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questions about acdf

Lela1122LLela1122 Posts: 119
edited 06/11/2012 - 7:43 AM in Back Surgery and Neck Surgery
Hi all, I read this forum almost everyday and I have a question for the neckies who have had surgery, I have a c6 pinched nerve, I would be inline to have the decompresion on the exiting foramen to give that nerve some room to "breathe". The ns said on our first appt that he said surgery was really the only option. I since, that appt have seen his pain management dr for cervical epidural injections which so far have not helped much. this past Monday when I saw my ns again, he said that he gave me a 60/40 chance of this surgery even helping me with the pain and numbness in my thumb, shoulder pain, etc,muscle spasms have any of you had this same conversation with your ns? I was shocked, I know that surgery is not a magic bullet, but I was hoping for better odds!!! I have arthritis, bone spurs in that area. I like this ns very much, I guess maybe I will just have to be in so much pain that I will opt for the surgery because its the only hope for relief!!! I am depressed about it, because I cannot live like this for much longer!!! He also said he was worrried more about my disc bulges that the other problems, anyway thanks for any input, I appreciate it. Lela


  • Howdy Lela,

    I am kind of both ends of the spectrum if you will, so maybe of help to you? Please see my sig for time lines. My C5/6 I was told that surgery did *not* guarantee relief from pain, but the odds were in my favor. My hernia for this level was back on the cord, and slow in developing. I had radiating pain, some numbness, not a lot of weakness. This surgery for me....was 100%. At just around a year, I almost forgot I had surgery, yeah, it was that good.

    The other end... A year and a month later my C6/7 went rather violently, even though what caused it was just a yawn! I had instant weakness, searing - burning pain in my shoulder blade, triceps, top of forearm and index, middle fingers. Surgery was 7 weeks later (partly my delay due to work). This surgery initially took care of all symptoms yet again. (Other side coming) At around 7 weeks post op, short of the shoulder blade burn, I lost strength again, and had shooting pains back down my arm (some on my other arm too). MRI showed nothing. At my 6 month check, and now on Lyrica for about 2 months, a crack was found 2mm below the bottom screw of my first fusion! See my avatar - totally different hardware between the fusions. I know next week if revision is on the plate - more likely than not, it is.

    I still suspect my "wing thing" is what changed the stress on my fusion areas. Plate pulls horizontally straight back, and the wing up and down. I know if this was a "mechanical" thing, there would be cause for induced stress and then cracks...(sorry use to work as an aircraft mechanic - hence my thinking there.) Except for pushing for same hardware, I wouldn't have done anything differently in my decision to have surgery. I just had something go wrong, and I don't think there is a "real" answer I will ever find as to why. I was given odds around 80% for the first, and 75% for the second as it was an adjacent level. Please keep us posted!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks Brenda,
    I have been reading your posts and know some of your issues, I did have to stop taking the Lyrica because it made feel like I wanted to run down the street screaming and yelling. You know some days are not so filled with the depression but other days I just cant see the forest for the trees. I have one more cervical epidural injection in 2 1/2 weeks.

    I clean houses for a living and some days I get by and some days I have a tough time just making it. I have always been so independent and never felt like I couldnt do anything, sorry for complaining. I knew I had a problem starting in earnest last Aug. I keep thinking that after he got in there he might actually see more than he thinks. He knows I am in pain and that I have a problem so its not that he doesnt believe me just that he might not help that much. So I will wait it out and maybe in a couple of months I will have my answer on my own!! Thanks Brenda

    Were you in the service? My husband was in the air force reserves and was curious.
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  • I'm confused about what surgery would have a 60/40 success rate? A forenatomy is not a fusion. If they just open up the area for the nerve root that is fairly easy surgery. Sounds like he is more concerned about the disk bulges which would mean a fusion and they would clean up the pinched nerve at the same time.

    The real question is what do you feel as symptoms? Often the doctors get hung-up on what the text book says should be the problem.
  • I have constant shoulder pain, numbness in my thumb, pain that radiates down my arm, headaches, not always horrible headaches, but when I get them, I am down for the whole day. my neck is in constant pain, from the arthritis. I have constant muscle issues tightness, in and around my neck and shoulder and at times the horrible spasms in my mid back.
    I am sure he said with the surgery that it would be a fusion and said that 60/40 chance of pain relief from the pinched nerve. He said the bulges werent that horrible on the mri either, I dont know, everytime I see him I forget to ask questions. I go again in a moth after I have another epidural injection in there, I am going to take my husband and get more answers. Thanks Kris
  • IT is easy to say and hard to do but get a notebook. Write down your questions and leave space for answers. Also keep a log of symptoms.

    Sometimes the doctors give odds to cover their butts. That way if the surgery doesn't cure everything you can't yell at them. You have to realize that with issues at multiple levels you may not have complete relief but hopefully the surgery will offer some redcution of pain.

    There are tons of pros and cons for when to have surgery. Age, health, work, pain level, potential for further spine problems. If you are uncertain make two lists. This will pinpoint some more questions for your doctor.

    Good Luck with your appointment.
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  • The percentages some doctors give are to cover themselves. Some surgeons, like mine, never mentioned percentages, he just had a positive attitude that he wanted to spill over to me. It did - and attitude helps a lot when facing surgery and recovery.

