Cervical Adjacent Segment Disease Relief with Fibrin: How a Retired Army Crew Chief Avoided Revision Fusion

A 48-year-old retired Army helicopter crew chief with cervical adjacent segment disease at C4-C5 and C6-C7 above a prior C5-C6 fusion reduced neck pain from 7/10 to 3/10, regained driving tolerance past one hour, and avoided revision multi-level fusion after intra-annular fibrin injection at ValorSpine.

This case is part of ValorSpine’s Cervical Spine and Neck Pain resource cluster, which documents how patients with chronic neck conditions evaluate biologic disc repair as an alternative to revision surgery. It also fits within our broader work on spinal fusion alternatives, where adjacent segment disease is one of the clearest examples of why patients increasingly seek non-surgical paths.

Context and Baseline

The patient served 15 years as an Army helicopter crew chief, accumulating thousands of flight hours in cramped cockpits with sustained whole-body vibration, heavy helmet load, and prolonged awkward neck postures. Years after medical retirement, he underwent an anterior cervical discectomy and fusion at C5-C6 for a herniated disc with radiculopathy. The fusion initially relieved his arm symptoms, but within four years he developed new, progressive axial neck pain and stiffness above and below the fused segment.

By the time he presented to ValorSpine, his average neck pain was 6-7 out of 10, with episodes radiating into the trapezius and interscapular region. Imaging showed degenerative changes and suspected annular compromise at C4-C5 and C6-C7, the segments immediately adjacent to his fusion. Driving was limited to 30 minutes before pain forced him to stop. Sleep was fragmented; he could not find a neutral neck position for more than two hours. He had been told the next step was a revision multi-level cervical fusion. Adjacent segment disease is a recognized consequence of fusion, with revision surgery rates that can exceed 20% within ten years, and he had no interest in extending the fused construct further.

Baseline Metrics

• Neck pain (VAS-equivalent): 6-7/10 daily, peaks at 8/10
• Driving tolerance: 30 minutes maximum
• Continuous sleep: under 2 hours per stretch
• Daily medication: NSAIDs, muscle relaxants, intermittent neuropathic agents
• Work status: medically retired, unable to sustain desk work
• Prior interventions: C5-C6 fusion, multiple cervical epidural steroid injections, 12+ months of physical therapy, chiropractic care, chronic pain management program

Approach

The clinical question was not whether the patient had cervical degeneration; imaging made that obvious. The question was whether his pain was discogenic at C4-C5 and C6-C7, or whether facet joints, myofascial structures, or hardware-related factors were the dominant generator. That distinction determines whether biologic disc repair is appropriate. Epidural steroid injections had failed, which is consistent with AAFP findings that epidural steroids are not effective for chronic axial low back or neck pain in isolation, and PT had reached a plateau.

The diagnostic plan combined high-resolution cervical MRI with provocative cervical discography. Discography confirmed concordant pain reproduction at C4-C5 and C6-C7 with intact patterns at non-adjacent levels. MRI demonstrated annular tears and Modic-type endplate changes at the same two segments. With discogenic pain confirmed at the adjacent segments, intra-annular fibrin injection became a defensible biologic alternative to extending his fusion. ValorSpine reviewed the data with the patient using the framework outlined in our guides on how to talk to a surgeon about non-surgical options and how to evaluate spine treatment options.

Implementation

The procedure was performed as an outpatient intra-annular fibrin injection under fluoroscopic guidance, with light sedation. A fibrin biomaterial was delivered into the identified annular tears at C4-C5 and C6-C7. Total procedure time was approximately one hour. The patient was monitored briefly and discharged the same day.

Recovery followed a structured protocol:

• Weeks 0-2: reduced activity, no overhead lifting, no prolonged seated computer work, neutral cervical positioning during sleep
• Weeks 2-6: gradual return to activities of daily living, isometric deep neck flexor work, scapular stabilization
• Months 2-4: progressive cervical and thoracic mobility, postural retraining specific to seated and driving postures
• Months 4-12: continued strengthening, monitoring for any change in symptom pattern at the fused or adjacent segments

The patient was educated that biologic disc repair is a regenerative process. Fibrin clinical data shows VAS pain scores moving from 72.4 mm at baseline to 33.0 mm at 104 weeks, with meaningful gains accruing across months rather than days. He was also told that, in the failed-back-surgery population, 80% of patients reported positive outcomes after fibrin injection, which framed realistic expectations for someone with prior fusion.

