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Old 12-27-2005, 05:36 PM   #1
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Second C7 SNRB - Any 2nd ACDF surgeries out there

background:
1 year post op 2 level C4-6 ACDF w/bone and plate.
- 12/04 surgery -> 03/05 full recovery and completely pain free
- 03/05 - 8/05 months of pain free, normal function - no meds at all
- 09/05-12/05 3.5 months pain and problems

I just had a Selective Nerve Root block on 10/31/05, it worked for a couple weeks after, then progressively the pain started coming back. I did PT (not any real help from it), and just did my second SNRB on 12/20. After a couple days I felt good, and am off the Neurontin and only occasional vicadin. Doc says if this doesn't last then he will do another acdf at C6-7. I am physically running down and not sure what else to try. I can only have one more injection in in this 12 month period.

My symptoms are the radicular pain down the right into my hand, shoulder, shoulder blade and some chest. These were all gone after my first surgery but have come back. I have nerve root compression , ridging on the endplate.

Doc says will take out original plate, the original 2 levels are fused now. Then go in anterior again and do the next single level and put in a smaller plate.

1) anyone out there had this at these levels? C4-6 then later C6-7?
2) did it go easily?
3) how was recovery?
4) any after affects or long term pain/problems?
5) did it work its way on to the next level?
6) any advice?


thanks if you answer.

 
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Old 12-27-2005, 05:43 PM   #2
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Re: Second C7 SNRB - Any 2nd ACDF surgeries out there

with that many levels fused it isn't suprising the disc below them went out. you are going to have to really be careful with your posture. If the disc is intact and the herniation is just sticking out, you may want to consider a less invasive endoscopic proceedure to remove the portion irritating the nerve. If you have yet another fusion what is to stop the next disc from going out? You need discs to cushion your neck.

At this point you may want to consider consulting Alpha Klinic in Germany or Dr. Bergantoni (probably spelled it wrong) for consultation on an Artificial Disc at that level to retain some motion in that segment. Yes Artificial Discs are not "proven" but they have been in use for 11 years in Europe. And Fusion isn't really proven either as the long term results are not really in.

The theory of adjacent disc disease is also unproven, but what appears to be proven is additional pressure is put on the remaining discs, this just makes sense and there are online studies to show this.

You have a whole lot to consider including additional fusion surgery. But at some point if you continue to have problems the doctors are going to say "we have done all we can do, you are going to have to live with it". And you want to be darn sure you make a really good decision now so you don't end up there.

You may also want to get a really good PT workup for muscle imbalances to make sure that there are not chronicall tightened muscles on the side of your disc protrusion that are further aggrevating your condition. For me I know for sure there are and I am working to correct them.

 
Old 12-27-2005, 09:32 PM   #3
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Re: Second C7 SNRB - Any 2nd ACDF surgeries out there

Hello az:
I found this site about 1 year ago and have been lurking, and maybe it's time to share some of my experience.

I had problems similar to yours, but in the other order. I had ACDF surgery about 2 years ago in Feb 04 for problems at C5-C6-C7. I had suffered neck and shoulder pain since 1995, and by Dec of 03 it became severe enough that it was finally diagnosed. Incredible pain in the months just prior to surgery, and immediate relief from the pain related to the pinched nerves (both spinal cord and nerve branches at the 3 levels) when I woke up in the recovery room. A lot of post-op pain and discomfort for the 1st week, then steady improvement for 7 or 8 weeks until I was almost pain free. The surgeon showed me on the MRI where the disc at C4-C5 was also beginning to deteriorate and cautioned me to take it easy and try to go long, but indicated there was a risk of needing more surgery within 8 to 10 years due to increased stress on the remaining discs.

Despite taking it easy, 11 months later I was back in surgery for ACDF at C4-C5. The original plate (3 level) was removed, and a smaller plate (2 level) was installed at the new levels. Again, the nerve pain improved, but it took 4 or 5 weeks this time. I'm 9 months post-op now from the 2nd ACDF, and I have enough residual pain to warrant seeing a pain management Dr each month, and taking pain medication every day.

From what I've read, the more levels and the more surgeries you have, the greater the chance of experiencing chronic pain. With 4 levels fuzed, I have noticeable loss of range of motion, and I have great concern that I will experience even more problems down the road due to the domino effect of increased strain on the remaining discs.

