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Newbie - 4 Level ACDF in 2 weeks - C3-4,4-5,5-6,6-7

KarenDKKarenD Posts: 742
edited 06/11/2012 - 8:52 AM in Neck Pain: Cervical
I just found this site a couple of days ago. I was recommended a 1 level ACDF by 2 doctors, and a 4 level by another (who was very highly recommended). He considered that as the "conservative" approach, because although 3-4 is the worst, 5-6 and 6-7 are bad, and although 4-5 is not that bad it is the "monkey in the middle" and would need to come out as well. Any information on what to expect from the surgery, pain and recovery would be very much appreciated.

I trust this doctor - other doctors go to him for spinal surgery. I was concerned with the recommendation for 1 level because I anticipated having to have other levels with later surgeries, dealing with more operations and potential scar tissue and other issues.

I've had neck pain for 10+ years. Originally I was told I was not appropriate for operation. Every 2-3 years I've had MRIs and each getting progressively worse - bulging, stenosis, bone spurs, now myelitis. I've gone through PT, chiropractor (until I was told I shouldn't use chiropractic), various types of shots (which worked for a while).

It's scary to think about this operation. I hear it isn't as bad as lumbar surgery, but...it's still scary.

Thanks for any advice.

4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.


  • I was rearended by an a/c truck herniated C4/5; C5/6; and C6/7 and impinged osteophyte complex at T1/2. I had 3 level ACDF of above - not to thoracic. Post surgery FUSION, i kept getting worse and I use my hands a lot as a court reporter - now, major pain in arms/hands/back. I wish I would have gotten disc replacement which they just NOW are doing. Typing is very painful. GET top opinions.
    No other procedures have helped. Good health otherwise. You can email CindeeSunnyFL@yahoo.com
  • If you have 2 very different opinions as far as the extent of the fusions, then get a 3rd opinion; You need to feel comfortable with the surgeon (OSS or NS). Which have you seen? I saw 2 OSS and 1 NS before I made my final decision. Luckily they were very similar. They all thought 2 or 3 levels needed to be fused. Do not have the surgery until you feel you neck is in the proper hands. You only have one neck and need to take good care of it. Do your research and ask similar questions to each doctor. Keep a journal of your questions, answers, symptoms, and what helps or hinders your pain. Some doctors are aggressive with treatment so they don't have to revisit and some are conservative. Mine was middle of the road. I went in hoping for a 2 level knowing that if the 3rd level looked worse than we thought he would fuse that one also. I also wanted an ADR, but wasn;t a candidate at this time. If I need another level in 5 years, hopefully I will be a candidate for a ADR then and not lose ROM. Good luck , keep us posted. :)
    ************************************************** **
    12/9/2010 ACDF C5-6 C6-7 with plate, screws,
    BMP & bone fragment filled cages
    2/14/2011 trying to go back to work as a teacher
    2/17/2011 starting PT
    wearing bone stimulator 4 hours a day
    DDD, arthritis, herniated disks, pinched nerves
    3 months saw a little bit of bone growth (YEAH)
    4/9/2011 ROM much better, still achy and stiff in the am
    49 year old teacher
    dealt with pain for more than 5 years before finally having surgery.
    tried PT, cervical epidurals, selective nerve root blocks and acupuncture
    4/15/2011 Home Tens Unit
  • I really appreciate your very thoughtful responses. Being new to the site, and especially being new to surgery for spine issues, your experience and information is invaluable.

    Any experience or advice you may have regarding what to expect after the surgery is appreciated.

    I've seen 2 Orthopedic surgeons and 1 Neurosurgeon. 1 Ortho and 1 Neuro recommended the 1 level, the other Ortho recommended the 4 level. The Ortho recommending the 4 level is an MD highly recommended by another MD of mine - he recently had lumbar surgery performed by that surgeon, and had very good results. He's known the surgeon for years and has referred other patients to him who had good success. Although I'm scared, I trust this doctor.

    A few years ago I had surgery (not spine related)and took a conservative approach. I wound up having 2 more surgeries in the next 2 years. I don't want to go through that again.

    I am worrying about what restrictions there will be or you would recommend - things to look out for - because I tend to "overdue" to my detriment.

    Thanks again,

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.

