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2007 - 3 level ACDF - now 3-4 is herniated? whats up !!

paradiddlepparadiddle Posts: 37
edited 06/11/2012 - 8:52 AM in Neck Pain: Cervical
I had 3 level acdf done 3 years ago. I had an MRI done (for unrelated matter) recently and its shows another herniated disc 3-4 above the ACDF area. What causes that ? I didn't have an accident and the disc was fine before.


  • RangerRRanger on da rangePosts: 805
    hey paradiddle,
    Join the club! I had the same levels, C3 thru C6 done in the fall of the same year. There is a few different causes for adjacent joint degeneration. For me it is my severe osteoarthritis, I have failure occurring above and below the fusion. Failure may occur on the adjacent joints to to the added stress next to the fused vertebrae. I know I will need more fusions soon but I'm going to put it off as long as I can without causing further nerve damage. My game plan this past year and the near future is to build core strength to support my spine. I want to believe it is working, I am still very active, and feel pretty good for the most part without taking any pain meds.
    Best of luck to you,
  • I'm doing ok myself. Just freaked me out to see that and so soon. so you think it's because that 3-4 region is taking more strain than before?
  • Hey paradidle,

    It very well could be the issue. I myself developed adjacent disc disease rather fast, so it all depends. But all of the pressure is being placed there. My last surgery they placed more rods posterior to sure it up and try and stop that from having. But if it is not causing you any issues yet, maybe better to leave alone? What did your doctors say about it?
  • RangerRRanger on da rangePosts: 805
    And like tamtam, I had rods installed posterior but right from the first acdf. But I had a corpectomy & discectomy so the rods were for additional support. The adjacent joint problems were discovered after a couple of years. It seems to be such a common problem that I don't think there is anything anyone can do to prevent it. I'm sure it's one of the several reasons surgeons prefer only to do acdf's as a last resort.
  • Long time no see. Sorry you're having problems above your fusion.

    In addition to adjacent disc disease, if, like me, you had smaller problems there before your ACDF below, then they can escalate quicker. That's what's happened to me. I have problems above my fusion, but there were problems there before my ACDF, just not enough to include them. Besides, a 3-lvl is a pretty big surgery and my surgeon really didn't want to add any more levels at that time. He only worked on the ones causing major problems at the time.

    Good luck and I hope you can hang in there for a while longer before needing any invasive treatment. For me, they'll try injections when I get to the point that the pain gets overwhelming.


  • Have you had any injections in your neck before?
    I was wondering if they helped, and what the science behind them is?
    I have been referred to pain management for my neck and thought they just meant giving me pain meds. It was my physiotherapist who told me that they meant ESIs. I am waiting to hear from them. As I am in the UK, I expect that will be a long wait!
    They also want to do flexion and extension x-rays.

    I think the whole of my neck is a mess, but the discs they are most concerned about are C3/C4 and C4/C5 which are pressing on my cord. Can injections really solve that?

  • HI to all.
    How was your cruise?
    I had 2 different types of injections. They only provided minimal relief for me. But it may depend how "far along" the issues are when you decided to have them. Maybe if I had tried acupuncture, cervical epidural shots and selective nerve root blocks 3 or 4 years age rather just when I was desperate they may have helped more. I was too far gone and needed the surgery.

    I have concerns about the stress that ACDF put on the areas above and below the fusion. My OSS thought about adding C4-C5, but chose not to. I am very concerned about needing future surgery. Am I correct that if you have a posterior approach and rods are put in then there won't be that added stress above and below? I know that I would have rather had an ADR than a fusion because I am concerned about ROM, flexibility and future surgeries. I'm not a spring chicken, nor am I too old at 49. Hopefully I have alot of living and don't want to be in pain or have a lack of ability to move. Thanks for letting me vent. To those who are celebrating today Happy easter to you and your families.
    **************************************** **********
    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)
    4/15/2011 Home Tens Unit

    Dealt with the pain and issues for more than 5 years
    tried PT, chiropractic, acupuncture, cervical epidural shots and selective nerve root blocks prior to surgery
  • Paradiddle, sorry to hijack your thread. We'll get it back on track...in a minute.

    Jelly and French, I haven't had any cervical injections before. When I had my C4-7 problems, I was way past any conservative treatments, although I did do 3 weeks of PT prescribed by my PCP before being referred to my surgeon.

    My problems are stenosis and facet joint problems, not disc-related. I also have a bone spur growing at C5/6, but they don't seem to be concerned about that as it means I'm growing bone. It's abutting the thecal sac, but not the cord itself.

    I have to say that with my job, I do a lot of light lifting that's no problem at all (reams of paper mostly), but it's strengthened the muscles in my shoulders and upper arms that help support my neck. I think that coupled with the rx anti-inflammatory are making me feel much better. I'm now thinking injections in 2012 instead of this year.

    I'm not sure about the science behind them, but I bet you could read about it in an article on this site. I assume that disc injections and FJ/stenosis injections would be different, I'm just not sure how.

    Anyway, that's kind of the deal. I strongly suggest that anyone with cervical issues work on those muscles in the shoulder and upper arm areas. Similarly, those with lumbar issues work on their core muscles. It's amazing how much getting those muscles stronger can help stave off treatment.


