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Is PCDF with autograft the answer?

IsthereananswerIIsthereananswer Posts: 17
edited 06/11/2012 - 8:57 AM in Neck Pain: Cervical
Has anyone seen solid results from a posterior cervical fusion with autograft after unsuccessful single level anterior cervical fusion with alograft at C5-C6? I am a young, healthy 28 year old man that has not fused after two attempts over the past three years and now contemplating a posterior approach with autograft. The debilitating symptoms now have me out of work and I'm unable to function without severe neck pain as well as some shoulder blade burning and last night had radiating left arm pain. 2nd Dr who did C5-C6 ACDF alograft said I had partial fusion and would not see a reason to operate again, but new dr said no such thing as partial fusion (either pregnant or not, no partially pregnant) Any guidance on this awful situation is much appreciated. Also looking at these minimally invasive Laser Spine procedures as a fix...

A Foraminotomy is a medical operation used to relieve pressure on nerves that are being compressed by the intervertebral foramen, the space in the vertebra where a nerve root exits the spinal canal. The term foraminotomy is derived from the Latin words foramen (hole, opening, aperture) and -otomy (act of cutting, incision). A foraminotomy is performed to relieve the symptoms of nerve root compression in cases where the foramen is being compressed by bone, disc, scar tissue, or excessive ligament development and results in a pinched nerve.
> A Laminotomy is a surgical procedure that is used to relieve pressure off the spinal canal for the exiting nerve root and spinal cord, increasing the amount of space available for the neural tissue and thus releasing the nerve(s). The term laminotomy is derived from the Latin words lamina (bony plate that covers the posterior arch of the vertebra) and -otomy (act of cutting, incision).
> A Percutaneous Discectomy is the surgical removal of herniated disc/bulging disc material that presses on a nerve root or the spinal cord.
> A Facet Thermal Ablation is a procedure very similar to a root canal a dentist performs. The surgeon uses a laser to clean the facet joint and deaden the nerve that innervates the joint and causes painful symptoms. The facet joints are the joint structures that connect the vertebrae to one another. Thermal ablation refers to the laser eradication of the effected nerve.


  • Isthere...

    Tuesday I will be undergoing Laminectomies from C4-T1 and then PCF C4-T2 thanks to a pseudoarthrosis from my last fusion (failed). If your neck is otherwise stable, they might be able to go back in the front and redo your fusion.

    If there is question, then they will probably offer PCF for better odds of success. They will be using my bone mixed with BMP, screws, a narrow plate vertical down the back of the facets, and then rods and lock it all down from there. The bone mixture of course will between the facets, and some on top of the plate.

    I don't have a lot of options with mine. I hope you have answers soon.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Sounds like your facing a major surgery Tuesday and I wish you the best of luck. Since i had a revision surgery about a year and a half after my first ACDF the same as the first without any different outcome, the dr said he would do the PCDF for a better outcome, but as always no gaurantees. The new dr said he would have done a PCDF after the first failed ACDF but he wants to use an autograft, which was the primary reason i didnt go with him for the second surgery because i feared about complications from the harvest site than idid the neck fusion operation itself. Could you explain to me a little about BMP? I came across that the other day and am ignorant as to its advantages. My neck is stable although dr sees some microloosening of one of the screws, i told myself i would not have the exact same surgery again that failed twice before but the recovery from the posterior is supposedly greater because there are more muscles in the back of the neck than simply moving the vocal chords & esophogaus out of the way for an anterior approach. Again, hope your pain is 100% gone after Tuesday. Wouldn't it be nice for us to have the hope that surgery will work like it does for so many others in our situation... After the high percantages of success i was told both times, i barely even hear the drs when they spout off % this and that!
  • Bone morphogenetic proteins - http://www.spine-health.com/treatment/spinal-fusion/bmp-bone-morphogenetic-proteins

    Here is a link from here, that goes into pretty good detail that might help. Basically it helps the allograph to grow (fuse) better. It is FDA approved for posterior cervical surgery - multiple levels, but only one level anterior due to possible overgrowth towards the esophagus. I had Osteocell (baby brother to BMP) for my C6/7 and it failed, formed a false joint and I did get forward overgrowth and swelling.

    On the surgical paperwork, mine is marked as "Posterior Cervical Decompression (laminectomies for me) and fusion with allograft Instrumentation and bone morphogenic protein, C4-T2." Dx: Cervical Myelopathy, Pseudoarthrosis and Radiculopathy and accompanied instability. In Brenda terms = a mess!! (G)

    I too was told (and sniffing around the net seemed to agree) the success rates for posterior fusion are much higher, so I am going to try and stay positive. He is also going to have me right out of the box using a bone growth stimulator. My last surgeon didn't put me on one until 4+ months post op! Yeah..fusion was failed, he ignored it... There are many here that fell into the same boat when things went south... Fingers crossed. :) Thanks very much for the well wishes.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks for the link Brenda and I appciate your insight. I too was placed on a bone growth stimulator immediately after my second surgery and actually went through 2 of them! The california co. That makes the bone growth stimulator that i was given looked like a golf cart steering wheel with a pad with a chord and remote attached to it. The insurance paid the $4,995. for it, (both times)but I was astonsihed that after 9 months it is COMPLETELY useless! I was asked to do it for 30 minutes a day and i never once knew if it was working because you cant feel any pulse or anything coming from it. The dr ordered a second one after the fusion didnt finish after the first nine months and after four months of using it told me i can stop using it because if it hadn't fused by now it wasn't going to by using the bone growth stimulator. Brenda, i am so frustrated to be so young and have to deal with this constant pain and inadequacy of healing that i just scream sometime. I am going to ask about how it can finally work this time and if i could use the bmp to minimize the chance of not fusing, but the swelling and other side effects are something that i would want to be cautious about. Best of luck with your operation on Tuesday and hope i can be guided to the right answer myself!
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