]This is an audio clip from Dr. Darrow’s weekly radio show.

Dr. Darrow is responding to a person’s email asking about her husband.

He is now in so much pain. The the worst is waking up. The pain is horrible but he gets up and goes to work. He gets no help with his pain. Please is there anything that can be done to assist him, he has been living with this for years and is getting worse since the surgery can you please help? So this is a cry for help because of a failed surgery.

I think the key points here are that number one:

  • This gentleman had cervical degenerative disc disease and this poor guy had a neck surgery for it and had a disc removed from his neck. I’m not sure what good that did because he’s in worse pain now. I see this all the time where people come in and have discectomy is and they’re worse. Sometimes the surgeon will put in what’s called a spacer or some type of plastic or metal device between the vertebrae to take the place of the disc they removed. Now some of these surgeries must work very well or they couldn’t keep doing them but I get cases where the surgery didn’t work. Should there ever be a surgery done for degenerative disc disease. In my position, here in the patients I see and the work that I do of regenerating the body, regrowing tissue by doing injections of platelets or stem cells or mixed together that we seem to get people better who have degenerative disc disease.

Not relying on MRI

  • I see many people with degenerative disc disease that don’t have any pain. So I’m not going to trust an x-ray or MRI to decide for me if the person has pain. I know this is a mind-bender for a lot of people because we grew up thinking that if we see something on an MRI or an x-ray that must be the truth of who we are and it just is not the case. It is difficult sometimes to  explain to new patients who come in that what they see on MRI and what they really have can be two different things. Studies show that people that have no pain at all can have terrible things in their MRIs and X-rays and vice versa, they can have terrible pain and their MRI or x-ray shows nothing. We have to be very careful, as doctors to remember to use our hands so as doctors we need to touch the area, move the person around, find out where the pain is being generated from.

The failed surgery

  • It is possible in this case that we discectomy in this man’s neck which was a surgery that in my book should never have been done.
  • Discectomy is a drastic surgery. It removes a disc to get rid of neck pain or back pain and in this case it didn’t work. I get patients like this all the time. They come in after these failed surgeries, failed meaning surgery was done and it didn’t work, now with a diagnosis of failed shoulder surgery, failed hip surgery, failed neck or back surgery. What do these recognized diagnosis tags tell you? That way too many of these surgeries are being done and they are failing people. These failed surgeries should have never been done in the first place.

How can this person be helped?

  • Regenerative medicine using platelets and stem cells are typically the answer for how to heal these areas. These treatments do not work all the time, but I am saying is that the landscape of medicine in musculoskeletal and orthopedics is totally changing from doing surgery to regenerating the body. The easy part about doing regenerative medicine is it’s a very simple injection process we don’t have to open up the body with a scalpel of the side effects are very minimal if any very rare to have side effects if possible that’s very rare wear a surgery there are many side effects.

In a person with failed neck surgery, we would have to examine the neck and as mentioned above, physically find the spots in the neck that is causing this person’s pain. Then we could develop a program to help alleviate the pain and restore function. Failure rate for neck surgery is considered low by some and more frequent by others. Secondary or revision surgery is usually considered as a last resort.

The failure of Cervical Total Disc Replacement

A March 2021 study (1) presented the experiences of doctors at the Department of Neurosurgery, at International St. Mary’s Hospital  with failures in Cervical-Total Disc Replacement and revision surgery outcomes.

The doctors “retrospectively examined patients who underwent revision surgery due to the failure of Cervical-Total Disc Replacement between May 2005 to March 2019. Thirteen patients (8 males and 5 females) were included in this study. The mean age was 46.1 years (range: 22-61 years), and the average follow-up period was 19.5 months (range: 12-64 months).

Results: The main complaints of patients were posterior neck pain (77%), radiculopathy (62%), and/or myelopathy (62%). The causes of failure of C-TDR were improper indications for the procedure, osteolysis and mobile implant use, inappropriate techniques, and postoperative infection. The most common surgical level was C5-6, followed by C4-5.

Cervical-Total Disc Replacement is good surgical option. However, it is very important to adhere to strict surgical indications and contraindications to avoid failure of Cervical-Total Disc Replacement.

References

1 Kim KR, Chin DK, Kim KS, Cho YE, Shin DA, Kim KN, Kuh SU. Revision Surgery for a Failed Artificial Disc. Yonsei Medical Journal. 2021 Mar 1;62(3):240.

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