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ACDF revision surgery & CT Scan repot help

Kujo85KKujo85 Posts: 10
edited 06/11/2012 - 8:51 AM in Back Surgery and Neck Surgery
Hi everyone. I had ACDF 2 level fusion and artificial disc implant surgery in April of 2009. looks like my 2 level fusion failed and now I require another surgery. Can anyone let me know what that entails?

Also I have a new CT repot and was wondering if anyone can help me decipher it. Have an appointment with my surgeon Wednesday and would like to be informed when I see him. Thanks in advance for your help.

CT Report:

I need help understanding my report. I'm seeing my Surgeon on Wednesday and i'd like to have an understanding of my report before i see him. If anyone can help me i would be eternally grateful. Thanks in advance...


1) At C5-6 and C6-7 levels, there has been an anterior fusion procedure. There are a few small areas of bridging bone, as described. However, a majority of the disk space does remain visualized.

2) Uncovertebral osteophyte formation resulting in moderate to severe degree of foraminal stenosis bilaterally at C5-6 and moderately at C6-7.

3) Satisfactory appearance of artificial disk at C4-5.

4) Congenitally small spinal canal. There has been no interval change when compared to recently performed MRI of 01/26/11.

5) Moderate right foraminal stenosis at C3-4 with truncation of the nerve root sleeve on CT myelographic images.

The course and caliber of the cervical spinal cord is normal. The canal is congenitally small measuring just over 9 mm at the level of C4. Visualized portions of the intracranial structures and orbits are normal. The paraspinal soft tissues demonstrate mild enlargement of the palantine tonsils with tonsilliths, most consistent with inflammatory change. Visualized portions of the lung apices are free of disease.

The intervertebral disks are as follows:
Occiput-C2: The occipitoatlantoaxial articulation is intact.

C2-3: The intervertebral disk, neural foramina, and facets are normal.

C3-4: The intervertebral disk is of normal height. There is bilateral uncovertebral osteophyte formation, right greater than left, resulting in moderate right foraminal stenosis. The right-sided nerve root sleeve is
slightly truncated. There is mild congenital spinal stenosis.

C4-5: The patient is status post artificial disk placement anteriorly. There is metallic artifact related to the artificial disk and given this proviso, there is no compromise of the central canal. There is uncovertebral osteophyte formation, left greater than right, resulting in a mild degree of left foraminal stenosis.

C5-6: The patient is status post anterior fusion procedure with screw and plate fixation and graft placement. The posterior and lateral margins of the fusion have significant lucency extending through at these levels. However, at the anterior margin of the fusion just posterior to the plate, there are areas of solid and bridging bone. There is uncovertebral osteophyte formation bilaterally resulting in a moderate to severe degree of foraminal stenosis. The patient has mild congenital spinal stenosis.

C6-7: The patient is status post anterior fusion procedure at this level with graft and plate fixation. There is significant lucency about the posterior and lateral margins of the graft. However, anteriorly and just apposed to the plate, there are a few areas of solid bridging bone. There is uncovertebral osteophyte formation and moderate degree of bilateral foraminal stenosis. There is mild congenital spinal stenosis.

C7-T1: The intervertebral disk, neural foramina, and facets are normal.


  • Hi

    First let me say welcome to spine-health. One thing we don't do is comment on imaging findings, as for one none of us are doctors. But, also the fact that not only imaging findings go into diagnosing a problem as well as the clinical findings.

    AS far as revision surgery they are a few of us whom have had it done. From my experience and most here the revision surgery is done posterior. But in your case it would depend if they need to remove the ADR, or if they plan on just removing the bone spurs. One of the things I would be asking about a revision surgery is what type of bone grafting materials they will be using, such as allograft, autograft or something like BMP. Ask what the odds are of fusing with whatever material they decide to use. I will tell you that recovery if they need to do a posterior incision does take a bit longer and the muscle spasms are some what of a issue. Another thing you might be asking about is what would be the length of stay in a hospital, and wether you will need to wear a brace of any sort and for how long? Also find out what they will do about the old hardware if it is anterior plates and they will be going in posterior will they be leaving that alone or removing it. If it is removed will it be replaced with new hardware.

    You will also want to be sure to ask about the bone spurs and if they will be removing all of them. ASk how stable is the bone around the adr and if any of it has shifted. They should be able to tell you what type of new hardware they will be using be it, rods, plates are cages. Also find out what would be the expected time to fuse with the technique they propose to you. Basically the surgeon should be explaining all of it to you and what he/she plans on doing.

    Good luck with the appointment and keep us posted on what happens. Once again welcome to spine-health. If there is anything I can do don't hesitate to pm me. Take care.
  • Thank you so much for your reply and all the question ideas you gave me. I really appreciate it. I tend to go blank when I see the docs and this time I'm going to make a list of all my questions.

    How long was your recovery? How are you now?
  • I had a recent 2-level ACDF surgery and am so sorry yours failed after 2 years ... Are you just finding out now that it failed? I thought they would have seen that during your follow up Xrays while recovering from the 1st surgery?? Tamtam has great questions and I would also ask "Is there something you need to do differently this time around to increase the chances of success?" (depending upon your recovery routine the 1st time - did you wear a bone stimulator the 1st time, how long were you out of work and were you previously prescribed Physical Therapy?) -- If you did not have some of these things the 1st time around if they add them maybe it would help increase the chance of success - just thoughts!

    I think the hardest part of the recovery of these surgeries is the stress of not knowing whether the fusion is happening.. I had severe Right arm pain and weakness prior to my surgery in December. Now 2 1/2 months later I have pain (not severe) in my left neck/shoulder that sometimes radiates down my arm .. makes me wonder if something else is going on or am I just over-doing it ...

    Anyway good luck with your appt and keep us posted - my thoughts are with you!
  • Thanks for your reply Mary.

    I'm not sure what happened with mu fusion. I had physical therapy for 9 months after my surgery. I didn't have a bone stimulator, only just heard there was such a thing. I was out of work for 4 weeks after the surgery. I saw my surgeon monthly for a year. He took x-rays every month and told me everything was fine and commented on how good my scar looked. Tell you the truth the last thing i cared about was my scar. Every time i complained that i was having constant pain he told be to be patient and that it was normal. After the year mark he sent me to a pain management doc. The pain management doc wasn't terribly helpful, he gave me injections every now and then and the last time i saw him he told me i was having phantom pain from my pain meds. So i finally went to another surgeon and as soon as he took a look at my x-rays he told me my fusion had failed and within the last two weeks he's sent me for a MRI, Myleogram and CT Scan. I go in tomorrow to go over my CT-Scan and hear about my surgery options.

    From my experience, if you think something is wrong, demand more test. I didn't and now i'm nearly two years post op and have more trouble than before my initial surgery and i have to have it done all over again. You know your body best and if nothing is wrong it will give you peace of mind while you are healing.

    I hope everything is fine with your neck and you have a successful fusion and you never have to see the inside of an OR again.
  • Wow - sounds like your 1st surgeon dropped the ball - sorry that happened! Thanks for the well wishes and I hope all goes well with your appt and you get on the right road for full recovery!
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