C4/5 ACDF Questions.

C4/5 ACDF Questions.

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Donnabe
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C4/5 ACDF Questions.

I just found out today that I have a bulging disc in c4/5 and ACDF has been recommended.

A little background info...

I am 23 and have been having issues with neck/shoulder pain for 4 years. It has been getting worse and worse with time, this year so far I can barely do my job (Restaurant Manager) because it is hard for me to lift or even reach. If I reach the wrong way it will "pop" and I will be in pain (8-10) for a week and still have to work! The pain will run from from the side of my neck all the way to my shoulder blade and upper arm.

I got xrays- Just showed mild scolosis.

I got an MRI, showed the c4/5 disc issue. The Doctor recommended I do the ACDF surgery.

I can't continue living with this much pain.

He said I will be back to work in 2 weeks with lifting restrictions. For those of you that had this surgery is that even possible? I read the recovery is a lot longer. Also I also read that some of you wore neck braces for up to 6 weeks after? He never told me anything about that.

Did the surgery help you? What is the recovery like?

Thanks in advance for your answers.

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CharliJ
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Hi Donnabe, I am 11 weeks

Hi Donnabe,
I am 11 weeks post ACDF C6-C7 and it has certainly helped me. It got rid of the shoulder/arm pain immediately. I had swallowing problems for a week which I hadn't really anticipated- but nothing too distressing. I did not have to wear a collar at any stage- I had a cage put in my neck and they said there were no stability issues for me- but I don't really understand why some people have to wear collars and some do not. I couldn't have gone back to work at two weeks. I am a scriptwriter and I'm finding computer work aggravates my fingers- I'm having little twists of nerve pain there and I am only slowly getting back to work now. I think everyone's recovery is different- and you are very young! If I had been in my 20's my consultant would have used an artificial disc in my neck- which means your range of motion is very good after the op. I think I felt noticeably better around the two month mark but my physio has said- it will take a year for your spine to settle completely- a year of gradual improvements. I think if you are in terrible pain and you have a surgeon you trust that this surgery is a good option for you. Good luck.

Cath111
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Hi Donnabe

Welcome to Spine-Health. You'll find a lot of info on this site and the members of the forum are very friendly, knowledgeable and supportive.

CharliJ said a lot of stuff that is true - the throat stuff, getting back to work, etc.

It sounds like you're having some major muscle spasms - are you on muscle relaxants? They can really help if that's one of your pain generators.

As for collars, I think it depends a lot on two things: how many levels you have fused and the surgeon's preference. Many docs feel that a collar will hurt progress more because it restricts muscle movement then you have that to deal with once it's removed. I had a 3-lvl ACDF with a hard collar for four weeks and a soft collar for eight (if I remember correctly). But I didn't have muscle atrophy problems.

I had major arm symptoms before my surgery and they were all gone when I woke up, thank goodness, and the recovery really wasn't too bad. It does take time, like Charlie said, and with your line of work you'll definitely have restrictions. Many doctors try to speed up the healing process when they talk to you about surgery, but your reality will be yours and yours alone. Back to work in two weeks sounds quite a bit quick, but with cervical surgery, standing isn't as much of a problem during recovery. And walking is always a help in recovery. But the lifting and moving might be an issue for you. I'd ask the doc to keep you off work longer and if you feel you can go back earlier, even part time, you can have your restrictions changed.

Again, muscle spasms are a problem during recovery as your upper back and neck revolt against what invasive measures the surgeon took, but they can be controlled. There's of course the "surgery" recovery - an incision that needs to heal, fusing to be done, etc.

So, I can't think of anything else to tell you so ask more questions if you have them or you can PM me if I can help you more.

Take care and please keep us posted as you move along on your journey.
Cathie

Donnabe
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Thanks everyone!

One of my biggest concerns is the information I read about people having a single level fusion and then having the two nearest levels have problems shortly after. For example I am having c4-5, what about 3-4 and 5-6. Is it common for problems like that to happen?

Also are there other methods of surgery I should be looking into besides the ACDF?

I am perscribed Carisoprodol(soma) 350mg one tablet every night. I am going to ask the doctor if that perscription can be upped because on bad days I would like to take it 2x during the night or during the day.

Will the muscle issues continue after I have surgery, ( I don't mean post op healing, I mean after that)?

I told work it will be atleast 2 weeks, but I really feel it may be longer than that. I work 10 hour shifts where I do a lot of bending, lifting, turning and so on. I am applying for FMLA. I have 14 days of PTO and do currently have disability.

ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg

CharliJ
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Muscle spasms etc

I worry about the adjacent disc disease thing too. But you should ask about the artificial disc thing- as then I think there would be less stress on the adjacent discs than if you have fused vertebrae. My adjacent discs look good and I am going to do some Alexander technique/ feldenkrais therapy and pilates to monitor my posture. I sit at a computer for long periods which is much worse than having an active job like yours. I have muscle spasms in my neck occasionally now when I have done too much- but this NOT like the showering pain down my arm before the op. It is controllable by pain meds and ic e and rest. MOst days I don't take painkillers now. My surgeon told me I coud go back to work at 6 weeks but it was 10 weeks for me and then only part time. I think with such a physical job as yours you'd have to be very careful. I had to have my op because I lost function and had significant weakness in my left arm and hand which came on very quickly- but if my herniated disc had been diagnosed more quickly I would have tried every conservative option before surgery- rest, PT, Alexander, time, I would have changed my office chair, worked on my posture, sleeping position. I feel I had no alternative to surgery as I was losing the use of my arm. AS to other methods of surgery I was never offered anything- but I'm sure there are people on these boards better qualified to answer that. Also you need to discuss that with your consultant. I don't know the tablet you are on as they have different names over here in the UK. I was on about 12 different tablets a day to try and control pain prior to my op and when I went into hospital I went straight on morphine. IT WAS BAD! But as everyone says here, everyone's journey is different...

Donnabe
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MRI REPORT

I got the MRI report and this is what it says:

There is reversal of the normal lordotic curvature. The cervical vertebral body vertical heights are maintained and there is no spondylolisthesis. Bone marrow signal intensity is within normal limits. The craniocervical junction is unremarkable. Signal intensity and morphology of the spinal cord is normal.

C4-5 Small left paracentral disc protrusion results in mild left neural forminal stenosis.
c5-6 Minimal degenerative changes of the bilateral uncovertebral joints with minimal left neural forminal encroachment.

Additional levels without significant stenosis. The Paravertebral soft tissues appear within normal limits.

Conclusion:
Small left paracentral disc protrusion at c4/5 results in mild left neural foraminal stenosis.

To any of you that know what this means... Please tell me. I would be having the ACDF surgery on 4/5. Does this mean 5/6 is already about to have issues? Also, "small and mild" scares me...

What do you think?

ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg

Metalneck
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Hey Donna ... Welcome to SH

A couple of comments - ideas:

You have mentioned "doctor" is this an Orthopedic surgeon specializing in spinal surgery or a Neurologist that specializes in spine surgery? Have you gotten a second or third opinion(s)

Have any of your healthcare providers discussed
less intrusive treatments?

Have you been through any PT, ESI's (Epidural steriod injections) massage, ultrasound, heat - ice?

For MRI comparison purposes ... take a gander at this:
http://www.spine-health.com/forum/neck-pain-cervical/my-bad-mri ... This was my MRI before I went in for a "simple 2 level ACDF" with a "two week recovery - no big deal" .... it led to another 4 surgeries 1.5 years later and continued problems that have literally changed my life. (not for the better).

I fully support the need for surgery when the pain is at the point where no meds can control it ... further damage could lead to paralysis - and ALL conservative modalities have been exhusted - and you have a consensus from a number of clinicians that this is the proper time and type of treatment.

Please make sure you have done your due diligence (research and consultation with others) and that this is indeed the appropriate time, place, and treatment.

I don't mean to scare you .... I am only providing the information I wish I had been given prior to my first surgery.

Best wishes for relief and better stable health for you - Respectfully,

d

Donnabe
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Re:

I have not gotten a second opinion yet.

The Dr. is a neurosurgeon. Multiple family members have had surgery from him in the past.

I did PT for a month and a half, it made things worse.

I have been having the pain for 4 years, worse in the last 2 years and even worse in the last 5 months.

ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg

Metalneck
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2nd opinion

I would consider getting a second opinion from a Board certified Orthopedic surgeon who specilises in spinal surgery ... and specifically ask him about the potential of other less intrusive treatments - also inquire about ADR (artificial disc replacement)which is becomming more popular and acceptable for single level disc problems.

If the other doctor doesn't agree with the first .... then get a third decision to "break the tie"

Best wishes and keep us posted!!

d

Donnabe
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Thanks

Great idea, I am looking at getting other opinions, I know the pain will just get worse and it is drasticly effecting my life. I am 23 and feel I can't have kids because I won't be able to lift them. I also love sports and bike riding and cant do any of them right now.

I used to be a great employee (they say I still am but seriously, I used to do a better job), I have learned to delegate a lot more. I was one of the only people that got exceeds expectations in most categories on my review- I was promoted to assistant manager at age 22, and at this company most are much older. I also am a hard worker and I have a degree in HR, Training and Development, as well as Labor and Employment studies. I feel like I used to have so much going for me and have been able to deal with this pain, but the pain keeps getting worse and worse, it no longer lasts 1 or 2 days and it goes in a horrible cycle. I am sure most of you can relate to me.

Thanks,
Donna

ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg