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Lots of questions about ACDF procedure and recovery

AKguyAAKguy Posts: 49
edited 06/11/2012 - 8:23 AM in Back Surgery and Neck Surgery
Pardon the long post, but I figured more background information is probably better than too little. I've posted here before about my lumbar issues which led to a microdiscectomy earlier this year.

Lately I'd noticed numbness in some of my fingers and thumb on the left side, and I've had some degree of neck pain and stiffness off and on for quite a while, but it is worse lately. So I approached my surgeon for an evaluation. He ordered an MRI and nerve conduction testing, so he had more information to go on. He also did a cervical X-ray during that first visit, which showed DDD at three levels.

A few days ago I got his assessment and suggested treatment plan by mail, in advance of meeting with him a week from Monday. I was pretty shocked, since I assumed he'd recommend a course of conservative treatment before diving in to surgery. Here is a summary of his findings:

His review of the MRI scan shows advanced spondylosis at C4-5,C5-6, and C6-7. At C4-5, C5-6 the AP canal dimension is down to 6 mm. There is definite flattening of the cord and loss of cerebrospinal fluid surrounding the cord, and no major signal change that he can determine.

I also have bilateral foraminal stenosis at those three levels (particularly at the top two discs). The AP dimension at C6-7 is about 7 mm. So he is diagnosing advanced degeneration and spondylitic spinal stenosis, central and foraminal.

Nerve conduction testing showed evidence of a chronic, old left C5 radiculopathy (I had shoulder pain and weekness in 2001, and her findings were similar back then). She suggested that C6 sensory issues could be on a central basis, but his clinical exam did not find evidence of myelopathy at this point.

Due to the degree of stenosis, at some point he believes I will develop progressive myelopathy, and I am at increased risk of cord trauma if any high velocity forces are exerted on it. So I guess no more downhill skiing, roller coasters, etc. for me. And hope I don't get in a car accident!

He says at this stage I could be considered for an anterior cervical decompression and fusion at three levels with allograft plate. If I progress to myelopathy, I may require a more extensive posterior decompression and fusion to maximally decompress the cord, which would be more traumatic.

Like I said above, I need to meet with him to get the full scoop, see how soon he would recommend this, etc. Given the nature of the surgery, I will seek a second opinion.

In preparation for my meeting with him, I've got a bunch of questions, some of which I'd like your insights on. Specifically:

1. Has anyone else elected to have surgery in a case like this? I don't have horrible pain, but I don't want the numbness to get worse. And of course I don't want this to progress to myelopathy, which based on other postings sounds horrible.

2. Can anyone clue me in on how long the recovery period usually is for a 3 level ACDF? How long typically in the hospital? How long is the typical time off of work? I work at a desk job in an office.

3. Clearly you'll loose your flexibility at those levels, so after healing, can you turn your head enough to safely drive, etc.?

4. If things go well with an allograft, how long does it typically take to fuse?

5. I've never gotten a second opinion and don't quite know how to go about it. I asked the neurologist who she'd recommend, if it turned out I need surgery, and she recommended I ask the surgeon directly. That way they two of them could discuss the case, and share thoughts about the best way to proceed. My PT also provide the name of someone she recommends, but does my neuro's approach have merit. Any suggestions?

Thanks!