  • The two types of surgery being proposed are very different.
    I would certainly want to know exactly why you need the 4 levels to be done (and why only the 1 level).

    It may be that it would be better to get all the levels done in one surgery rather than have to have more surgeries in the future.

    Another question I would want answered is about the risk of non-fusion. I believe that the chances of that problem are greater with more levels fused.

    I would definately want to have the various surgeons give their reasoning for the suggestion that they make, and what they think of the other option and why they feel that isn't the way to go.

    Please do let us know what you decide.

    I have just been diagnosed with cord compression on C3/C4 and C4/C5, and will be interested to hear how you get on.

  • Welcome to Spine-Health. Reading about ACDFs on this site might really help you understand some things.

    As for experiences, I had a 3-lvl ACDF in Oct. 2008 and was very glad I had it done. My cervical spine was such a mess and with all the radicular symptoms down both my arms and in my shoulders, my doc and I saw no other way than surgery. Let me throw in that all my symptoms were gone upon waking from surgery and I was apparently very giggly with happiness, according to my hubby.

    Although it truly is a very scary thought having cervical surgery, the recovery isn't severely awful. You're right that lumbar recovery is much more difficult, but that doesn't discount that recovery from cervical surgery in itself takes time and patience.

    There are a lot of variables with regards to recovery - will you be wearing a collar, how will it affect your throat and swallowing, what hardware will they be installing, etc. - and some things are static. Meaning, that you'll have BLT (bending, lifting, twisting) restrictions that must be adhered to for a few months at least, especially the lifting and bending. Twisting isn't too hard on the ol' neck area. Walking when you can is another given. Walking is great for us spineys.

    The best thing if you're going to have surgery is look up the post-op must-haves sticky at the top of the surgery section and make sure you have some of those things. Nobody needs everything mentioned, even for lumbar, but I found that bendy straws, pillows, a "station" to put yourself when you're home, like a recliner with a table beside it that rolls, and a shower chair were very valuable.

    You may need help the first week or two, someone to make your meals and regulate your medications if needed. After surgery, you tend to get tired very easily at first, then you start a walking program a little at a time until you're walking a good distance comfortably. Your stamina will increase gradually and the tiredness will also lessen.

    Inevitably, you'll have days where you'll feel pretty darned good and overdo it, do something(s) you shouldn't, then pay for it the next day, stuck in your "station."

    Also be sure to have things to exercise your mind during recovery, such as a NintendoDS, puzzle books, movies, etc. I'm an avid reader, but had a difficult time concentrating that much during my recovery, so I didn't read much. I played a lot of solitaire on my DS (it's so small you can hold it up to your head so you're not looking down) and watched movies.

    So, sorry for the long post. But you were asking about experiences post-op and so I've given you my 2cents worth.

    Just make sure to take care of yourself realizing that you've had major surgery - it's ok to let others help you - and measure your recovery in weeks, not days. It's a fairly long recovery, probably around three months for most, so be prepared for some down time.

    Take care and feel free to PM me if I can help you in any way.

  • If you think surgery will get rid of neck pain, you had better think again. If you have neuropathy in your shoulders, arms or hands, that's different. I am not a doctor, but over 10 years ago I had a four level cervical fusion. At the time, I couldn't raise either arm more than 45 degrees. One year later, I wound up having that hardware removed and two adjacent levels fused for a total of six cervical levels fused. It was a huge operation: over 7 hours. So was my revision. I don't have time to go into details now. I just found this forum and felt I had to register to talk you out of a four level fusion. Ask this doctor how many four levels he's done. It's very rare, and depending on which levels it can be problematic. I wound up with a paralyzed vocal cord and speech and swallowing problems.
  • I have had a 6 level anterior and posterior fusion Memorial Day 2009. I felt pretty good for quite awhile but this year being a consumer service person working at a desk job probably isn't the smarted job for me now. I am starting to have more problems above my surgery level (C3/4) I've been told this is probably scar tissue. When I wake up in the morning it's very hard to get started because my neck tightens up so bad it's hard to swallow. Muscle spasms are awlful now. After I get myself moving, it's much better. I don't have body shakes like I used to thank god, but I still have pain everyday. Very few headaches. I'm just letting you know, it doesn't go away. You will always have some pain. It's just getting the pain under control. I take Advil everyday all day every 4 hours. more for inflammation than pain towards the end of the day. I make sure I don't take any meds on an empty stomach. We're all here with different problems and it's really super nice to be able to read these and post your own experiences with others. It helps lots. For me anyways!! Good luck.
  • Hi everyone.. I am new to this site but i had to jump in on this one. My surgery took 8 1/2 hours i have 10 screws and 5 plates and two rods. I was in a soft and hard collar for 15 months. I have been on pain pills and getting pain blocks as well as epidurals. As a matter of fact i got an epidural this morning. I lost feeling in my left arm, and had serious athorpy in my left arm prior to them figuring this out. My left arm is 26in. in diamiter and my right is 34in.. This surgery is crazy, and the after effects are worse. I posted a pic of my neck after one week of my surgery (not a pretty sight) But the up side to this is if i wouldnt have had this, I wouldnt be walking right now. So all the drama and all the pain was in deed worth it to me. If you or anyone wants to talk to me about this please feel free to contact me either here or at my e-mail addy.
    susie_Ssusie@yahoo.com :X :X :X :X :X :X :X

