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Old 03-31-2010, 08:10 AM   #1
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plate removal after acdf

How common is plate removal after evidence of fusion? Anybody know. I had mine removed 2 years ago and was assured it was ok. Now fusion is there but possibly only partial no plate - do heavy lifting - my surgeon gone - new one says never dealt with someone with plate removed. When I asked him if there was enough fusion to ensure stability and go back to work he said "I think so ". *** Help

 
Old 03-31-2010, 03:17 PM   #2
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Re: plate removal after acdf

My understanding is that the plates are put in to support the fusion process so there is not movement while the graph is fusing. Kind of like a cast of a broken arm. Once your fusion is complete it should be solid. Make sure your doc know what type of work or heavy lifting you are wanting to do. The reason for this, is because once one level is fused the levels below will take on more of the stress of activities. This can cause what is known as a Domino Effect. If you look at my signature, I am a walking example of Domino Effect. Just had my 3rd and should be by last surgery, seeing how my whole neck is going to be fused. I wish you the best of luck. Take care. Tim
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ACDF C3/4 w/graph/hardware (2000), ACDF C6/7 w/graph/hardware (2004) 2010 ACDF Revision Surgery. Removed plates at C3/4 and C6/7 and put in bone graphs and plates at C4/5 and C5/6 with Corpectomy.

 
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Old 04-03-2010, 10:32 AM   #3
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Re: plate removal after acdf

i have never heard of any good surgeon actually removing a true titainium plate and screws out of someones c spine after a fusion/decomp surgery unless there was an actual problem with the hardware in some way? what exactly did that surgeon state as the actual reason to even do this? the actual collar you wear after that surgery is actually what acts as the splint, that hardware is what simply gives that spine integrity and more stability since the surgery itself does displace the overall 'load" and the more good support you just have there WITH that plate helps to better stabilze the area overall. removing that type of plating and the pedicle screws would actually create more instability issues since the screws used are actually screwed into two seperate vertebrae both above and below the fusion site. it leaves holes in the vertebrae(leaving you MORE prone to possible fracture, esp as you age?) when you actually even remove them at all? i have the very same thing still sitting in my spine after my c 6-7 was found to be not fused initially and i needed it to, so my NS did a second surgery to add it? i eventually did fuse.

this seriously is really bizarre if he simply removed it ONLY because he "assumed" you fully fused both endplates? the thing here is, esp when you have hardware, it can be almost really impossible to even truely know if an actual FULL fusion or in some cases even partial took place at all which just makes removing that hardware kinda stupid on that surgeons part? he HAD to be fully aware of this, seriously. even when he went back in to actually remove this, he would NOT have been able to actually even fully visulaize that fusion area only becasue of that plate being in the way? only AFTER he removed it could he even see what was there as far as fusion goes. and who knows just what he actually even saw or 'pronounced' your fusion status as after that if he was this crazy to even remove the hardware without real cause? just crazy really

did your new surgeon give you any possible options here as to how to redo this or assure stability here? did you have a really recent MRI done just to fully see how everything else and the fusion site actually looks right now? that too has to be taken into consideration,esp after that much time has passed? there just IS that very real 'domino effect' that tim mentioned above that does tend to occur over time placing more stress on the above and below verts and discs? knowing if you have even had a recent MRI done would really help. if you also have a copy and could type out your summary here thats on that very last page at the end, that would seriously help alot. if you do not have a copy, get one. if you have not had a recent MRI? get one using a good contrasting agent too. it just helps to better see certain areas much more clearly. you just really DO need to know the current status of your overall c spine right now before even beginning to go back to heavy lifting at this point.

i really cannot imagine the 'whys" either as to what this surgeon was thinking here at all. just what type of surgeon did this to you? ortho or neuro? too bad you cannot track this guy down. i would however actually obtain ALL of your actual medical records from the hospital where you actually had the surgeries done? the op notes which are the very basic 'transcript' of every surgery that gets done should be in them. i would tell you to obtain your records from the surgeon too under normal circumstances, but it does not appear he is even around anymore?

