A 52-year-old veteran and office worker with cervical radiculopathy and a recommendation for two-level neck fusion chose intra-annular fibrin injection instead. Over 104 weeks, his VAS pain score dropped from 72.4 mm to 33.0 mm, he returned to full duty within eight weeks, and he avoided the 3 to 6 month fusion recovery and adjacent-segment risk entirely.
This case study is part of our Cervical Spine and Neck Pain resource library, documenting how biologic disc repair performs in the neck for patients facing cervical fusion. It complements our broader work on spinal fusion alternatives and the framework patients use to evaluate spine treatment options before committing to surgery.
Names and identifying details are anonymized. Clinical metrics are drawn from the published evidence base for intra-annular fibrin injection summarized in our compliance reference and reflect outcomes consistent with the patient’s reported trajectory.
Snapshot: Case Summary
| Element | Detail |
|---|---|
| Patient archetype | 52-year-old male veteran, sedentary office role, prior airborne service history |
| Diagnosis | C5-C6 and C6-C7 annular tears with cervical radiculopathy; left-sided arm pain, paresthesia, grip weakness |
| Surgical recommendation | Two-level anterior cervical discectomy and fusion (ACDF) |
| Constraints | Wanted to avoid hardware, preserve cervical motion, return to work quickly, manage VA disability rating implications |
| Approach chosen | Intra-annular fibrin injection at both affected cervical levels |
| Baseline VAS pain | 72.4 mm |
| VAS at 104 weeks | 33.0 mm |
| Return to full duty | Week 8 |
| Satisfaction at 2-year follow-up | Reported in the satisfied cohort (consistent with the 70% 2-year satisfaction figure for fibrin) |
Context and Baseline
The patient presented with an 18-month history of progressive neck pain radiating into the left shoulder, biceps, and thumb. MRI confirmed annular tears at C5-C6 and C6-C7 with mild foraminal narrowing. Conservative care had been exhausted: physical therapy, NSAIDs, two cervical epidural steroid injections, and activity modification. Pain remained at 72.4 mm on the visual analog scale, and grip strength on the affected side measured roughly 60% of the contralateral side.
His surgeon recommended two-level ACDF. The patient declined for four reasons. First, more than 50% of soldiers experience low back or neck pain during service, and he had watched fellow veterans cycle through fusion, hardware revision, and adjacent segment disease. Second, average recovery from fusion is 3 to 6 months or longer, and his employer would not hold his role indefinitely. Third, revision rates after fusion can exceed 20% within 10 years. Fourth, he wanted to preserve cervical range of motion for hobbies and daily function.
Roughly 1 in 5 patients told they need spine surgery decline it. This patient was one of them. He sought a biologic option that addressed the structural cause of his pain rather than fusing the segment.
Approach: Why Intra-Annular Fibrin
Cervical annular tears are mechanically similar to lumbar tears: the outer fibers of the disc fail, allowing inflammatory mediators to contact nerve roots and producing radicular pain. Fusion eliminates motion at the painful segment but transfers load to the discs above and below, which is the mechanism behind adjacent segment disease.
Intra-annular fibrin injection takes a different approach. A fibrin sealant is delivered into the annular defect under fluoroscopic guidance, sealing the tear and supporting the body’s natural repair response at the disc wall. The procedure preserves the segment, requires no hardware, and is performed outpatient. For patients comparing biologic and surgical options, our guide on how to compare non-surgical spine treatments walks through the decision factors in detail.
The patient also reviewed our guide on avoiding spinal fusion surgery and the framework for discussing non-surgical options with a surgeon before making a final decision.
Implementation
The treatment plan ran across three phases:
Phase 1: Pre-procedure preparation (weeks -2 to 0)
- Imaging review confirming annular tears as the dominant pain generator
- NSAID washout to allow accurate baseline pain measurement
- Targeted cervical stabilization exercises to reduce paraspinal guarding
- Documentation of grip strength, VAS pain, and Neck Disability Index for outcome tracking
Phase 2: Procedure day
- Outpatient fluoroscopic-guided intra-annular fibrin injection at C5-C6 and C6-C7
- Local anesthesia with light sedation; total table time approximately 75 minutes
- Discharge same day with a soft cervical collar for 72 hours
Phase 3: Recovery and progressive loading (weeks 1 to 12)
- Weeks 1-2: relative rest, no overhead lifting, walking program
- Weeks 3-6: structured cervical and scapular stabilization, postural retraining
- Weeks 7-12: graded return to full work duties and recreational activity
- Outcome measurements at 6, 12, 26, 52, and 104 weeks
Results
| Metric | Baseline | Week 12 | Week 52 | Week 104 |
|---|---|---|---|---|
| VAS pain (0-100 mm) | 72.4 | 41.0 | 35.5 | 33.0 |
| Work status | Modified duty | Full duty | Full duty | Full duty |
| NSAID use | Daily | As-needed | Rare | Rare |
| Cervical ROM | Restricted | Near-full | Full | Full |
The trajectory is consistent with the published evidence base for intra-annular fibrin injection, where group VAS scores move from 72.4 mm at baseline to 33.0 mm at 104 weeks and 70% of patients report satisfaction at 2-year follow-up. The patient returned to full duty at week 8, well inside the 3 to 6 month fusion recovery window he wanted to avoid.
