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Cervical laminectomy - with plastic "spacers"?

SwedishFishSSwedishFish Posts: 57
edited 06/11/2012 - 9:03 AM in Back Surgery and Neck Surgery
I'm looking for help about surgery - in a nutshell I have 3 bulging discs, osteophytes, foraminal narrowing from mild to moderate, from levels 4-7, DDD and straightening of the normal lordosis and while the MRI didn't show it, my neurosurgeon (and my PT) thinks that I do in fact have some spinal cord compression based on symptoms in the C7 area. I never had an injury so it's most likely osteoarthritis and a lifetime of bad posture.

I did PT on my own for 10 weeks as I initially thought that I had impingement syndrome in my left shoulder. My friend who is a PT had me come in to start exercises to see if I could avoid another shoulder surgery. In the process, figured out that the pain was coming from my neck, and my symptoms increased dramatically. Over time and with neck traction, it improved, but then I had it on both sides instead of just the left, just not quite as painful as it was before. I kind of reached a plateau where I just wasn't getting any better. Most of my pain is in my arms/hands/fingers although my neck itself is sore and I get shocks of pain in various places including along my spine. I now have the exact same symptoms in my lower back/legs/feet/toes. I am sure that I have lumbar issues too but at this point I don't want to even know until I have my neck taken care of then I'll go have the offered MRI on my spine.

My first neurosurgeon had me try a number of the less invasive things first and he sent me to pain management since I'd already done PT. I have had Oxycodone, Valium, Gabapentin, Meloxicam with little results. I have a terrible time sleeping and was given Trazadone and hated it. Last night I tried Lunestra that he gave me some samples of and I actually slept really well for once. I have had foraminal injections on both sides of C6-7 and then I had a cortisone epidural and neither did anything.

The first neurosurgeon said that if it got to surgery he would do an anterior fusion from C4-7. Recently I saw a 2nd neurosurgeon who I like the best and feel the most comfortable with so have switched to him.

My new neurosurgeon wants to do a posterior laminectomy at 5, 6 and 7. Something else at 7 (worst bulge is there) but can't remember exactly. He would then use plastic sort of spacers in between the vertebrae. This is the part that I can find no information on. He said that he did at least a thousand of this same procedure as an intern/resident at the Mayo Clinic as his chairman when he was there was the guy who invented it (the plastic part I would assume). He said that the reason that a lot of surgeons don't do it is because they haven't been trained to do it and the ACDF is well the gold standard and most just jumpt to that.

This surgery he said would have a 2 week recovery - no cervical collar. The initial week's pain would be worse because of the posterior approach. This Dr. has a very good reputation (as does the other who I saw). He was the one that my PT really wanted me to see and as a friend I greatly respect his opinion. The neurosurgeon said that I'm a perfect candidate for this procedure and that personally if he had to have it done, he would go this route and not have the anterior fusion. I'm 46 years old and he said that very likely I'm looking at another surgery in 10-20 years with the fusion. With the posterior approach it's unlikely he thinks that i would need another surgery but if I did, then I'm looking at a 1 level anterior fusion.

I am having a nerve test on 6/4 but the neurosurgeon anticipates that it will be negative for carpal tunnel but that has to be ruled out before moving to surgery.

So just wanting to hear I guess experiences from those who had posterior laminectomies versus anterior fusions and if anyone knows about that "plastic part" of the surgery. I have googled and haven't come up with much. I'm a teacher so if I am going to have surgery, it would be best for me to have it sooner rather than later so that it's the summer and I have plenty of recovery time.

Thanks for any information! Carmen :)


  • I had an ACDF C3-7 in May of last year and my surgeon used plastic spacers. That is what he uses. Others have talked about material used from the hip that I understand is quite painful. Maybe others could provide feedback from a posterior laminectomy. I am surprised that a multiple level would be a 2-week recovery. I thought posterior approaches were more difficult.
    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Thanks, Karen. I got the impression that plastic was becoming more "in". I know that some don't like to use the cadaver bone mostly because it doesn't fuse as well as your own bone but that you end up with more pain in the hip than in the neck if they use your own!

    I was surprised when he said 2 weeks. I too thought that the recovery was worse from the back because you have to cut through all of those muscles. He did say the pain during the recovery would be worse as he said from the front the incision site really isn't that painful but it will be from the back. He gave the 2 weeks as when you can go back to work - not sure if there are still any other restrictions and I'm sure I can assume that that doesn't mean I'd be at 100% because we all know how that goes with any sort of surgery recovery. And yea it would be at levels 5, 6 and 7 so seems like 2 weeks is on the 'best case scenario side'. I mean I had a Spigelian hernia a few years ago and they acted like people were out playing golf the next day - I couldn't even stand up by myself for almost a week!

    I will of course ask a ton more questions when I go back in after my nerve test from the neurosurgeon directly, but I have found along the way the more information that I have going in, the better my questions are! And as a teacher, hoping that if I get it done during the early part of the summer, I will have plenty of recovery time regardless. But then I have to go have the spinal MRI and start a new process. Yay! (not lol)

    And just curious - did they do your laminectomy from the front?

