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Failed acdf c5-7 ...now what

sinatrafan44ssinatrafan44 Posts: 64
edited 06/11/2012 - 7:47 AM in Back Surgery and Neck Surgery
Had ACDF c5-7 on June 2009..Been struggling last 6-9 months with arm pain after being treated for fibromyalgia with a host of drugs, gabapentin, lyrica, savella, naproxen and oxycodone..pain worsened so an MRI was done and revealed a herniation at the level above the fusion..given dose of steroids..worked for a few days but pan came back.My PCP put me on 20 mg of Oxycontin with 5 mg of oxycodone as needed usually 3-4/day. He is also trying another anti seizure med Valporic Acid, I went to NS and he sent me to have a selective nerve root block with floroscope..It did not work..and because of the possible complications with the block, opted not to try the 2nd or third shot...Saw a second NS to look at options and he too did not want to do more nerve blocks, especially because it did not work..He did recommend PT to strengthen my back and shoulder muscle, and also to use cold laser treatments (never heard of that one before)..So if the PT does not work, and while it may strengthen things, I will be left with the decision of surgery or not. As the consult NS stated, they would probably have to rip out my hardware and build another level including c4-5..I just can't fathom this again especially at the higher level..I have such a fear of swallowing and vocal problems, which is more prevalent at this level..I guess the question is at 46, should I try to fix things surgically, or deal with the pain from the herniation using narcotics...there is no good answer and I am so confused/ distraught not to mention battling serious depression, working 40hrs week, and trying with my husband to raise 2 teenagers..Anyone else in this predicament..also what are the harmful longterm effect of narcotics (other than the addiction possibilityy...thanks for any help you can provide...AMY


  • I don't see anywhere in your post that the present fusion itself failed, but an "adjacent" level - the one above failed. Am I reading that correctly? If that is the case, they will probably (if surgery is on the table) go in, take the old hardware out, fuse the next level and add new hardware.

    My fusion is failed due to a crack between the fusions, and for that they will go in front and back. With that, they would revise the whole mess, plus with me another level has gone for me as well, the one below again C7/T1, so that level will be added in.

    So, by what I am reading, all they will do is take the hardware out so they have an area that they can add the new hardware with the new level. They put this cement like substance in the screw holes to maintain the integrity of the vertebral bone. Yes vocal cords are at risk, but they are with pretty much all levels. Mine are constantly swollen due to movement between my last two fusions. If the fusion indeed failed, like what they told me, they will revise the whole shibang!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Having a failed fusion or failed neck surgery syndrome would be two different things. One is did you fail to fuse at the two levels you already had operated on? Meaning the bone didn't completely incorporate from one vertebre to the other. Now Failed neck surgery syndrome means the surgery failed to relieve you of your symptoms. Question is did you ever feel better after surgery and then at sometime things got worse.

    AS far as having the nerver root blocks I am not sure what they explained to you about them. They are not meant to give you long term relief but rather used as a diagonistic tool to see which nerve is the offender.

    Also I am not sure if they explained that if you are fused you no longer really need your hardware. Once fusion takes place the hardware isn't doing any work any longer. So if your fused and you have the level above your fusion out, in essense they will be just doing the one level and to get at that level and place the hardware appropriately they will need to remove your old hardware. Trust me I had someone leave the old hardware and caused tons of issues by not removing it. Removing hardware is pretty simple task as long as they know the name of the plate and bring the right tools to the OR. So if your using a different surgeon that you previously used they will need your previous surgical notes.

    Now if you have a failed fusion I can say the surgery itself is typically a posterior entry and is a much harder surgery on you as far as pain goes. But the good thing is you know it is surgical pain and it will get better. On the posterior entry in all reality I think it takes about a year to heal from that surgery.

    I can truly understand your frustrations with having another surgery not getting relief from surgery and the whole process. Unfortunately it is a definite risk of surgery. As someone whom has had 6 cervical surgeries i really get the frustrations. I am fused from c3-c7. But I also applaud you in still making it to work and taking care of your family, so you know you are a strong person. That in itself takes so much out of you.

    While I know it is a difficult choice to go back in surgery, what are the surgeons saying your risk are by not doing surgery? How bad is the level above the fusion? I would ask them if it weren't for going back in for the other levels would they do surgery on just the one level? When you speak with them I would find out if it is a failed fusion? What will they be using for the new bone grafting if it is and what approach they will be using?

