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ACDF C3-C7 all now or two now-two later

I am 43 and have moderate to severe stenosis from C3-C7. With C4/5 and C5/6 the most severe. The middle two need to be done now, while the outer two likely have a few years left. Fortunately, I have little to no associated pain. I am concerned with range of motion loss with the four level, but also concerned about having to go back in for surgery a second time. All the doctors believe that eventually all four will need to be surgically fused.

It would be nice to keep the range of motion for another 5-10 years, but the risks and surgical complications of going back in concern me. Not having been through it before, it is hard to judge how big a pain in the neck it is (pun intended) to do this procedure twice versus just getting it out of the way now.

Interested in thoughts of others who may have had the same decision to work through.


  • There will be ROM loss but it may not be that bad. Your surgeon should be able to warn you on what ROM loss he/she expects. The pain is different for everyone. I felt normalish within 3 days short of being able to swallow well that took about a week. Granted I am only 28. The possible problems that may arrise from not having the surgery would outweigh anything else for me. I know it sucks but if you dont have the surgery things could easily take a turn for the worse. I do not know how bad the impongement of your spinal cord is but I know when I had mine my surgeon told me if I took a hard fall or had a fender bender I would likely end up a quadroplegic. It is a personal choice to go through something like tgis, if you trust your surgeon trust what he feels you need to correct your problems.

  • I am not a medical person, so can only share my experience with you.

    I had/have problems with my neck from C3 down to C7. C3/4 and C4/5 were the worst levels, with my cord being pressed backwards into bone and being indented. There was no spinal fluid around the cord, so I was told, like bpreachers, that I was in danger of having a spinal cord injury if I had a fall or was in, even a minor accident.

    The rest of my neck is also very degenerated with protruding discs. My surgeon said that I may need more surgery in the future, and he mentioned that he would do that from the back. He said that he would only do the two worst levels this time because there is a much higher chance of a successful outcome in he doesn't fuse more than two levels.

    I am only 12 weeks since my C3/4 and C4/5 ACDF, but things are healing well. I do still have many of my symptoms, but my surgeon says there is still time for them to improve. He did warn me before the surgery, that it was being done to sstop the progression of damage to my cord, and I may be left with my symptoms. He said he expects 70% of his patients to get some relief of their symptoms but he can't predict how much relief or how long it would take to see it. I am still waiting.

    I hope that this helps you. :-) Do ask any other questions that you may have.
  • I had 4 levels fused on jan 3rd. The doctor discussed only doing 2 and possibly having to go back in later. He recommended all 4 and that is what I had done. I had already lost a lot of range of motion. The surgeon said I would not lose that much more. I had C3 thru C7 with a corpectomy at C4.
    I have to admit it has been rough. I still have difficulty swallowing. I can manage salad if it is chopped up fine enough. I tried a piece of toast today, but it hung up, so I will wait a few more days before I try bread again. The pain is moderate. I think the swallowing issue is because of the multiple levels done. BUT, I have to tell you, my surgeon had another patient in the hospital the same time as me. This was another physician which made me feel good that a doctor had chosen my surgeon to operate. That patient had 2 levels done and could not swallow at all. They had to run a feeding tube. Both my surgeon and the hospitalist said that was very rare.
    I guess all my rambling leads to this conclusion. each of us is different and have different experiences. personally, I am glad to have done all 4 especially given that healing can take months and months. I want my life back as much as possible as soon as possible with no do overs.

    4 level ACDF completed on January 3rd.
    I developed an infection which required reopening the wound on January17th
    Looking forward to life without as much pain!
  • Thanks for comments. Very helpful listening and absorbing. Hope your recoveries go well.
    My surgeon hasn't shown too much concern of success fusion while doing the multi levels. But did say the swallowing issue is more probable.

    Curious Penny, now that you are three weeks out what is your activity level? My doctor says to plan for four weeks out of work and if lucky back in three.

  • I developed an infection so they had to reopen the wound to clean it out on January17. This entailed being intubated once again. Thursday will be 4 weeks from fusion surgery and 2 weeks from cleaning the wound. Right now my activity level is low. Before the surgery and before the pain from my neck really settled in, I was very active. I worked out at the gym, spin class. I also walked and my husband and I love kayaking. As the pain increased, I stopped everything except the walking. I would walk 4 miles several days a week. I am very healthy for an old lady (57) and was in fairly good shape.
    Now, I get up each morning and after breakfast and running my IV antibiotics I clean up. Still can't shower so I sponge bath. I straighten up the house a little. Wiping counters light sweeping etc. My husband does all the intense stuff. I take a short walk. This morning, Mapmywalk told me I walked .65 of a mile. That normally requires a rest with some guided meditation as it really stirs the pain at the base of my neck. Usually 20 minutes or so. The rest of the day is pretty much down time. I read, play on the computer or watch TV. I was forced to retire because of my neck so I don't have work to return to. I don't know what kind of a job you do, but I know I would not be able to do much. I have no stamina. I don't know how much the wound clean set me back. It is possible you will do better.
    4 level ACDF completed on January 3rd.
    I developed an infection which required reopening the wound on January17th
    Looking forward to life without as much pain!
  • Thanks for the response. I sure hope your recovery continues and you get to some of your activities.
    The point you make in the decision process on doing all four at once is the one weighing most on me; only having to go through the recovery process once. I've seen two highly recommended doctors, one an ortho and the other a neuro-surgeon. The orthopedist is advocating doing all at once primarily to avoid having to go through a second recovery and the potential complications that always go along with surgery in addition to going back into an area with scar tissue. The neurosurgeon on the other hand is more even about doing 2 level now and doing a wait on see on when to do the other 2 levels. His view was the ACDF surgery had such low complication rates (and infection rates - so your input is of particular interest) and very high success and satisfaction rates, that going back in as a planned option wasn't necessarily a bad plan.

    As I have no pain now, the procedure here is essentially preventative. Based off five years of tracking the condition via MRI and EMG along with simple manual diagnostics (reflexes, gait, etc), the deterioration seen of late requires timely action. So as an otherwise healthy and active person and outwardly certainly so, giving up the ROM before its time, is really the only argument I have in favor of doing only two level now. Your input on the complexities of the surgery is very helpful. From the surgeon's perspective month+ long recovery might not sound difficult, but for the patient a very different story.
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