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ACDF C4-7, waiting to schedule

CheekyCCheeky Posts: 40
edited 06/11/2012 - 9:03 AM in Neck Pain: Cervical
**** I know I wrote mini novella - sorry about that! Any help/suggestions/insight would be greatly appreciated!****

I went to my neurosurgeon on Friday 5/25/12 to discuss lumbar & SI joint fusion (damaged when I slipped on a wet stair case 10/31/11), however when his PA checked my reflexes, she noticed hyperreflexia, and after a few more tests in the office, it was decided that I needed an MRI & follow up with the neuro ASAP. They squeezed me in for an MRI on Tuesday (it was already after 6pm when I left his office on Friday, & Monday was a holiday), and got me in for follow up with the neurosurgeon Wednesday (yesterday).

The MRI showed that the C4-5 was collapsed & putting pressure on the spinal cord, C5-6 was "precarious", and C6-7 was completely collapsed and the giant dent in my spinal cord was obvious even to my untrained eye. Because of the pressure on the spinal cord, it was decided that I need a 3 level ACDF from C4-7 before they can even consider starting to treat the lumbar facet & SI joint problems, or I could be paralyzed from the neck down during intubation (or if I fall, which is entirely possible since my right leg drops and both of my feet go numb, or if I even have a little fender bender!).

We had NO idea there was any damage to my cervical spine, in fact I had an EMG done a month or so ago because of intermittent numbness in my left arm & hand, but that came back clear, and I was told that there was nothing wrong with my neck, and the PMR & pain mgmt doctor both dismissed my request for a cervical MRI, telling me that there was nothing wrong with my neck, and an MRI was not necessary.

My neurosurgeon is wonderful, and took the time to explain the surgery, the reasons it is necessary, and answered all of the questions I had for him - I have absolute confidence in his abilities, but this came totally out of the blue.

I was mentally prepared for the idea of lumbar & SI surgeries, but ACDF isn't something I've researched for months on end like the lumbar & SI fusions, and it scares the beejeebers out of me!

I'm 33, long winded (you probably already noticed that! :)), a total Type-A, and while I keep telling people it's going to be okay, inside I'm terrified.

I know I'll be in the hospital for at least 4 days (1 in ICU, then 1 day per level minimum on a surgical floor so the neurosurgeon can keep an eye on me), and in a collar for 6 weeks minimum, but aside from that, I really don't know what to expect - I've found some great info on 1 level ACDFs, but it looks like 3 level's is a game changer.

Any help or insight would be greatly appreciated - what can I expect when I'm released? Realistically how long will it take to recover? What will I want to do & be surprised that I can't? Just... anything you can tell me, or any links you can provide would be wonderful :)

Thanks for reading my whole long winded story (or even skimming it :) )
Slipped on a wet stair case the morning of 10/31/11, landed flat on my tush & blew up my spine & both SI joints.
3 level ACDF C4-C7 7/11/12 (collapsed discs & severe cord compression)
lumbar fusion to be scheduled once healed from ACDF


  • HI Cheeky, there is alot of info on this sight that can be helpful for you and I suggest you review it but I will tell you what I went through and it may help calm some of your fears. I had 3 Level ACDF on April 16 C4-7. I had bulging disc C4-5 with bone spurs, C5-6 had herniated and was compressing the spinal cord and I had a severe bulging on C6-7. My chief complaint was severe right arm pain and numbness in fingers,right arm was becoming very weak and I was losing the ability to use it. When I woke up from surgery my right arm pain and numbness were GONE! I was only in the hospital 1 day and came home. The surgery itself was not a problem for me. I had several pains post-op pains that were not there before but alot of them have receded now. You are going to have a sore throat so stock up on soft foods like soups, pudding, ect. The anterior approach causes that but it lasts only a few days 4-5. Make sure you have lots of pillows to prop up on or a recliner, sleeping if at all will need to be at an angle sitting up. Take ur meds every 4hrs even if you have no pain because once it comes it is very difficult to control. I live alone so I had all i needed on the bed next to me or in the kitchen at eye level no reaching. To be honest it is just pain management and trying to not over do it ( I had a problem with that one) I started to feel better with in 3--4 weeks, so I fell down some stairs for good measure and I am fine now. I was terrified and this sight was so suppportive and helpful to me. Weeks ago there was a video someone posted under this forum that explained it all if you could find that I think maybe you tube originally. My doc had an optional soft collar because I had 3 plates and 8 screws in place and I wore it at first, but all docs are different. My range of motion is good, up and down area little limited but only slightly.I am working in PT for stregnthening. I am just over 6 weeks and I feel really good I will be going back to work soon. I have no lumbar issues so I cannot say for sure what your situation will be like but I can tell you, the surgery was a good decesion for me. A quality of life issue and i am better for it. i hope this helps and I will keep you in my thoughts and prayers. Keep us posted- Kim
    Kimberly Martin
  • Welcome to Spine-Health.