    GOD BLESS ALL OF YOU >:D< >:D< >:D< >:D< >:D< >:D< >:D< >:D< >:D< SUSIE
  • I want to thank you all for your concerns and advice. I did follow up with additional questions and was convinced and comfortable with the 4 level. I had it done 3 weeks ago and am healing as well as could be expected. Of course I still have pain, and am really tired. I am still having trouble swallowing, but am managing. My speaking voice is basically back but my singing voice is not. I hope with time and healing things will at least be back to where they were more or less, if not better.

    The one thing I really did not want to do is have surgery this year and have it again in a year or two. I've had a surgery a year for the last few years and had issues from scar tissue and anesthesia.

    Thanks to all of you, and I wish you better health and freedom from pain.


    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Well I'm so pleased to hear of your outcome. I have to say, I'm better than I was prior to my surgery.

    I live, love, and laugh OUTLOUD now because if i didn't, I would be a mess so I wake up every morning and think to myself "I'm going to have a great day!" And then I do.

    I don't know what a day without pain feels like anymore, but I know I'm alive and here enjoying grand children, my children and my husband. I have found out that the more I think about my situation, the worse I feel, so I decided to say hey, Thank your lucky stars and move on!!!

    I hope you will keep your chin up and live love and laugh with your family too and be thankful!!

  • Thanks for reply.. I just take one day at a time... some are better then others but i keep movin on.. God Bless you and yours and keep in touch....

  • Thanks for reply.. I just take one day at a time... some are better then others but i keep movin on.. God Bless you and yours and keep in touch....

  • I was just informed that I need an ACDF and the surgeon (best in the area) is recommending I have 4 levels done. 2 levels are in really bad shape with the other 2 levels not far behind. I am only 46, but must have inherited my mothers spine (she has the same problems). I have tried everything including 2 rounds of steroid shots and nothing has helped. I am in the medical field (CRNA) and have had several people look at my MRI with the same reponse (Thats an ugly cervical spine).

    I wanted to see how many other have had 3-4 levels and how they did post-op. Also, looking for any little things that can make the recovery a little smoother.

    My surgeon has told me I could probably resume my anesthesia duties after 2-3 weeks since its not a physically demanding job. I haven't seen anybody returning to work that quickly in any of the post and was wondering if anybody has.

    Thanks in advance for any info....
  • Bishop,

    Your situation sounds similar to mine. I'm 52. I had C3-4 which was really bad, and C5-6, C6-7 that were not far behind, with C4-5 not quite as bad, but you couldn't address the 3 without addressing the one in the middle.

    I had different opinions from different surgeons, whether to do a 1 level and "wait and see" about the others, and a very highly recommended surgeon who said the 4 level should be done, and he considered that the conservative approach. He said, which I agreed with, that if I only did 1 level, that in a couple years I would be in for the others.

    I had the surgery 4+ weeks ago. Just this week I'm getting some energy back. I couldn't imagine doing much the first 2 weeks. I just got the hard brace off this week and then started driving. I have other physical issues as well, so you may recover quicker.

    Feel free to PM me with any questions or respond further here.

    Good luck, KarenD

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
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