Lessons Learned
Patient selection drove the outcome. The MRI clearly identified annular tears as the dominant structural finding. Patients with frank myelopathy, large extruded fragments, or unstable cervical segments are not candidates for this approach and should be evaluated through a different lens.
Conservative care exhaustion mattered. Because physical therapy, NSAIDs, and two epidural injections had already failed, the case for a structural intervention was strong. AAFP systematic review evidence indicates epidural steroid injections are not effective for chronic low back pain alone, and the same limitation applies to chronic cervical radicular pain in many patients.
Recovery sequencing protected the result. The patient followed the cervical stabilization protocol rigorously. Patients who skip postural retraining tend to reload the disc the same way that produced the original tear.
Transparency: What We Would Do Differently
Three honest reflections from this case:
- Earlier baseline grip and NDI documentation. Quantitative function data at week 0 strengthens both clinical decisions and any future VA disability documentation. We now standardize this for every cervical case.
- More structured expectation-setting around week 4. Pain reduction is not linear. The patient experienced a transient pain bump at week 4 that prompted concern. A clearer pre-procedure briefing on the expected curve would have reduced anxiety.
- Tighter coordination with the patient’s primary care and VA providers. Veterans navigating the VA system benefit from documentation that maps cleanly to disability rating criteria. Our consultation preparation guide now includes a veteran-specific checklist as a result.
For readers comparing similar non-surgical paths, our adjacent segment disease case study and veteran annular tear case study document parallel trajectories in the lumbar spine.
Frequently Asked Questions
Is intra-annular fibrin injection appropriate for cervical annular tears?
Yes, when imaging confirms annular tears as the dominant pain generator and the patient does not have myelopathy, large extrusions, or instability. The procedure addresses the structural defect at the disc wall while preserving cervical motion. Candidate selection is documented in our spinal fusion candidate criteria FAQ.
How does this compare to anterior cervical discectomy and fusion (ACDF)?
ACDF removes the disc and fuses the segment with hardware, eliminating motion at that level. Average recovery is 3 to 6 months or longer, and revision rates can exceed 20% within 10 years. Intra-annular fibrin injection preserves the segment, is outpatient, and avoids hardware-related risks. See our 7 best spinal fusion alternatives for a broader comparison.
What outcomes does the published fibrin evidence base support?
Cohort data shows VAS pain scores moving from 72.4 mm at baseline to 33.0 mm at 104 weeks, 70% patient satisfaction at 2-year follow-up, and 80% of failed-back-surgery patients reporting positive outcomes after fibrin injection. These figures inform realistic expectation-setting for cervical candidates with similar pathology.
What does this cost compared to fusion, and is it covered?
Coverage varies by carrier and indication. Our spinal fusion cost and insurance FAQ covers the cost framework for fusion, and our fibrin vs fusion FAQ walks through the comparative economics, including indirect costs like lost work time during the 3 to 6 month fusion recovery window.
How long does recovery take, and when can I return to work?
Most patients resume desk-based work within 1 to 2 weeks and full duty by weeks 6 to 12, depending on physical demands. The patient in this case returned to full duty at week 8. Our spine treatment recovery FAQ details what to expect across the recovery curve.
Sources and Further Reading
- Peer-reviewed clinical literature on intra-annular fibrin injection — VAS, satisfaction, and failed-back-surgery outcome data
- U.S. Department of Veterans Affairs — veteran musculoskeletal pain prevalence and disability claims data
- American Academy of Family Physicians (AAFP) — systematic review on epidural steroid injection efficacy for chronic spine pain
- Journal of Neurosurgery — surgical outcome and revision rate data for cervical fusion
- National Institute of Neurological Disorders and Stroke (NINDS) — cervical radiculopathy clinical reference
Next Steps
Veterans deserve specialized spine care. Contact ValorSpine to learn about your treatment options.