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Comments

  • Hi; first of all I salute you for being so informed and open minded at the same time. I had C4-C7 'done' Jan 2008 I had many of the same problems you do, the stenosis with root and cord compresion etc. but my neck had never hurt they found this by accident. Anyway, he went in from the front (anterior) replaced the disks w/spacers and then did the plate, screws and cadaver graft (my bones are not healthy enough to use for the graft) for the first time in yeras my back did not hurt. I was in less pain in the recovery room than I was before my surgery-
    at my 6 week check up I was allowed to again lift my grandson who weighesd about 20lbs.
    The first 2 weeks are the longest as you need to rest a lot. Your body has been through a lot to deal with and you need the rest to heal faster. If you have that level of compression you need to get it fixed. I put mine off for a year and it was much more involved than it could have been.
    As far as movement goes yes you can drive the most restriction will be in your up & down movement my side to side wasn't hardly affected at all. now with the 2nd surgery I don't know what movement I'll have but you should be good just have them tell you everything no matter how small like can you sleep on a pillow? that was a shocker when the nurse said I couldf not have a piollow at first.
    Hupe this helps a little,
    Ramona
  • Hi- I can relate to your experiences sum what.
    I do have myeolpathy symptoms, and I'm waiting 4 surgery
    My cord is being compressed severely at C6-7 and 2 other areas are touching cord. Myelopathy is very serious and awful.all I can tell you is that once the symptoms start they usually don't get better even with surgery. The surgery usually just stops the progression of the paralysis,
    This is just my opinion have the surgery as soon as you can, because, you don't want to be where I am with the myelopathy.
    You can P.M. any time! Patsy
  • i wish u a sucessful solution to your problems. i have had similar problems and surgery. its great u are making a list to ask questions and concerns, i also do this as i cnat remember things as good anymore. to answer your questions remember this is just my input from my surgery.
    1. ns's told me surgery vs. death.
    2. my recovery as of 13 months is not even close to what i use to do. i was in hosp 6 days. i am on ssdi.
    3. i lost alot of rom and was released to drive about 4 mons post op. i usually turn my shoulders to look and use my wifes eyes for what i cant see. if alone i ususlly limit where i go because of my rom, like not pulling out for a left hand turn with traffic coming both ways- i will turn right and then make a left turn into a parking lot then proceed with a right turn.
    4. my fusion took about 4 mons but at 9 mons there was a 1mm movement.
    5. i talked to 3 ns after mri and had surgery 5 days after mri.
    thats my story and i am sticken to it. ha ha. really i wish u the best. i hope my info helps.
    God bless all
    kc
  • First Hi!!
    I pasted your questions so that I could try to help the best that I could ;)

    REMEMBER these are just are personal experiences/opinions
    Some of us may be in the medical field some way or another but are NOT QUALIFIED to give you direct answers to medical issues as you probably know already. ;)


    1. Has anyone else elected to have surgery in a case like this? I don't have horrible pain, but I don't want the numbness to get worse. And of course I don't want this to progress to myelopathy, which based on other postings sounds horrible.

    **ANSWER: I elected to have surgery. I did not have alot of pain either in my neck. I could not turn my neck all the way. My gait was off. I had horrible numbness and tingling in my left arm. I also would get severe headaches.After reading about perm nerve damage in some people from waiting so long. I went full force and had surgery within 2 weeks of my visit with my ortho. I'm VERY PLEASED with the outcome. All symtpoms gone!!! Mabye because I did not hold off?? Im not sure and I will never know that answer.**

    2. Can anyone clue me in on how long the recovery period usually is for a 3 level ACDF? How long typically in the hospital? How long is the typical time off of work? I work at a desk job in an office.

    **ANSWER: Each recovery varies from person to person not one the same. I only had one level. I was in 36 hrs. Most stays now a days depending on your dr are 24-72 hrs. My incsion was from the front and I was in a soft collar for 4 weeks, then on and off from there.
    Work depends on your work. I was back in 4 months. I had a heavy lifting job. You have a desk job and personal opinion only with 3 levels your going to have to be able to put your head down to do desk work and be comfortable.**

    3. Clearly you'll loose your flexibility at those levels, so after healing, can you turn your head enough to safely drive, etc.?

    **ANSWER: I have full movement of my neck. Sideways, forward, backward. But again I was a 1 level. But that took a year or more to do with extensive PT. I'm not sure about people with 3 levels and flexibility. I imagine some more 3 level patients will come along soon. To have some ideas on that one.**

    4. If things go well with an allograft, how long does it typically take to fuse?

    **ANSWER: I had my own bone graft. Fusing can start in weeks to months up to a year or more depending on the patient.**

    5. I've never gotten a second opinion and don't quite know how to go about it. I asked the neurologist who she'd recommend, if it turned out I need surgery, and she recommended I ask the surgeon directly. That way they two of them could discuss the case, and share thoughts about the best way to proceed. My PT also provide the name of someone she recommends, but does my neuro's approach have merit. Any suggestions?

    **ANSWER: Your in the right direction. Second opinions are always great if your uneasy about a situation. I went to a orthopedic spine specialist for my surgery. He was highly recommended so I felt no need for a 2nd opinion.**

    If you do not need a referrel for another opinion just call around and get some good names of both NS's and Ortho specialist. Remember not all Orthopedic surgeons are not qualified for the spine. Do your homework ..
    Alot of people try consecutive treatments first if offered by the physican. Injections etc. Sometimes they work sometimes they don't Again depends on the situation and the person. Surgery is usually a surgeons last option unless they feel that treatments will not work for you.
    My surgeon was straight out and said " you can have injections if you want' "i doubt they will work for you" or "you can have surgery".

