Neckpatient are you out there? July needs a consult! - Spinal Cord Disorders Message Board

julyg · 01-24-2008, 10:11 AM

Hey Neck Patient! Please help me out here.
My NS moved and I had the hospital fax my surgical records to my primary who gave me a copy today. I had 2 level ACDF a yr ago Oct and everytime I went back to NS he said Fusing and a dark spot on one level but never said I wasnt fusing.I always asked "whats the dark spot? But he poo pooed it away.

My final visit was in Dec where he pronounced me fused.

Please read this and tell me what you think.

Result:
"Four views of cervical spine are compared to the prior exam dated 6/20/07. The patient is status post ACDF from the levels of c5 through c7. There is bony fusion at the c5/c6 level. No fusion between the inferior endplate of c6 and bone graft is seen.There is good bony alignment. The hardwear is unremarkable. There is narrowing and anterior ostephyte formation at the
c4/c5 level. The prevertable soft tissues are within normal limits.
IMPRESSION:
No significant change compared to 6/22 07 visit.

I confess I am confused with the "no fusion sentence followed by good bony alignment sentence.
So am I fused at both levels? What do you think?

Local docs had wanted to do a 3 level with c4/c5 included but noooo, I had to go to the "best"

Also is it normal to change hardwear position during surgery? Notes indicate thats what happened.

Thanks for your imput
July

PNo · 01-24-2008, 11:30 AM

Happy Thursday - are you having symptoms? My understanding of what you wrote is that you are not fused at that C6.

The endplate is the part of the vetebral bone that touches the disc. So When you had your surgery they removed the disc, they shave the endplate to cause kind of a bleeding and to allow for a host attaction for fusion, then inserted the bone graft in its place and fusion should happen along that line. Your plate is holding it all in "bony" alignment (that is good that it hasn't moved). Your anatomy dictates where they place the hardware, so once they were in that could have changed. The inferior endplate is more concave than the other side called superior and I think more people have problems there when they don't fuse.

Hope this helped.

julyg · 01-24-2008, 03:25 PM

Whew!
Ok please take a take a look at the 6/22/07 report. (above post was page 1 of !0 this is from page 2)

"Four postop anterior fusions films were obtained. There is a plate with screws at c5-c6-c7. There is a spacer at c5-c6. There is no prevertable soft tissue swelling. There is no motion on flexion and extension views. There is no acute compression fracture.
Impression:
Stable postop anterior fusion findings over the additional 5 months from a previous study of 1/11/07"

Ok Am I seeing this right, In June of 07 I was fusing Ok but in Dec 07 there is no fusion based on my first post to you. If I have that right does it mean you can start to fuse and then not??

What does it mean to me that I am not fused is my hard wear pretty much holding me in place?

I am not in the unbearable pain I was in pre- surgery and have occassional minimal tingling in fingers, but I sure have a tension neck ache now for real!

How concerned should I be?

PS I deeply appreciate the effort on your part to take the time to help me out.

July

PNo · 01-25-2008, 08:07 AM

Hi Julyg - didn't forget you, spent yesterday at ER w/my sister who is having an IBS attack.

Now that I read this additional info, it is interesting. In the 06/06 report there is no mention of a 2nd bone graft (spacer) at C6-7. Now I am only working from my little knowledge but it would lead me to think that maybe you didn't have a 2nd bone graft at C6-7. I can only guess but in that scenario you would have had the disc removed at C5-6 and bone graft inserted, the surgeon may have only cleaned up C6-7, maybe removed part of the disc and then put the plate in to keep the height and stability.

The inferior end plate of C6 is the bottom of it I believe so either you have a graft in there and it isn't fused, or you don't and we wouldn't expect it to be fused.

julyg · 01-25-2008, 10:01 AM

Sorry about your sister. It seems this is not a good week. It sure sounds like yourr hands are full.

I didnt sleep at all after reading thr Drs report.

My NS at Cleveland Clinic Fl. has moved out of state, and two others from the spine institute have left as well. I do not know the staff.

Here are notes from actual surgery.....

"an intraoperative x-ray confirmed the location of c5-6 and c6-7 interspaces. Appropriate self-retaining retractors were placed. Attention was first made to the c6-7 disk space. Casper distractors were used. The anulus was incised and the disk height an disk space gently distracted. Disk material was removed. The microscope was used to help decompression and to drill off the posterior osteophytes. Atention was particularly made towards the left foramen. Once good decompression was acheived the area was copiously irrigated with antibioticsolution. A7-mm allograft packed with DBX was placed in the space and coutersunk. The C7 distractor was removed. The C6 distractor remained, as attention was turned to the C5-6 interspace. Again, the disk space was gently retracted,disk material removed,and osteophytes were drilled down. The posterior longitudinal ligament was visualized and the nerve root was used to palpate for any additional subligamentous fragments. An 8-mm allograft also packed with DBX
was placedand coutersunk and the distractors were removed.
At this point the anterior ostephytes,which had been drilled down at the start of the case was continued to be drilled to allow good purchase of the plate. a 34-mm Synthes Vectra plate was placed. A single fixation pin was used to anchor the plate. A superior pin at c5 and an inferior pin on the colateral side at c7 were placed. An intraoperative x ray was taken, both ap and lateral. Based on the lateral film, the original pins were removed and the plate rotated slightly towards midline. Additionally the c5 screws were angled more superiorly using a variable angle screw. Two variable angled screws were placed in c5 and fixed construct was quite solid. alllockinging mechanisms engaged. Apost placement film showed good placement of the plate grafts and screws.

The notes go on to describe the closing. It looks to me like I had 2 grafts.

So how concerned should I be?
And what do I do now?

I am walking around feeling like now I have a broken neck held together with just a plate.

And thanks again for your time, you are so insightful.

July
(My surgery also had the result of a right paralyzed vocal cord.)