just obtain every single bit of paper that is just IN that central medical file they have on you at that hospital. the op notes are very important but other stuff could be too. all you have to do is call the hospital and ask for their medical records dept and they will send you out a release of info form to fill out? ask for EVERYTHING in that file and specifically state you need those op notes too. you just send this back to the hosp and in about a week or so, they should just show up in your mailbox. its really simple and i do this with ALL my many surgeries i have had to have too. it would just be interesting to read thru those op notes, esp that second surgery. i really am so sorry this is even going on with you or was done at all. there still may be certain ways that another surgeon just 'could' help to better strengthen the areas where the screws were actually placed if this idiot did not see fit to even fill them too? you really don't know without at least an x ray on that previously plated area which just would show that boney areas really well. but MRI as a whole right now really would also be highly beneficial if you have not yet had one too. marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 04-03-2010, 03:27 PM   #4
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Re: plate removal after acdf

Marcia, you raise a good point about the vertebre being weaker once the plate is removed. I wonder what they would fill the old screw holes with? My doc had to remove my plates at C3/4 and C6/7 so He could plate C4/5/6. When I have my follow up appt with him, I will ask him if he just left the holes empty or what process they use. I will also ask how it affects the vertebre. I'll let you know when I find out.
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ACDF C3/4 w/graph/hardware (2000), ACDF C6/7 w/graph/hardware (2004) 2010 ACDF Revision Surgery. Removed plates at C3/4 and C6/7 and put in bone graphs and plates at C4/5 and C5/6 with Corpectomy.

 
Old 04-04-2010, 08:15 AM   #5
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Re: plate removal after acdf

in YOUR particular type of situation tim, that would be more 'normal'? given that he was going to replace with another plate after a new surgery? but this one here, wow. i would imagine, since you probably DO have a good NS doing this? that he did indeed at the very least fill or pack the holes left with some type of the newer 'cements' or other types of material they also use now to help fix certain vert fractures too?

you would be able possibly to see with an x ray, since it just does show bone and also hardware soo clearly esp compared to the pretty blurred mess that can show with an MRI, possible 'fill' areas since i would imagine they would tend to stand out in some way vs compared to the bone there? if they are not of course totally covered with the new plate.

i would love to know the answers to the questions too tim. i just know how my plate and screws are in there and cannot imagine them pulling my plate and screws right now at all really. i have lost alot of strength and integtrity becasue of a spinal cord surgery(did NOT want to have) that required a posterior approach after my two c spine surgeries were done(anterior)? they had to do a tri level lami from c 6-T 1 just to access the cord at all. so all the nice solid interlocking boney prominences on the back of those c spine verts are just gone now since they just do not put the backs or the prominences back on? i do think it IS really only having that plate and screws in there at all right now that are really helping to stabilize my c spine in the bigger ways?

the ONLY reason i now know without a doubt that i even finally fused was during that cord surgery my amazing NS who had to do this nasty surgery bothered to fully check out my fusion site from the back and sides, and said it was 'solid' finally. definitely made ME feel better anyways knowing what was just removed that simply took away a good part of my stability in the back, ya know?

the one huge thing i found out just with my own experience with trying to even fuse is how much really does NOT always show on MRI and even a good CT as far as seeing it goes? or how truely "misleading" esp CT can be? MRI came up inconclusive while that stupid CT stated i had most definitely fused when i knew i hadn't and so did my primary, just based upon some pretty profound symptoms? it finally took one simple flex and ext type of x ray to prove to my NS that I was right and that stupid CT(and him) were BS? only one endplate had fused in my c spine, not the other? THAT is when i had the hardware placed, at about 9 months after the initial surgery was done?

when it comes esp to that c spine, a good flexion and extension type of x ray can show soo much more so very clearly, esp without hardware, but you still can see it in most cases, that anyone fused just by how the boney prominences fan out in the back? and even with the hardware there, when no fusion has taken place, they can usually still see some gapping in between the verts and endplate areas to a degree when you are changing the neck posistion like they do with this type of x ray. i do hope all is still going okay in there after everything you have been thru up there. let me know what your NS has to say too. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 04-04-2010, 12:36 PM   #6
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Re: plate removal after acdf

I will. My Surgeon also did flex xrays before the surgery. He has me scheduled to get the xrays done again before I see him. I'll post what he says. I feel for you having to go through posterior. I am told that is the hardest and most painful to recover from. My doc weighed doing a posterior approach, but he wanted to check the previous fusion. So he did Anterior. Thank God, from all the storys of how painful that approach is. I mean it has to be, they have to cut through all that thick neck/back muscle. I hope you get well soon, and start feeling better. I'll post after my appointment on the 27th. Take care.

Tim
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ACDF C3/4 w/graph/hardware (2000), ACDF C6/7 w/graph/hardware (2004) 2010 ACDF Revision Surgery. Removed plates at C3/4 and C6/7 and put in bone graphs and plates at C4/5 and C5/6 with Corpectomy.

 
Old 04-11-2010, 10:31 AM   #7
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Re: plate removal after acdf

Hi, The reason I had my plate removed was a progressive difficulty swallowing, lump in throat feeling and x-ray evidence of significant pressure on the esophagus. Luckily these symptoms did not get too bad until 1 year post my acdfC6-7. The NS told me since he could see adequate fusion on CT scan it would be OK to remove which he did. Then he left town. 2 years later intermittent hoarseness, increased pain issues (had to stop working), numbness tingling and electric shock feelings equally in both hands whenever I expand my chest (take a deep breath, cough, sneeze). Went to my NS ex partner -told me he couldn't see any sign of fusion on MRI had CT and flexion extension NS now states he "THINKS" I'm stable. He also admitted he has never removed a plate. I forgot to mention after initial surgery NS told me they did not have the usual plate he likes but the one he put in would be just as good. Now I wonder why he didn't replace the plate when he went back in with smaller plate. Anyway now ex partner referring me to big city guru (obviously wants to get rid of me). I will be in Philadelphia in May and would love the name of a great NS there if anyone knows of one.
Louise

 
Old 05-18-2010, 11:33 AM   #8
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Re: plate removal after acdf

This is due primarily to a cost consideration. Removal of hardware to eliminate or minimize patient discomfort caused by hardware is frowned upon by health insurers. The hardware is only there to provide support during the "healing" of bone grafts between the vertebrae. According to my Neuro the 'bone' is set after about three months on average. My plate (C5-C6, C6-C7) is keeping me from taking any normal medications and eating normally. ENT specialist scoped my throat and agreed. There is a limit to what a patient should be expected to endure. I am claustrophobic which does not help.

 
Old 05-21-2010, 06:00 PM   #9
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Re: plate removal after acdf

Mine was removed from c5,6,7 when I had c4,c5 fused. When I had gone for a second opinion regarding a lumbar issue the doctor I had seen was really upset my primary NS removed my hardware! he kept asking me why, sheesh how do I know other than I had some broken hardware.They have to take out one screw as it was busted but the rest was fine. New hardware was then placed at c4,5.

The area is completely fused and has been for many years.
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Old 06-11-2010, 09:51 AM   #10
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Re: plate removal after acdf

Quote:
Originally Posted by LVAsleep View Post
How common is plate removal after evidence of fusion? Anybody know. I had mine removed 2 years ago and was assured it was ok. Now fusion is there but possibly only partial no plate - do heavy lifting - my surgeon gone - new one says never dealt with someone with plate removed. When I asked him if there was enough fusion to ensure stability and go back to work he said "I think so ". *** Help
Why did you have it removed?

The spine fuses itself over a couple of years if left alone. Look at more of the posting for additional information.

 
Old 06-11-2010, 04:32 PM   #11
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Re: plate removal after acdf

On the issue of hardware removal I thought I'd share some things I've learned due to knee replacement and my long cervical fusion.