    Please keep us posted on what you decide to do about surgery and how your getting along. If there is anything i can do don't hesitate to pm me. Take care.
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  • Hi Brenda..that is correct the fusion is fine it is the herniation above that is causing the problems..Honestly I am not sure i can have another surgery.I just can't bear the thought of them taking it all out, only to rebuild it with the possibility of it happening again and again like a vicious cycle of surgeries...I don't know..Pain meds keep things tolerable but I doubt i could use them for the next 30-35 years given that I live into my 70's..Or if nothing else is it something that surgery will be inevitable..Down and out today.
  • Sinatrafan,

    Okay, cool, thanks for clarifying. :) As Tamtam just posted, and I too, they will go in (probably from the front) remove your old hardware, add the new level, and add hardware for that level only. I will give you a heads up here. As you can see by my avatar, I have 2 distinctly different types of hardware between my fusions. AVOID that if at all possible! My ENT (cuz my NS wouldn't admit it) agrees that the different type of loading these types have, cracked my vertebra between my fusions, thus creating a whole new animal of problems. :)

    The original 'game plan' when my C6/7 went was to go in, remove my hardware from the C5/6 level, then do the C6/7. When I awoke from surgery, my NS happily told me that he didn't have to remove the old hardware, that this new 'anchoring' system came out. Well, 7 weeks after that surgery, I wasn't as happy as he! Now losing yet another level, I will demand this not to happen again - hell I will scribble it on the consent forms!

    *Deep breath* Now with all that said, from what I've seen on here, other surgeons don't do that. They go in, take the old hardware out, and then work the new level as it is, 1 level. I know it sucks big time to think of another surgery, in those shoes in two areas of my spine now. Like your original surgery, *you* will have to decide when and if you go through it. Have very frank and honest talks with your surgeons of your concerns, and hopes for outcomes. Also too, as long as permanent damage isn't a risk - gotta think of that aspect to. :)

    Revision surgery. As Tamtam sadly has experienced many times too many, those surgeries are normally front and back - and now from what I'm learning from doctors (and really Tamtam months ago), that recovery is a bugger - long and hard. Adding a level as happened with me, and maybe with you now, is almost like what we already went through. I hope that gives you a little bit of a perspective on it?

    We're here if you need us of course!! *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • thanks guys for sharing your experiences..appreciate all the support..i'm sure at the next appt options wil be discussed..thanks again..Amy
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  • Amy,

    I know this don't sound like good news, but sense your fusion is fine itself and healed. Then there is some good news that they can do the other level from the anterior approach. I know no surgery is good news, but whenever possible the anterior approach is a much better option. My guess is that you already had some issues at that level and the fusion caused the herniation. I would also ask them about using your original scar for the approach. Each of my anterior approaches have been opened up twice so if they say they can't that is false. Just if your using a different surgeon that you did prior they like to make thier own new scar. But just something else you might want to check into.
  • I have two thoughts - one is your in misery now; is your pain realistically going to improve without more surgery? If there is any chance it can improve on its own without surgery (not all herniations need surgery, even those that hurt may heal completely without surgery)? We all now the "next level" is always at risk (adjacent disk disease), but do you have to have surgery now, and is it inevitable? Retrospectively, I wish I personally moved quicker on my second surgery when it appears inevitable - quicker surgery = more forward on the road to recovery sooner.
    Next, its OK to get multiple opinions; you have a complicated problem.
    The other thing that strikes me is your obvious pain, not under control. Some pain docs don't want you to be "100% pain-free because it leads to tolerance"; but also the higher you live with intense pain the more likely it is that chronic nerve pain pathways can be established (please do not ignore this possibility), and pain cause be doing other bad things - like causing high blood pressure. Since you are so young, has anyone suggested aggressive pain management such as an SCS before you even have another procedure?
    I hope tomorrow is a better day for you.
  • 7/16/2013 acdf c5-7 with hardware , numerous spurs removed and foreaman opened up . 9/9/2013 I returned to work and pain returned . Was told it was just part of the healing process.. 1/13/2013 back to the NS with c/o continued and worsened pain, fatigue and hump on upper back below c7. New xrays show fusion of c5-6 but failed fusion c6-7. MRI today....... I'm trying to stay cool!!!!! But lack of sleep, pain and just getting through the work day so I can get home to the couch and lortab is not the way to live!!!!!!!
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