    I had a 3-lvl ACDF, C4-7 also and can only echo what Kim has posted. I only spent one night in the hospital and they took great care of me, along with a dilaudid drip (didn't like that so had a morphine drip for my lumbar surgery).

    I woke up with a hard brace and all my arm symptoms were gone. Before surgery, I had pins and needles/tingling 24/7 in my right arm and pain and weakness in my left arm (to the point that I couldn't even pick up a glass of ice water). Everything was ok when I woke up - yay, it felt like a miracle.

    The hard collar is difficult to get used to, but you will. It's a little hard to sleep in and I also slept for the first few weeks in my recliner.

    Straws are good to have, a grabber, and a "station" where you can plant yourself. For me it was a recliner in the living room with a rolling table next to it where I could keep everything.

    If you have a hard collar with padding on the inside (like a Miami J), make sure you have an extra set of pads or two on hand so you can change them when you want. It gets hot under that collar and you may tend to sweat and want to change them to feel cleaner and cooler.

    When I got home, I was able to eat one of my hubby's famous pork chops, so the throat thing is variable from person to person. I had a sore throat for a couple of weeks and raspy voice for 6 months (and it's never gotten back to normal), but didn't need only soft foods after surgery. Others have had to stay on soft foods for weeks following, so be prepared for both. Good news: it's legal to have ice cream for breakfast after an ACDF. :-)

    Keeping up on your meds is imperative, like Kim said, to stay ahead of the pain. Once it gets ahead of you, it's very hard to get back under control. Muscle spasms are very common after this surgery, so keep those muscle relaxants handy.

    Then there will come a time when you're feeling better and will start getting bored during your recovery. Have some things on hand to keep your mind busy - games, magazines (I couldn't concentrate on books and am an avid reader), movies, etc. You'll want to start doing things you shouldn't yet like house cleaning or laundry, but that will still be a no-no. In some ways, I found that to be the hardest part of the ACDF recovery.

    Even though 3 levels is definitely more difficult than 1 or 2, it's not really a game changer. It just takes a little more recovery and your scar will likely be vertical instead of horizontal. I'd say that I felt much better after 3-4 weeks also, and realized then that it was just the surgical pain I had to deal with, not the cervical problem pain or internal pain from everything being moved around.

    My ROM now, 4 years later, is pretty good (better left and right than up and down), but I find it difficult to keep my head turned in any one direction too long. So for instance, I need to lay dow to watch fireworks instead of looking up for 20 minutes.

    I guess that's all I have to offer - sorry if this post was too long, but hope it helps. Almost everyone on here will tell you that the anticipation of the surgery is worse than the surgery itself, but I'm sure that doesn't help - you'll have to realize that yourself post-op.

    Take care and keep us posted.
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  • Hi Cheeky and welcome,
    You are correct a 3 level is quite extensive and does take a long time to recover from I know because I'm still doing just that. You can see from my pic I had a 4 level fusion on Dec. 19th, I stayed in the hospital for 3 days and was home for the next 3 months.

    The first 2 to 4 weeks is tough so get as comfortable as possible for that time and make sure you take it easy and follow all doctors recommendations. Very important stick to the pain med schedule and get off them as quickly as possible. I was off them in 2 weeks but we're all different.

    I wore my brace for 3 months and returned to work at that point. Work for the first month or so was exhausting and took some time getting used to. I basically work from a computer giving presentations to our service people which required a lot of typing which was difficult at first, but getting better everyday.

    It is also important to do your pt when the time comes but don't over do it which only causes more pain. This process takes time.

    For me I'm getting better by the day and even went for a ride on my HD for 250 miles a couple of weeks ago free from pain for the first time in years. I have no problems at work anymore and other than the rom restrictions am pretty much back to normal.

    The only thing I haven't been able to do is golf, i was a avid golfer and the rom issues seem to be holding that back, that and I want to make sure I am completely fused before giving it a go.

    So, you now know what we've all found out and that this is quite a long process but there is light at the end of the tunnel. Be patient especially for the first few months and you should be fine.

    Good luck and keep us posted on your progress.
  • Thank you for all of the responses!