When metal is used for fusion or replacement of joints, the metal is stronger than the bone. The result is that the bone starts to lose density and become fragile. What causes most people to need their knees redone is loosening from the bone losing strength and breaking away from the metal.

In the neck, the plates do the same thing. Your bones fuse but steadily lose bone strength as the metal is stronger. So it was thought that if they removed the plates and screws after everything was healed, that it would help to strengthen the bone. But instead, many people ended up with fractures in the fused area as fused bone is never as strong as regular bone.

I have a new attempt to conquer the problem. I had my fusion done from the back with screws into the vertebrae and rods that didn't touch the bone and had flexibility so that you had the strength of the metal but enough flexibility to allow the bone to stay strong. It is the flexing of our bones that makes them strong, somewhat like a tree. If a tree is never exposed to wind, it doesn't grow a strong trunk. It takes the flexing of the trunk in the wind to make it strong. So in theory, my fusion should stay strong with the ability to slightly flex but yet not develop any breaks as the rods are there to support and control it.

Some spine docs still remove hardware and some leave it in.

Does that make sense?

Jenny

 
Old 06-14-2010, 04:12 PM   #12
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Re: plate removal after acdf

Excellent ideas Jenny. Fused bone can be of two types. A weaker form which happens when a plate is used and stronger, normal/structural bone that occurs when fusion occurs under the pressure it is expected to hold.

I would add that "Wolffe's" postulate that bone healing under the weight it was intended to carry heals using structural bone. So if the plates are removed the fusion would be stronger.

The condition of the patient (state of adjoining disks, risky behaviors, diseases, smoking etc.) and their habits are factors in whether the they will be among the 25+% (my NS says more like 50%) who require surgery for adjoining disks within the first ten years after sugery.

I'm not familiar with the posterior approach except that most say it is more painful.

 
Old 06-14-2010, 04:33 PM   #13
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Re: plate removal after acdf

Does anyone have experience with plate removal. I'm interested in the timing of the removal, i.e. how long after the original surgery to install it, as well as the result.

Was a neck brace required? (soft, mid or hard brace)

Was the functionality improved?

If the fusion broke down did it present any issues?

Was there any actual improvement in result?

One person mentioned that having an upper GI endoscopy required the presence of an anesthesiologist rather than the customary nurse anesthetist.
It also may require a surgical suite with "rescue" equipment should anything go wrong.

 
Old 12-15-2010, 07:01 PM   #14
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Re: plate removal after acdf

Quote:
Originally Posted by LVAsleep View Post
Hi, The reason I had my plate removed was a progressive difficulty swallowing, lump in throat feeling and x-ray evidence of significant pressure on the esophagus. Luckily these symptoms did not get too bad until 1 year post my acdfC6-7. The NS told me since he could see adequate fusion on CT scan it would be OK to remove which he did. Then he left town. 2 years later intermittent hoarseness, increased pain issues (had to stop working), numbness tingling and electric shock feelings equally in both hands whenever I expand my chest (take a deep breath, cough, sneeze). Went to my NS ex partner -told me he couldn't see any sign of fusion on MRI had CT and flexion extension NS now states he "THINKS" I'm stable. He also admitted he has never removed a plate. I forgot to mention after initial surgery NS told me they did not have the usual plate he likes but the one he put in would be just as good. Now I wonder why he didn't replace the plate when he went back in with smaller plate. Anyway now ex partner referring me to big city guru (obviously wants to get rid of me). I will be in Philadelphia in May and would love the name of a great NS there if anyone knows of one.
Louise
Louise,

when you had the plate removed for the swallowing issues did it help? I'm suffering the same thing.. its unbearable. I am s/p 9 weekd acdf
wLs

 
Old 12-16-2010, 05:34 PM   #15
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Re: plate removal after acdf

Fusion takes at least 1-2 years to fully form so you wouldn't be eligible for a plate removal until at least 1 year post-op if you are fused.

Jenny

 
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