    Thanks again for your response.
  • in my ACDF 3 weeks ago (2 levels, C5-7), and it hasnt bothered me a bit since surgery.
    I too, read all about the horrific pain of hip graft, but decided to do it anyway, since it has high fusion success rate.
    The first 3-5 days after surgery I had some burning pain at the graft site, when moving, but since I didnt move that much anyway at that point, it was not a problem.
    Pain scale I would rate a 6 at the most, but most of the time 0-2.
    3 weeks in the hip is still swollen, but it was a very pain free experience for me.

    As for spacers I wouldnt know. My surgeon used 2 cages that he filled with my hip bone.
    No end plate, the cage is closed of towards the spinal cord.

    (from Sweden :)
    Cause: car accident & genetics
    Effect: herniations C4-7, stenosis, osteoarthritis, myelopathy, neuropathy
    Non-invasive Treatment: everything under the sun
    Invasive Treatment: 2 level ACDF, C5 & C6, May 2012
    Moving Forward: SCS
  • Ms Pixie - that's great that you had so little pain from the hip graft as many really complain about that! So thanks for sharing that.

    For me it's really not an issue in the whole scheme of things if I go with the posterior approach as there would be no fusion involved at all. Which his what I'm definitely consider the most at this point. But still asking questions and still deciding!
  • Sorry for being off topic - but you had a spighelian hernia? I had one about 10 years ago and it was emergency surgery because it had been misdiagnosed, and wound up with strangulation (I was in the hospital for 5 days).

    After the ACDF - at my 4 week check-up I was already showing good progress toward fusion.

    The laminectomy & discectomy was from the back - much easier recovery than the ACDF. With the 4 level ACDF I was in the hospital 3 days and used a walker for the first week (to make sure you don't fall in case your're at all unsteady) then a cane for a while. I was 52, so I may be older than you.

    Take care Carmen.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Ha ha that is crazy on the hernia! Luckily mine was diagnosed relatively early so I had it done laparoscopically. They are relatively rare so we're in a small club!

    I am 46 so not too far off!

    Thanks for more specifics on your surgeries!
  • KarenD; Hi to all, Ihad a c3-7 laminectomy and posterior fusion with instrumentation, which basically means titanium rods and screws with a bone graph.I also had 5 severe cord compressions and a condition called Kyphosis a reverse curvature of the neck,so not only was I squeezed but stretched as well.I had a choice of cadaver bones or bone graphs taken from my hip but instead my surgeon used the spinious process and lamina they removed during the surgery it was told to me that it is better than the other options because it is less invasive than bone removed from the hip and heals better than donor bone.My surgery was in Dec. 9,2010 and you are right my recovery was about a year long process,while I was only in the hospital 5 days it took a while with PT and pain meds as well as neurontin for nerve damage.And with it mussel,shoulder,hands, and leg pain. My only other option was paralysis, so I made the right choice and am pretty happy with the outcome.
  • Thanks for the other responses. I guess this is different because my neurosurgeon is not recommending fusion at all. He's recommending a posterior approach with laminectomies at 5, 6 and 7 and something else at 7 (maybe it was a discectomy - it's the disc that bulges most closely to my spinal cord). Then the plastic spacers - and I'm not sure how he said that they are held in there (I do have a follow up with him on Wed after my nerve test on Mon so will ask more questions for sure). I just can't seem to find anyone who's had this specific surgery done. The other neuro said he'd do a C4-7 fusion, but yowza. I'd much prefer the option of retaining more neck motion if possible! And I figure in the end, if it doesn't work, they can fuse them. I mean I don't want more surgery but if I go the fusion route, that's it - I'm fused, game over I guess.

    It has been a hard week and next week more of the same. Final 2 weeks of school and I've been under a lot of stress, sitting and grading a lot and well my whole body is reminding me constantly!!!

    I did find a little on the Mayo Clinic site that mentioned that for multiple levels a posterior approach without fusion is actually preferred, whereas the anterior is preferred when it's only 1-2 levels. Given that it increases the chance for a level above or below to go bad, well that ends up practically being my whole neck!