    Its all up to you in the end. Like I said everyone responds to surgery different. Not 1 surgery is the same as the other.

    Good luck let us know how you make out!!!
    Terri O:)

  • 24-7 Your info always helps. Patsy-(my opinion)-smiles
  • Dave went to 3 ( who are noted as being the best in our area). Each one told him something different. One said to do 3 levels, another said that would be a huge mistake. The third one said laminectomy (instead of ACDF). The other 2 said that surgery was done 20 years ago!!


    In the end, you need to decide who you trust, and what makes the most sense to you. Do your homework. I know--it's not easy.

    Linda MI

    BTW---it was a very easy surgery for Dave. The worst is wearing the collar for 12 weeks. Surgeons all have different ideas about that, too.
  • Linda, you are very right with all the diff. opinions. I have found that out with my own problems, all them have many different ideas and some are almost the opposite as the one before. This has also happened to me many times with different neurologist. not only surgeons. I have found you need to find one you trust, understand, and believe in(with all your heart and feelings) then stick to that doc.

    MY OPINION ONLY seeing to many sometimes is just confusing and not a good thing. Patsy
  • Perhaps this may answer some of your questions. To quote you.

    "He says at this stage I could be considered for an anterior cervical decompression and fusion at three levels with allograft plate. If I progress to myelopathy, I may require a more extensive posterior decompression and fusion to maximally decompress the cord, which would be more traumatic."


    In my case I ended up with a 4 level acdf to help with my stenosis, but they also needed to do a 3 level posterior laminectomy to help with the spinal cord decompression, due to the stenosis and the progression of myelopathy. The acdf surgery was a very easy recovery the first time, 2 level Nov 07, I was off pain meds by the third day after surgery and a muscle relaxer once in a while. I was home 2 days after surgery. The second surgery was 10 hours, 2 level acdf and a 3 level laminectomy c-5 ,c-6, and c-7 posterior. I spent 4 days in the hospital with 1 of them being in the ICU. I was on my pain meds for about 2 months, once in a while I may take some if I overdue things. This recovery has been much harder due to the laminectomy. I am now a little over 6 months post op and the symptoms of myelopathy are still with me, but they are not getting worse, so I would say that the surgery was sucessful in that reguard. I am still taking muscle relaxers at this point before bed. The muscles seem to take longer to heal posterior than anterior. I am not going to be able to return to my former job(master plumber), but according to my OS I should be able to start a less physical job around March 09, and that "bone wise" I am probably 100 per cent fused at this time, but neurologicaly it will be another 12 to 18 months. Of course you should remember we all heal at different rates and doctors treat everyone different. I also trusted my doctors and that does mean a lot. Good luck and keep us posted.

    mark
  • I appreciate the feedback and ideas you've provided. I'll know more next week after I see my surgeon.
  • OK, I went to see the surgeon and I think it was mostly good news.

    His earlier suggested treatment plan recommendations were based on reading the radiology report that discussed severe stenosis, both central and foraminal, and the nerve conduction testing. After looking at the MRI's himself (I brought them to the appointment), he could see compression of the cerebral spinal fluid around the cord at 3 locations, but none were compressing the actual cord. I don't have much room for error, but this isn't so critical that I need emergency surgery.

    My main symptoms are some hand and finger numbness (both sides, likely caused by stenosis affecting different nerve roots), and occasional pain in left shoulder.

    He did see a small disc herniation at one level, but most of the issues seemed to be related to stenosis and bone spurring.

    The doc said that for now I should see how debilitating this is, and if the pain isn't too much, I can postpone surgery for now and see how it goes. He said that in some patients the bone spurring is so significant they basically form their own fusion, and that I might be heading in that direction.

    So for now, he prescribed continuing PT, and a cervical traction device (home unit). We will see if that helps improve my symptoms. According to my PT, the traction units can be helpful to some people with cervical stenosis.

    I'm still a bit nervous about this progressing to myelopathy, or having the radicular numbness go on so long it is permanent. But on the other hand a 3 disc fusion is major surgery and I'd like to avoid that as long as possible, so I'm happy to try these conservative measures first.



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