The 2nd surgery was a little worse, recovery wise, than the 1st, but certainly less pain than pre-op, and if I had it to do over again I would still do it. I had signficant loss of function due to nerve damage and muscle atrophy, and I'm a whole lot better off than had I not had the surgery. While I did not achieve a pain free result, (yet?) I'm still very grateful for the improvements, and hopefully for eliminating or reducing the rate of disc & spine degeneration.

I wouldn't pretend to offer advice since each case is unique, but I've found that it helps me to know what other people with similar problems have experienced. In my case the surgeries worked miracles - I had all but lost the use of my left arm & shoulder - and I just wish there was a better way to tell what all of this will lead to over the next 20 years.

Best of luck -
Bob

 
Old 12-29-2005, 01:37 PM   #4
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Re: Second C7 SNRB - Any 2nd ACDF surgeries out there

Hi Az,

I know what you are going thru. Been there. The other respondents to your posting covered a good bit of ground. I can give you a bit of the down side.

I was fused with donor bone c6/7 in 1989. Within a year C5/6 which had been damaged just refused to heal. likely because of the additional stress on them from the fusion below. That is a common experience. Additionally, at that time the original NS noticed the donor bone at 6/7 was turning grey. He was concerned. In those days, with AIDS just getting going, there was allegedly problems obtaining quality donor bone. Anyway he said he would check it when he did 5/6. Five six was fused/plated and everything went well.

Fast forward to 2002. I started to get the pain again. After going back to my family doc "to many times" with the same problem he suspected the fusion. An x-ray confirmed the upper fusion surface at C6/7 had broken as was letting the spine above move several mm's. I was immediately sent to an NS for evaluation. I was shocked to hear the answer.

It's broken but we can't do anything about it. The NS and two colleagues agreed that there was so much scar tissue on my vocal cords that they felt a 95% plus chance that I would be mute after the surgery. No procedure exists that will deal with this problem yet. I was sent to a Pain Clinic and have been going there since. A doc in San Francisco is working on a solution and hopefully he'll perfect it one of these days. In the mean time I deal with the pain, which by the way, the Pain Doc has pretty well under control.

The final analysis is that lots of folks have second and more anterior neck surgery without major issues. However, I thought I share this with you just to show you one down side. I'm sure you will do well.

Good luck and keep us posted

dootag

 
Old 12-29-2005, 05:18 PM   #5
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Re: Second C7 SNRB - Any 2nd ACDF surgeries out there

Thanks for the answers to my questions and your stories. I have more:

When you go to the pain clinic what do they do for you? I guess I am looking if I am missing something. I go to a large Orthopedic institute with a spine center, very good docs. The dr. that handles my injections is on staff at the Institute Surgical Center. Since my post today I have started up with a little more pain, I don't think the injections are my answer, 1-2 week solution is no good. Plus 3/year isn't enough. Is there something else I should be asking for? I have been on Neurontin 1800 mg - 2400 mg a day (off this week!), and vicadin as I need them but am very cautious about them, since I know I am building a tolerance. Ibuprofen only worked to tear up my stomach and still left me hurting. I really don't want to go back on the Neurontin long term :-(

I agree I wish I had a crystal ball. I am 47, I am thinking right now that it would better to try the 2nd surgery, try to get better now while I am younger. I notice it is not as easy as when I was 30 to bounce back.

I don't work in a physically demanding job, but it is hi-tech, computer world and hectic and stressful at times. I was moving up in my company. I am holding myself back right now because I can't predict how I feel from one day to the next. It is totally depressing.

Where I am right now is take the chance of fixing it, maybe a successful outcome - maybe not. If I don't fix --I know it is going to get worse, it degenerated quite a bit more in a year. So there is a 50% chance I will be better (my odds, not the doc), and 50% chance I will be as bad as I have been, barring no horrible complication. Levels above 4 look very good no DDD. C8-T1 look good as well.

Did you ever question why they told you to wait years to address it? Doesn't it make sense to take care of it early? Reduce nerve damage, etc., heal faster? Why did your doctors say to wait?

Thanks for your thoughts, cynthia

 
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