Hi all. It has been awhile since I have last visited this site which was prior to my 4-level ACDF on November 16, 2011. I want to give everyone an update (to at least add a data point to those facing multi level fusions) and maybe get some feedback.
For a quick background. My C3-C7 ACDF was performed due to cord compression at C3/4. C5/6 and C6/7 with myelopathy detected via MRI at C3/4. Lots of bone spurs and narrowing of the foramen as well. Pain was generally mild prior to surgery, maybe 2 out of 10, generally in the upper shoulders and left arm. I had various neurological symptoms although not severe. Sporadic tingling/numbness in the hands and on more rare occasion, in the feet. Cadaver bone with plate and screws were used for the fusion.
Surgery lasted approx. 4.5 hours. No voice impairment post surgery. Liquid diet first day post op. Soft foods second day. Solid foods third day. Swallowing was at 70% after the first 2 weeks and maybe at 100% after 3 months. 2 night hospital stay. Took Norco or morphine while at the hospital. Sent home with a prescription for Norco but only needed a handful more pills for a few days. Completely off narcotic pain meds since. Have been on an electric bone stimulator since discharge from the hospital (the one that looks like a steering wheel, used for 30 mins a day). Wore an Aspen collar (hard brace) for approx. 3 months.
My neurological symptoms have improved post op, fewer occasions of tingling and numbness.
Pain was completely resolved immediately post op but pain in my left arm began creeping back around week 3. At weeks 5-7, it was pretty bad at about 150% it’s previous level. Since then it has subsided a bit and now hovers at around 125% of previous level. I would describe it as moderately uncomfortable but not debilitating. I have also been experiencing pain in the neck and upper shoulders which feels a lot like muscle tightness. Many days, that seems to bother me more so than the arm pain. I suspect it may simply be due to the fact that I now have 4-levels but don’t know for sure. Because of the muscle tightness/soreness, the ligaments on the side of my neck and on top of my shoulders pop and creak more often than before.
I have been taking Neurontin for the pain and Zanaflex for the muscle spasms. I’m not quite sure whether I am getting a lot of benefit from the Neurontin and am considering weaning off it to see if there is any difference. The Zanaflex has lost its effectiveness so I will be switching back to Flexeril which has worked reasonably well for me in the past.
I was at my NS for my 4th post op checkup this week. X-rays still show that the hardware is stable. He won’t comment on fusion (I’m not sure if he can based on X-rays alone) other than to tell me that he will assess it via a CT scan at the 6 month mark. He is concerned than my arm pain still persists and remarked that one possibility is that further compression may be needed involving the lamina through the posterior. If there is no improvement in pain during the upcoming weeks, then he will probably schedule a myelogram with the CT.
At this point, I am a little concerned but still hopeful. As I said, the arm pain is only slightly worse than pre-op and not terribly uncomfortable. My hope is that neither the arm pain nor my current neck/shoulder pain is due to a failed fusion or the need for further decompression. I read somewhere that in cases of myelopathy, after decompression surgery, 1/3 improve, 1/3 stay the same and 1/3 get worse. If I could simply be in the 2/3 that don’t deteriorate, I would be thrilled.
I’ve been back at work full time for 2 ½ months now. Walking a mile and a half day and doing some PT exercises.
Any thoughts or feedback will be deeply appreciated. Also, can somewhere tell me where to go to update my profile. I can't seem to find the right link.