    I can't tell you how many people on this forum have woken up from their cervical surgeries with all their arm symptoms gone.

    I had a 3-level ACDF in Oct. 08. My cervical spine was a complete mess and my symptoms were very severe - tingling and numbness in my right arm 24/7, severe pain and the loss of use of my left arm, and painful muscle spasms in my shoulder and back. When I woke up after surgery, they were all gone. I had full use of my left arm, no pain the my limbs, no numbness or tingling. Sometimes it take time for the symptoms to go away, but many times it's immediate.

    Recovery pain was normal, pain at the base of my neck and continued muscle spasms, but they can go away with time if you fuse.

    So, try to think positive about this surgery and don't accept the 60/40 theory. Tell yourself you're going to accept this surgery well, you'll fuse and get back to a good life again when you get through recovery. It happens more than you would expect.

    Take care,
  • Good afternoon Lela,

    10 years Army and reserves here. Aviation - helicopter mechanic (though a pilot in civilian). If I were 17 again, I pretty much feel I would make the same choice and sign up! :-) Best decision of my life.

    Sorry to hear Lyrica didn't work for you. For me it gave me a bunch of my life back! Did or are they going to have you try other nerve meds? As you get closer to surgery they might not as this way you won't have to ween off of them.

    Cleaning? I know what "regular" cleaning did for my neck. I bow in respect that you are able to continue, just don't hurt yourself! As for thinking you are complaining, lol, not even close! That is one of the beenies of this site, most of us can sooo relate to each other, and none are seen as whining or complaining! :-) *hug*

    I am so hoping that when you awake, it will be such a "happy tear" time! When I woke up, the surgical pain was so low I didn't notice it! I FULLY noticed all (yep, all) my radicular pain was GONE! I actually had "happy tears" so big that the recovery nurse thought I needed "pain meds" to control the pain! My answer to her with what I am sure was one of my biggest smiles..."What pain?!?! These are happy tears!!" Please keep us posted! Support *hug*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • SpineAZSpineAZ WiscPosts: 1,084
    I went into my C5-C7 ACDF with left arm and shoulder pain, numbness and tingling to the fingers, and those nerve zinger pains (searing pain) down the arm. I agree that the 60/40 is probably trying to prepare you. Everybody's problem in the neck is different and from what I've heard from my doctor and other people on sites like this is it appears anatomy is not as concrete as you see in text books or websites. People have been told "wow, that vertebrae was odd" or "wow, your disc seemed to be undersized"...etc. And, I have definitely found that imaging (MRI, CT, xray, etc) really only tell part of the story.

    My ACDF was very successful and I'd say I had 80% improvement. My one personal fault was that my orthopedic spine surgeon said the C4-C4 disc looked "iffy" but not something I had to worry about just then (2006) and now it looks like C4 may need to be added to the fusion. But I have really bad bones, joints, etc which the surgeon wouldn't have had my full orthopedic history. So I wished I had said "just include C4".

    The ACDF was one of the easiest surgeries I've ever had. I had some post op pain but they go through the front of the neck so they are not going through muscle. 2 years later I had a foraminotomy for stenosis at C6-C7 from the back of the neck and that hurt far more. But that's the one that showed me test results aren't too reliable. My surgeon had said "well maybe a foraminotomy will help" and I was game. When I woke up he was saying to my hubby how sever the stenosis was and none of the results had showed how severe and he's glad he got in there when he did.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Hi all, thanks for your posts, I didnt even think about the surgeon covering his butt about chance of pain relief. I am only 44 yrs and have a lot of LIFE left, to live and work and be a productive member of society.
    I know I may have to change my job title, although I have cleaned homes for so long that I am not sure what I would do to make the kind of money I do, and all of my clients are like my best friends.
    I will get a notebook and write everything down, its the only way to come out feeling like you have all the answers you need to either do the surgery and know the risks of what might happen while you are recovering. I am really leaning to do the surgery. I will say that at this point the cervical epidural injection did help, not entirely, but the arm pain is not quite as bad as it has been.

    I dont know if they are going to try me on another nerve drug or not. I dont see my pain management doc again until June. I really do not like the guy, but he is hooked up with my ns whom I really like, so I will stay until I get through this, thanks all,
    Brenda my husband was air force reserves went to afghanistan 2 years ago, passenger services, he loved it, some of the best friends he ever made!! He retired last year. Thanks for your service Brenda
  • I'm glad you're thinking this through thoroughly, too many people just jump in thinking it's the only way without trying conservative measures.

    Since your conservative treatments don't seem to be working, surgery might be the best choice for you. You've heard from a lot of us that an ACDF is doable and the recovery isn't as bad as a lumbar recovery, so that might be the right choice.

    Try reading through the FAQ section on this site. It has a lot of links about what to think about before deciding on surgery, what questions to ask, what to expect during recovery, etc. This surgery is indeed a serious surgery and has a long recovery, but for many of us it's been just what we needed to get back to a relatively normal life without all the arm radiculopathy that we suffered with for so long.

    You are young, and I had my surgery at 47 and had a good recovery (other than an incomplete fusion at C6/7, but that's another story), and I found it successful and worth everything that I went through.

    Good luck on making your final decision. It's a very personal one and I know you'll choose the right road for you.

    Take care and know that we're here to support you whatever you decide and will be with you through it all.

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