    I don't want to rush into anything, but as I mentioned as a teacher if I'm going to go with the surgery, then I need to decide sooner rather than later. I think that on Wed if the nerve test turns out as expected by the neurosurgeon that he will want to go ahead and schedule the surgery. I am definitely leaning towards doing that but I'd sure love to find someone who has had this procedure done in this way before then!
  • Make sure that you can have a fusion done if your treatment doesn't work out. Some of the disc replacements make it tough to have a fusion afterwords if its needed. Make sure to question your Dr. about that when you see him.
  • Bkins - thanks that is a good question to ask for sure when I see the neurosurgeon again next week. I do know that he said that a 1 level if needed later could be done - but he didn't say anything about the other 3 levels! I appreciate you posting that for consideration! Thanks :)
  • the bit that worried me it the TWO WEEK RECOVERY !!!
    try more like at least 12 months .ALIF approach is better for the consultant as he/she has better eyes on and can get to the job better .all spinal surgery is MASSIVE and recovery is long .people forget how major it is ..on my ALIF i was in hospital for a week the the following 6 /8 weeks i was on my recliner totally zombied .5 months on i am still in pain and still recovering {consultant told me i would take about 2/3 years]} BUT THAT'S MY SITUATION 3 years is very long the average is more 18 months ..if your no better after that you not going to get any better .just be careful with consultant being very optimistic about surgical outcomes ..you could be very disappointed .
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • When he said "2 weeks" I think he was only referring to being released back to work. As I mentioned he has an asst who had the surgery and was back at work in 2 weeks - I do want to talk to her if she's working when I'm there this week. I have learned to take ALL recovery times with a grain of salt. This neurosurgeon is very highly regarded in the community though and my physical therapist who is also a good friend recommended him without hesitation. I know a number of people who have had varying results with the various surgeries, although far more have had anterior fusions. And the fusions for sure take far longer to recover from from everything that I've read.

    One person said that they think the plastic "spacers" might actually be cages. Obviously I need to ask but it seems reasonable based on what they do.

    He said it would be 1 night in the hospital. The impression that I got was posterior was worse initially with greater pain, but a shorter recovery (remember, no fusion). Anterior was easier as far as pain, but a far longer recovery (which would be a fusion).

    I keep hoping I can find someone who only really had what he's recommending just to see what their experience was. I have my nerve test on Mon, and then follow up with my neurosurgeon on Wed and if that test is negative (which he expects it to be) then we are discussing surgery. At least as a teacher I have a 10ish week window where I wouldn't have to miss any work so it is the ideal time to have it done.

    I've also read varying information on cervical collar vs. non-cervical collar after the surgery. Did all of you have the cervical collar for recovery? The first neurosurgeon who I saw that would do the anterior fusion I think said 6-8 weeks in a hard cervical collar 24/7. The neurosurgeon who I'm seeing doesn't have you use a cervical collar for the anterior surgery (I assume with fusion) either. It's weird how there is so much variation out there with how the different neurosurgeons deal with similar problems.
  • Sorry - my post posted 2x again - I don't know why my computer keeps doing that. Wish I could just delete my own posts!
  • Bkins - when I saw my neurosurgeon I asked if necessary later would I be able to have a fusion (not that I want one lol) and he said yes. Tony- what all did you have done? Remember that this is with no fusion which makes a huge difference in the recovery time. No disc replacement. I don't know if he will shave off any of the bulging discs but I will find more out at my pre-op appt on July 10th. I have done a lot of reading online and that 2 week time period seems pretty consistent. Obviously it's not 100%. Most say that the pain the first week is horrible but by the 2nd week they were feeling somewhat better. Most have said it's more like 3-4 weeks until they feel more back to their normal selves - 3 mos probably for full recovery. Most seem to go back to work after 3-4 weeks though. Luckily I have 5 weeks until I have to go back to work (high school teacher) and then another week before I'll actually be teaching with students. Obviously every case is different. At this point I have had the nerve test, carpal tunnel has been ruled out and I'm going to have the posterior laminectomy/foraminotomy surgery on July 12th. It is a 1 night hospital stay. I have found someone online who I have been corresponding with and have now even talked to her on the phone who had this same surgery. The only difference is that she had it done at 1 level and mine will be at 3 levels. But she said it was really 3-4 weeks for her before she was doing most things that she was doing prior to the surgery. She is 3 months post op and back riding motorcycles with her husband, etc. - she's 62. Anyway, that's my update. I will let you all know how it goes.
  • Oops and the plastic spacers he had referred to was if he does a fusion, that's what he uses instead of bone grafts. But I'm not having a fusion with this surgery.
  • I hope all is still on target for your surgery. Let us know how you do.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • KarenD - thanks - on for a posterior laminectomy foraminotomy at C5, 6 and 7 - July 12th. I will let you know how it goes!
  • bookcatbbookcat United States Posts: 66
    It's less than a week now; seems like you've managed to get your summer schedule accommodated. I am looking at a1-level posterior foraminotomy at C3-4 after my 2-level ACDF in Aug. I will be watching for your posts. Thanks for clarifying the point about the plastic spacers. I'm glad you don't have to go through that.

    Best wishes for a straightforward surgery and easy recovery. I will be sending some positive thoughts your direction on Thurs! :-H

    2-level ACDF (C5-7) scheduled for 8/6/12
    3 PLIFs (L2-5): 2003, 2005, 2008
    PLIF L1-3 6/13
    ACDF (C5-7) 8/12
    PLIF (L2-5) 2003/05/08
  • Thanks so much I will let everyone know how it goes! Best wishes to you for your surgery in August and well then I can let you know about the posterior foraminotomy!

    Carmen :)
  • Surgery went well I'm now 6 wks post-op - I did post a very long, detailed post about my surgery experience and the first week after. I think you can search for me by username and find it!
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