    My neurosurgeon insists on 1+ day in ICU, and a minimum of 1 day per level, so I'll be in hospital for at least 4 days, even if everything goes perfectly. I will be in a hard collar for 6 weeks - he only wants it removed for bathing. Per your suggestions, I'm definitely going to ask for extra pads - I live in Florida, so having this done mid summer means oppressive humidity anytime I step outside... I don't want to think about how gross those pads will feel once they're saturated with sweat. Yick! :)

    I'm not sure if he's so adamant about all of this because of the amount of spinal compression (c6-7 is pushing about half way through the spinal cord), or if it's because of the other spine issues I have going on. He is hoping that the ACDF will help with some of the low back problems, but we won't know until a few months after surgery.

    I've been on percocet 4x daily, flexeril 3x, cymbalta & celebrex daily, plus various sleeping meds since the accident 7mo ago - I'm diligent about taking them on time so that I keep the pain at more manageable levels (there are days that the meds don't even touch the pain though), and I've been keeping a pain journal since a few days after the accident - I started it because I couldn't remember if I'd taken my meds or not, and has since become habit :) I'm sure I'll be on different pain meds post surgery & then will probably be switched back to what I'm currently on until the other spine issues are corrected (I really don't recommend slipping on a wet staircase, flying up & landing on your butt - it can really do a number on your spine! :) )

    I'm learning to be more patient with myself - I am an absolute type A personality & was ALWAYS on the move prior to the accident - working 50h/week (I love what I do), yoga 5x weekly, walking our dogs 3-5m/day, ballet isometric exercises, cooked elaborate meals most nights after work, etc etc etc - I've been on medical leave for 7 months now, and am slowly learning to accept that I can't spend hours in the kitchen (standing for 10min leaves me in agony), I can't walk our dogs, do yoga, go to work, clean the house, etc - those are the changes I'm having the biggest issues with. The first few weeks after the accident were a nice little vacation & I enjoyed being "lazy", but it's gotten old, and I sometimes find myself doing things I shouldn't be doing without thinking - how do you stop yourself from scrubbing the kitchen sink, or doing a load of laundry on the days you feel "up" for it?

    Cath - I really hope I can manage a famous pork chop or something like it, but my boyfriend is more of a Kraft Mac n Cheese cook - which is a good thing since it's pretty soft & should be easy to swallow :) thanks for all of the great suggestions - I have a list started :)

    Dave - I'm so happy you're feeling so much better!! It must be wonderful to be able to ride you HD again :)

    Sunshine - I'm glad that tumble down the stairs didn't set you back & that you're recovering nicely!

    I'm waiting to find out if insurance will approve the surgery, or if they're going to require a 2nd opinion first - I'm hoping that since even I can see the spinal cord compression (it was hard to miss lol), that they'll just approve it - I want to get this scheduled ASAP and get the ball rolling on returning to a more normal life :)
    Slipped on a wet stair case the morning of 10/31/11, landed flat on my tush & blew up my spine & both SI joints.
    3 level ACDF C4-C7 7/11/12 (collapsed discs & severe cord compression)
    lumbar fusion to be scheduled once healed from ACDF
  • Hi,

    I had level, c3-4, c5-6-7, on May 15th. Was in the hospital for 9 days, which is not the norm. Had swelling in throat, so they kept me intubated, under sedation, for 2 days. After that, I was on heavy IV steroids to minimize swelling.

    I think it went well. Most pre-op pain is gone. Still using neck brace some of the time.

    Good luck.
    - Vin

    3 level ACDF, c3/4, c5/6/7 in May 2012
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  • Hi there.

    I had a three levelC4-7 and was in the hospital for two days. first day in ICU and the second one on the floor. I didn't have to wear my brace unless i was up an walking around doing something. I found it very difficult after surgery because i hated doing nothing. and the only thing that i was allowed to do was walk for the first two months. I got really good at that lol. I bought pick ups from the dollar store and found them of great use,because i found that everything that i needed i had to bend over for. I got bored very quickly and my husband started going out and had bought me lots of movies to watch to help with that lol. I did feel sick enough that i didn't feel like spending much time on the computer,i was totally exhausted for the first three or four weeks after the surgery.But my body was exhausted before my surgery as well because of everything that i had gone through and the long wait for the surgery.Its been four years since my surgery almost and i can turn my head very well but i still have lots of issues because of the spinal cord injury from the compression. Don't be surprised if things come up even a year after your surgery. Your very lucky that your surgeon is jumping on this so fast .He may be sparing you a lot of problems. By the time i had even seen my surgeon the first time my issues were already there and there was nothing that surgery would have fixed.the surgery itself was not anything too difficult. Of course the day you come out of it there is pain but your surgeon sounds like the type that will definitely take care of that.Everyone asked me for a long time how my surgery was and i just kept saying that i've never had surgery before so i had nothing to compare it too and for me it was nothing that bad. Good luck with yours.
  • Yikes Vin!!!! 9 days in the hospital?! That must have been pretty scary for you and your family!