  • Sorry to take your post off in another direction. :|

    I have been told that when you have a level or levels fused, because they no longer move, the levels above and below have to move more. That can put a strain on those discs causing problems with them.

    Are you having any symptoms from that level?
    Do you get headaches?
    I get headaches very freuqently now and think they are being caused by my C3/C4 disc problems.

    If you aren't having any symptoms, they may well leave well alone. :-)

  • The cruise was just wonderful, thanks. :D

    My back stood up very well to the long journey out and the various activities during the cruise. We had a few very relaxing days on Puerto Rico before flying home.

    That journey took its toll, and I had a flare in pain in my neck and back. Today, I am feeling much better again, so hopefully there is no long term pain from it.

    Hope you have had a happy day today. :-)

  • I had my C5/6 fused, and a year and a month later my C6/7 herniated so fast it damaged the right exit nerve. 5 months post surgery, now my C7/8 started going. Getting diagnostics updated this week and electrical studies in 3 weeks to see where this mess is at.

    Like was said, see what the surgeon recommends. If you don't have symptoms, the herniation might not be on any nerves, and maybe you won't have to have surgery. Fingers crossed that you don't have to have more surgery.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    You know the potential of adjacent disk disease (I'd almost rather refer to it as a syndrome). I like many of the previous posters had a simple two level fusion in 2006 - Anterior plate only with cadaver bone as the replacement.

    I took me another 1.5 years of yelling and crabbing at a squadron of other "specialist" before they finally agreed that I had another disk that had gone bad, as well as fusion failure to the original attempt.

    This last surgery was 9 days inpatient - 3 in ICU ... A total of 4 surgeries over a three day time frame including 2 corpectomies (vertebrectomies)another level of fusion, bone harvested from my Iliac crest, Anterior plate, cage, posterior rods, and 12 screws.

    As the story continues .... I now have a disk above my harware that is stenotic, being pinched from both the front and the rear of the cord. So once again it is not a question of if .... but a question of when I will need another surgery to relieve the preasure on my cord at C3 - C4.

    Bottom line .... once we start down this path ... for some of us ... it becomes a cascade of issues ... like dominos falling down (or up).

    I won't bother to yack about my lumbar issues...

    Best of wishes and hopes of cervical stability for you!! You are not alone in this situation.


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  • I think I forgot to turn on my notifications.

    anyway. I mailed a letter to my old neurosurgeon ( who did the 3 level) with 2 photos from my MRI disc. They called me right away and want me in ASAP.

    I have what they call a military neck (cervical khyphosis). The 3 level put some curve back in but above it went back to straight and I think that's what blew out c3-4. I had been having some sharp pain in my neck each AM then went away. no other major issues other than some hand tingling.

    Originally he only wanted to do 2 level but said that while we were in there we should fix everything so I wouldn't need to come back. now I'm 4 years out and need another. maybe we can do an artificial but my hunch is another fusion.

    Does anyone think the doc did something wrong?
  • Paradiddle,

    Sorry to hear you're having problems again. I wouldn't jump right to the doctor doing anything wrong. I too have a 'military' neck, and as such the loading we put on our disks is not what they were designed for!

    I had C5/6 done, and at a year I almost forgot I had surgery I felt so good. A month later I yawned and my C6/7 went, shortly after that another fusion. 5 months after that surgery I lost most of the feeling and much function along the C8 nerve (Ulnar), and per my MRI, that level is now going, and the 2 levels above my fusions isn't too pretty either.

    Basically once we have a fusion, the loading on our other disks change to take up what we lost in the fusion. What happens to some of us (and maybe you now?) is we suffer what is called "adjacent level failure" or another term "adjacent level disease". Basically the levels above and below take a lot more stress and loading, subjecting them to possibly fail in the future. Not all have that happen, but for some of us, it happens.

    Please let us know how your appointment goes, and what he tells you for the reason(s) for the issues at that level. Fingers crossed for you.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • what are symptoms of C3-4 herniation?

    I get a sharp pain in the right side of the neck as I lift my head from the pillow and after I do some rotations and have a cup of coffee , its moderately better.

    The only other issue I have had lately is a pain in right rear buttocks near hip deep and some leg weakness ( i think this is unrelated to upper cervical but I don't know what level controls that region.

  • I fractured my neck and it healed wrong. I ended up with acdf 3levels in 2008. I have low back L5-S1 and rt hip hip pain too. I imagine from walking around with a fractured neck. Anyway, This summer I started having problems with my rt shoulder/arm. MRI showed problems where I had acdf and the disc below. I go back to Neurosurgeon 9/27. Don't know what they can do. I work in a laboratory. My job has become very painfull. I do understand how you feel.
  • I've been ok lately. I'm on Lyria still and now on Klonopin for anxiety but it also seems to help my muscle tightness.

    No more sharp pains. I saw another neurosurgeon to look at my MRI with the c3-4 herniation and he said not to worry unless I have severe symptoms.
  • It's good to hear from you again. I'm glad you're feeling better with the Lyrica. I used to take Klonapin and it did help tightness as well as anxiety. I really tended to tense my neck muscles any time I got stressed.

    Take care.
    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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