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Looking at 2-level acdf and posterior foraminotomy

bookcatbbookcat United States Posts: 66
edited 06/11/2012 - 9:03 AM in Neck Pain: Cervical
Hello everyone.

I have decided to have the surgery recommended by my orthopod, acdf at C5-7 and posterior foraminotomy at C3-4. My neurologist is coming around to the idea after being adamant about postponing surgery as long as possible. Now I want everything to happen quickly; am I unrealistic?

My neurologist will do an EMG in a week. I see the orthopedic surgeon next week for followup after a selective nerve root block of the C4 nerve. I haven't told her I want the surgery. I'd like to have it in June and can't decide whether to push or wait for all of this to unfold.

I posted in the New Members forum about my story but don't know how to create a link. I have severe neck pain with radiculopathy in my left arm to my little finger and thumb, w/mild myelopathy both arms. Bad genetics, ddd, herniations, osteophytes are all factors that got me into this situation. At 62, I am way too young to have this 80-yr-old back. I've seen several posters who say the same thing.

I've been reading the articles and watching the videos on this site. If anyone has suggestions for how to prepare for the surgery, please share them. Thanks.


PLIF L1-3 6/13
ACDF (C5-7) 8/12
PLIF (L2-5) 2003/05/08


  • HI Catherine,

    First let me say welcome to spine-health. The first question I would have for you is why are they doing a posterior incision in place of the standard ACDF(anterior cervical discectomy and fusion)? The reason I ask is most will have the anterior as the posterior carries more risk, along with it is a much harder recovery. I am not trying to scare you from your decision, just asking if you know why?

    Do you know what level they are doing the nerve block at yet? It sounds as though your surgeons are still doing testing, with the nerve block along with the emg study? Remember it is so important they find the pain generator prior to surgery or the surgery really won't work, if they don't get it. Do you know why your neuro is against the surgery?

    Some other things to do is be sure you have researched the surgeon, and no their qualifications as it pertains to your case. One thing I always encourage everyone to do is to get a second opinion. Have they discussed your ROM(range of motion), following surgery. Will you be required to wear a neck brace or collar following surgery and for how long? What type of bone grafting material will the be using, such as allograft(cadaver), autograft(your bone), or some other type of synethetic form. Have they also discussed doing surgery may cause the need for additional surgeries? For myself that one surgery turned into 6 surgeries. Or that sometimes the surgery fails to relieve the pain? My experience after being very physically active and having many ortho surgeries, has showed me spine surgery is not like all of those other surgeries. Like I said I am not trying to scare you, but rather to make the most informed decision you can about the surgery. I will say once myelopathy starts the only thing that can be done is surgery to stop the progression of it. Something you might want to talk to your neuro about. Now I have never heard anyone say they just have it in their arms. Myelopathy happens when there is cord involvement.

    AS far as trying to push the surgery up, it is already May and by the sounds of the testing they are doing, it will take till that time to get the results back. Sometimes after they put certain medications in us, they can't perform surgery right away, so something you might check on?

    At the top of the page you will find a tab called FAQ, inside that tab is a link to 38 questions to ask a spine surgeon. I always suggest that members go through the list, and see what they can answer themselves, and then begin to ask questions from there.

    Just thought I would stop by and welcome you to spine-health. If there is anything I can do, don't hesitate to pm me.
  • jlrfryejjlrfrye ohioPosts: 1,110
    I have to agree with TamTam, the posterior surgery has more risk and a much harder recovery then the anterior approach and I would want answers as to why the posterior approach is being used. I also am not trying to scare you but recovery from this surgery is tough. Along with a much longer recovery time then the anterior. My surgeon hates to use the posterior approach on his patients and will only do so as a last resort. On the other hand it finally did fix my neck but it wasnt a easy surgery. Good luck on your surgery and keep us all posted
  • bookcatbbookcat United States Posts: 66
    Thank you for your responses! I've read numerous posts by both of you and truly feel welcomed.

    I am going to have 2 surgeries. The first will be an ACDF at C5-7. The second will be done 6-12 weeks after the first to provide for healing time to fuse. That surgery will be a posterior foraminotomy at C3-4, posterior because of the location of the extensive disk herniation. My C4 nerve root block has relieved some of my pain already so it's clearly part of the pain picture. The EMG will be very helpful in figuring out the overall picture.

    I have gotten 4 opinions, 2 of which called for 4-level posterior fusions along with either a 2- or 4-level anterior fusion. My neuro (logist) was taken aback at the extent of the recommended surgeries. As a pain management specialist, he wanted to give me adequate pain control and hope for better options in the future. However, so far the pain control hasn't been effective. I am now taking 30 mg of oxycontin every 12 hours, which is providing some relief.

    I am living with an incurable cancer and spent most of last year being treated for that and a second cancer. As a result, I have become super-focused on quality of life. While I know a surgical neck can lead to more surgeries (I have 3 lumbar fusions: L2-5), I am willing to accept the risk to achieve a better quality of life. My neuro agrees I have myelopathy, heard me when I described my quality of life and that currently I have insurance, and has decided that I might be one of those rare highly motivated and willing to follow directions patients who could do well after surgery. He has made sure I understand that I am unlikely to be pain-free and that stabilizing my spine is the goal.

    He has recommended I use the orthopod for my surgeon. She is fresh out of a joint fellowship program in ortho and neuro surgery at the Manhattan Spine Center. She is local and shares his views on the role of surgery etc. When I last saw her we talked about ROM but have not gotten to the level of bone graft (I want auto) or cervical collars. I will talk to her about this next week.

    I've decided not to rush, thanks to your comments, although my ortho is pregnant and I will have to find out her surgery schedule. It's a relief not to have to feel so pressured.

    PLIF L1-3 6/13
    ACDF (C5-7) 8/12
    PLIF (L2-5) 2003/05/08
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