    I'm glad you're feeling better now! :)
    Are you able to swallow/eat non soft foods?

    Does anyone know why some people are required to remain in rigid brace for 6wks while others are able to go without a brace at all soon after surgery? Is it just doctor preference, or are there certain conditions that make it more necessary?
    Slipped on a wet stair case the morning of 10/31/11, landed flat on my tush & blew up my spine & both SI joints.
    3 level ACDF C4-C7 7/11/12 (collapsed discs & severe cord compression)
    lumbar fusion to be scheduled once healed from ACDF
  • It's all up to the surgeon ,whatever they prefer you do. Some like the collars and others don't think that its necessary.
  • Hi Tammy –
    I’m right there with you on the boredom front! I’ve been on medical leave for 7 months now – the first couple of weeks were kind of nice since I’m the type that is always doing something, but after that it got old. Fast. Lol My boyfriend has been amazing through all of this, but he works all week, and while our dogs look at me & cock their heads when I’m talking to them, they’re not very good at keeping up their end of a conversation ;)

    What are the pick ups you got from the dollar store? Are they like the grabbers, or are they something else?

    The surgeon did tell me that I’ll be on a pain killer drip while I’m in the hospital, and that he’ll prescribe the proper meds to ensure that I’m not in pain, because he does want me to be as active as my other injuries will allow while I’m recovering – he hopes that the ACDF will correct some of the Lumbar & SI joint problems because things will be in better alignment up top, but we aren’t sure if it will work, or if the numbness in my hands & legs & some of the other problems we’re now attributing at least in part to the cervical spine/spinl cord will be corrected because it has already been 7 months & by the time my insurance approves & we’re able to schedule it will likely be closer to 9mo since the accident.

    For those of you who found a recliner to be the most comfortable place to be while recovering, was it recliner you already had, or was it something you purchased especially for the surgery, and if so, was it a power lift recliner? We don’t currently have one, and I’m looking into purchasing one, but wonder if one is better than another support wise, particularly with low back issues on top of the neck?
    Slipped on a wet stair case the morning of 10/31/11, landed flat on my tush & blew up my spine & both SI joints.
    3 level ACDF C4-C7 7/11/12 (collapsed discs & severe cord compression)
    lumbar fusion to be scheduled once healed from ACDF
  • Hi Cheeky, I did not own a recliner and was really not in a finacial position to go and buy one. I just propped my self up with lots of pillows in my bed and that was enough, not super comfortable for sleeping and I did not sleep very well the first week but I am not sure if a recliner would have changed that.My lifesaver (if you do not have one try to get one)was a cervical pillow it is just a small round pillow, kind of like a tootsie roll. I put mine right under my neck and it gives me support because some days my head feels like 1000 pounds and my neck muscles cant support it even sitting up in bed. The one I have is filled with little balls, like a bean bag so it molds- very useful! Now I believe I left the hospital sooner than I wanted I was happy with my dilaudid pump and them managing my pain because I live alone but my doctor came in and talked me in to leaving, gave me dilaudid pills(not the same thing!) and I struggled to manage pain and get around on my own at home. It is a good idea he keeps you in longer. Now I asked my doc about the collar, he is younger and perhaps my case is better because other than my cervical area my spine is good. He believes a soft collar for comfort or car rides first 4 weeks only. He said he put hardware in my neck to keep it straight the collar is not needed. I am glad I did not have to wear but know alot of people who have and it is just per MD. I have hope for you that chances are because you have spinal cord compression that some of your pain will be lifted when they take away that pinching..I wish that for you because it was a wonderful day, when that pain was gone.I am not pain free but I see that in my future. I am bad at recovering too. I cant sit still I live alone there is no dishes fairy or laundry fairy that comes in and does everything. I do dishes I pay the price. I fell down stairs for something stupid and it could have been much worse. I still have skinned up feet, legs and arms but I protected my neck when I started to fall.Boredom is tough, I got a kindle for chritmas so that came in handy and lots of movies. Ask about a bone stimulator I received one as soon as I came home from the hospital and still wear it four hrs a day.I am not sure if that is optional but every xray appt shows bone growth. I have not started to fuse yet but that could take up to a year. wew!!Sorry so long just thought of some other things to help. You are in my thoughts..keep us posted. Kim
    Kimberly Martin
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