posterior access. But we know this was likely going in, and the widening of the foramen and removal of some of the lamina were routine and successful.
The first couple weeks of recovery were difficult, and the pain was somewhat worse than before surgery. There was no pain around the incision, but there was a constant aching in my arm and some tingling in my hand, which I had never had before. I was freaking out, of course, but everyone assured me this was a normal consequence of all the surgical irritation around the nerve. That said, despite some pain, I was back at work in about three days with minimal painkillers (I think I averaged one Vicodin a day for about two weeks, then none after that). After about three weeks, the pain started to subside. Once I was cleared for some physical activity, the pain went away within days. So in the grand scheme of surgical recovery, I was really fortunate; this is of course a major advantage of the foraminotomy compared to anything that requires bone healing.
I was running again at three months out, and running long distances at full speed by four months. I got greedy at about 4 months and overdid it with activity (not running, which has never been a problem, but other more bend-y twist-y activities), resulting in a mild setback. Once again, I freaked out, but the pain completely subsided again within a couple weeks.
Now at almost a year out, I’m still at 100%, more or less. The surgeon was honest about not being sure whether the surgery would resolve the tightness/neck-cracking issue; unfortunately, it did not, and I still have tightness and some desire to crack my neck. But it’s mild compared to pre-surgery. I can sit again, which means I can read to my kids, play piano, see movies, travel, etc., though I still experience discomfort (though not quite pain) if I sit for a long time, or sit with my head turned. Every once in a while, I get a very slight hint of pain in my arm or tingling in my finger, just enough to remind me that the herniated disc is still there, we’ve just made some more room for the nerve. Consequently, I don’t think I’m finished with this issue, and may well end up at fusion at some point (which I would choose over disc replacement if I had to do it today). But for the low cost in damage and recovery, I feel really good about the decision to go with a foraminotomy first. And it may just be paranoia worrying about future surgeries; with luck, I’ll live a long and active life with the same very tolerable symptoms I have now. And even if I do end up in surgery again at some point, with disc replacement technology continuously advancing, a minor surgery that delays the major surgery by a few years may pay off on the basis of available options.
Hopefully this story is helpful to someone either (1) considering similar surgical options or (2) recovering and worrying that things aren’t going to improve. I have chosen not to mention specific doctors by name here; I live in the Seattle area (in Bellevue), and I’m happy to discuss providers via private message.
2020 update (four years post-op)
2020 update: I continue to be nearly symptom-free, although that partially reflects the minor lifestyle changes (rarely sitting) that I mention above. I.e., I think if I sat at a desk for a couple days, my arm might get a little tingly. My neck is maybe a tiny bit stiff once in a while, but no radiating symptoms.
