Question:Mother has severe neck pain that goes down her arm from degenerative disc disease. She's 83 years old and wants to have the surgery her doctor recommended. Is this really advisable at her age?
Answer:There have been many studies done on the results of surgery to treat cervical radiculopathy. Cervical refers to the neck and radiculopathy describes the painful symptoms that travel down the arm.
Surgery for this condition varies depending on the extent of the problem, the condition of the patient, and the preferences of the surgeon. Most often, patients are directed to try a series of noninvasive treatment measures first before considering surgery.
Conservative care usually includes medications (pain relievers, antiinflammatories); physical therapy; or rest, heat, and massage. If a six-month trial of care does not reduce the painful symptoms, then steroid injections may be suggested next. When all else fails and the patient's quality of life is significantly affected, then surgery may be advised.
It may be that your mother has gone through all the steps of conservative care possible. But it's worth asking what has been done so far. If these steps haven't been taken, then there are some options before accepting surgery.
Age is an important factor. Most operations performed for disc herniation are done on patients under the age of 65. Osteoporosis (brittle bones) and general health are always factors when considering surgery in older adults.
When surgery is done for cervical radiculopathy, about 70 to 80 per cent of the patients experience pain relief and improved function. These results occur in the first six to 12 weeks after surgery. However, this also means that 20 to 30 per cent have no improvement or only minimal change in their pain.
It may be best to express your concerns and questions directly to the surgeon. Accompanying your mother to her next appointment can be very helpful. If this is not possible, then a phone call or written communication may help you understand the risks and benefits of the proposed surgery.Eugene J. Carragee, MD, FACS, et al. Treatment of Neck Pain. In Spine. Supplement to February 15, 2008. Vol. 33. No. 4S. Pp. S153-S169.
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