Results

Pain

• Average neck pain at 8 weeks: 4-5/10 (down from 6-7/10)
• Average neck pain at 6 months: 3/10, with peaks at 4/10
• Interscapular radiation: substantially reduced; no longer daily

Function

• Driving tolerance: 60+ minutes by month 3 (up from 30 minutes)
• Sleep: continuous stretches of 5-6 hours by month 4
• Work: returned to part-time desk-based work by month 6
• Recreation: resumed daily dog walks and light gardening

Medication and Surgery Avoidance

• Off daily NSAIDs, muscle relaxants, and neuropathic agents by month 6
• Revision multi-level cervical fusion was not pursued

The patient described the change as life-altering rather than cosmetic. The cervical spine was not restored to a pre-injury state, and that was never the goal. The goal was to restore enough structural competence at the adjacent segments to break the pain cycle and avoid extending the fused construct, which is the failure mode every adjacent-segment patient is trying to escape.

Lessons Learned

Three points stand out from this case.

Adjacent segment disease is a candidate condition, not a contraindication. Prior fusion does not disqualify a patient from biologic disc repair at the adjacent levels, provided the discs above and below show concordant discogenic pain on provocative testing and intact-enough annular architecture to hold an injection. The same logic underpins our published adjacent segment disease fibrin case study in the lumbar spine.

Provocative discography earned its keep. MRI alone would have shown degeneration at multiple levels, including non-painful ones. Without concordant discography, the treatment plan would have been less precise and the outcome less defensible. This mirrors the diagnostic discipline described in our veteran annular tear fibrin case study.

The patient’s prior surgical experience shaped expectations. Patients who have already been through a fusion are skeptical of any procedure that promises rapid relief. Framing fibrin as a months-long regenerative process, with documented satisfaction rates of 70% at 2-plus year follow-up, was more persuasive than any short-term claim. For patients newer to this decision, our consultation preparation guide covers the questions that matter most.

Transparency: What We Would Watch or Do Differently

• Longer pre-procedure conditioning. An additional 4-6 weeks of targeted deep neck flexor work before injection would likely have improved early-phase comfort.
• Earlier ergonomic intervention. The patient’s home workstation was a meaningful contributor to his symptom load; addressing it before, rather than during, recovery would have shortened the rehab arc.
• Open question at the fused level. Fibrin was delivered at C4-C5 and C6-C7 only. The fused C5-C6 segment was not addressed. Long-term surveillance imaging is appropriate to monitor for any new changes at remaining motion segments.
• Patient selection rigor. This outcome depended on confirmed discogenic pain. We do not generalize this result to patients whose pain is primarily facet-mediated, myofascial, or stenotic.

Veteran-Specific Context

Cervical spine injuries are common in service populations. More than 50% of soldiers experience low back pain during service, 65.6% of veterans report pain in the past 3 months, and veterans have a 40% greater rate of severe pain compared with non-veterans. Aviation roles compound these rates because of helmet load and vibration exposure. Adjacent segment disease after cervical fusion is a recurring presentation in this population, and patients who have already absorbed one surgical recovery are often the least willing to accept another.

Frequently Asked Questions

Is intra-annular fibrin injection a substitute for cervical fusion?

It is not a substitute for fusion in cases of frank instability, severe stenosis with myelopathy, or progressive neurologic deficit. It is an alternative for patients with discogenic pain from annular tears, including at segments adjacent to a prior fusion, when the disc still has enough structural integrity to support a biologic repair.

Can fibrin be injected directly into a fused level?

No. A fused segment has no mobile disc to repair. Fibrin is targeted at adjacent levels with confirmed annular pathology, which is exactly the pattern that drives adjacent segment disease.

How long until results appear?

Most patients notice initial change between 8 and 12 weeks, with continued improvement across 6 to 12 months. Published fibrin data show VAS pain scores improving from 72.4 mm at baseline to 33.0 mm at 104 weeks, indicating durable rather than transient relief.

Why did epidural steroid injections fail this patient?

Epidural steroids reduce inflammation around irritated nerves but do not repair structural disc damage. AAFP reviews find epidural steroids are not effective for chronic axial pain in isolation, which is consistent with this patient’s experience.

What is the realistic chance of avoiding revision fusion after this procedure?

Outcomes vary by anatomy and adherence. In the failed-back-surgery population, 80% of patients reported positive outcomes after fibrin injection, and 70% reported satisfaction at 2-plus year follow-up. These numbers come from peer-reviewed cohort data and are the best available benchmarks, not guarantees for any individual patient.

Sources and Further Reading

• Peer-reviewed clinical literature on intra-annular fibrin injection — VAS, satisfaction, and failed-back-surgery outcome data
• American Academy of Family Physicians — systematic review of epidural steroid injection effectiveness for chronic axial pain
• U.S. Department of Veterans Affairs — published prevalence and severity statistics for veteran pain populations
• Journal of Neurosurgery — adjacent segment disease incidence and revision surgery rates following cervical fusion
• National Institute of Neurological Disorders and Stroke — overview of cervical spine pathology and conservative care benchmarks

Considering Your Own Cervical Adjacent Segment Decision?

Veterans deserve specialized spine care. Contact ValorSpine to learn about your treatment options. For broader background, see our spine treatment recovery FAQ and the cervical spine and neck pain pillar.